AzTrials
AzTrials

Antenatal DepressionNCT05533138

Internet CBT for Antenatal Depression

A study testing Therapist Guided Internet-CBT for antenatal depression, Therapist Guided Internet-CBT for antenatal depression and perinatal extra support. and Diagnostic assessment by telephone, video or face-to face - Allocation by chance in people with Antenatal Depression, run by Karolinska Institutet at 1 site in Sweden.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Pregnant women in pregnancy week 8-29 screening positive for antenatal depression will be randomized to either choose or to be allotted by chance to different forms of diagnostic assessment; i.e. telephone, video or face-to-face assessment. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Antenatal Depression
What is being tested?
Therapist Guided Internet-CBT for antenatal depression, Therapist Guided Internet-CBT for antenatal depression and perinatal extra support. and Diagnostic assessment by telephone, video or face-to face - Allocation by chance
Could I receive a placebo?
No, everyone receives an active treatment
How many people
415 participants
Where
1 siteSweden
Study dates
25 Feb 2021to 31 Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Mild to moderate major depression
  • Pregnant at treatment start
  • Regular contact with maternity mental health clinic
  • > 18 years old
  • Being able to start the treatment earliest in gestational week 8 and latest in gestational week 30
  • Stable medication for depression and/or other psychiatric conditions for at least 3 weeks.
  • Being able to participate in the treatment during the treatment time and having access to and being able to use the internet and mobile phone during the treatment time
  • Being able to understand the Swedish language orally and in writing

Who cannot join

  • Montgomery-Åsberg Depression Rating Scale-Self report version (MADRS-S) score below 15 (symptoms of depression to low) or above 35 (severe depression)
  • High risk of self harm or suicide (based on semi-structured clinical suicide risk assessment)
  • Psychiatric comorbidity, disability, somatic disorder, or pregnancy complications that prevent treatment participation or that can be negatively affected or compose a risk for the fetus by treatment participation
  • Ongoing psychological treatment with similar content

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Marie Bendix, PhD contact

+46 73 6370 864

marie.bendix@ki.se

Sweden1 site, 1 recruiting
  • Psychiatry Southwest, Department of CL Psychiatry & Internetpsychiatry

    Stockholm, 141 86

    Marie Bendix, PhD, +46 73 637 0864, marie.bendix@ki.se

    Recruiting

Other trials in Sweden

About this study

Official title: Guided-internet Cognitive Behavioral Therapy for Antenatal Depression - Treatment Effects, Assessment Modalities and Extra Support.

Pregnant women in pregnancy week 8-29 screening positive for antenatal depression will be randomized to either choose or to be allotted by chance to different forms of diagnostic assessment; i.e. telephone, video or face-to-face assessment.

Those diagnosed with mild to moderate major depression will then be randomized to treatment with therapist-guided Internet-delivered Cognitive Behavioral Therapy (ICBT) adapted for women suffering from antenatal depression or to the same treatment with addition of up to three contacts with extra support by a midwife or experienced perinatal mental health nurse.

The primary aim is to assess whether extrasupport in addition to internet-guided pregnancy adapted ICBT decreases depressive symptoms more than internet-guided pregnancy adapted ICBT only. Secondary aims include effects of extrasupport and assessment mode on treatment satisfaction, fidelity and credibility.

Being tested
Therapist Guided Internet-CBT for antenatal depression, Therapist Guided Internet-CBT for antenatal depression and perinatal extra support., Diagnostic assessment by telephone, video or face-to face - Allocation by chance, Diagnostic assessment by telephone, video or face-to face - Allocation by choice
Keywords
Cognitive behavior therapy, Internet treatment, Self-help treatment, Perinatal support

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Therapist Guided Internet-CBT for antenatal depressionBehavioural

    A 10 week long, structured self-help program with weekly reports to, and feedback from, a CBT therapist over the Internet. Includes traditional CBT-methods for depression adapted for antenatal depression.

  • Therapist Guided Internet-CBT for antenatal depression and perinatal extra support.Behavioural

    A 10 week long, structured self-help program with weekly reports to, and feedback from, a CBT therapist over the Internet. Includes traditional CBT-methods for depression adapted for antenatal depression. Additionally, up to three supportive contacts with a midwife or perinatal mental health nurse to support ICBT treatment and adress general pregnancy related health problems.

  • Diagnostic assessment by telephone, video or face-to face - Allocation by chanceBehavioural

    Structured diagnostic perinatal psychiatric assessment of women screening positive for antenatal depression (pregnancy week 8-29) by telephone, video or in a face-to-face meeting. Assessment form allocation by chance.

  • Diagnostic assessment by telephone, video or face-to face - Allocation by choiceBehavioural

    Structured diagnostic perinatal psychiatric assessment of women screening positive for antenatal depression (pregnancy week 8-29) by telephone, video or in a face-to-face meeting. Assessment form allocation based on patient preference.

Study groups in NCT05533138
Study groupRoleWhat they receive
Assessment form allocated by chance & guided ICBT for antenatal depressionActive comparatorPatients are randomized to assessment modality (telephone, video or face-to-face visit) of a perinatal psychiatric semi-structured assessment \& and are randomised to treatment with internet-CBT for antenatal depression without extra-support (10 weeks)
Receives: Behavioral: Therapist Guided Internet-CBT for antenatal depression; Behavioral: Diagnostic assessment by telephone, video or face-to face - Allocation by chance
Assessment form allocated by choice & guided ICBT for antenatal depressionActive comparatorPatients choose assessment modality (telephone, video or face-to-face visit) of a perinatal psychiatric semi-structured assessment \& are randomised to treatment with internet-CBT for antenatal depression without extra-support (10 weeks)
Receives: Behavioral: Therapist Guided Internet-CBT for antenatal depression; Behavioral: Diagnostic assessment by telephone, video or face-to face - Allocation by choice
Assessment form allocated by chance & guided ICBT for antenatal depression with extra supportExperimentalPatients are randomized to assessment modality (telephone, video or face-to-face visit) of a perinatal psychiatric semi-structured assessment \& and are randomised to treatment with internet-CBT for antenatal depression with extra-support
Receives: Behavioral: Therapist Guided Internet-CBT for antenatal depression and perinatal extra support.; Behavioral: Diagnostic assessment by telephone, video or face-to face - Allocation by chance
Assessment form allocated by choice & guided ICBT for antenatal depression with extra supportExperimentalPatients choose assessment modality (telephone, video or face-to-face visit) of a perinatal psychiatric semi-structured assessment \& are randomised to treatment with internet-CBT for antenatal depression with extra-support (10 weeks)
Receives: Behavioral: Therapist Guided Internet-CBT for antenatal depression and perinatal extra support.; Behavioral: Diagnostic assessment by telephone, video or face-to face - Allocation by choice

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Montgomery Asberg Depression Rating Scale, self-rating version (MADRS-S)

    A 9-item self-rated measure of depression severity that also screens for suicidality (Montgomery \& Asberg, 1979). Scores range from 0 to 54 points with 13-19 points indicating mild depression, 20-34 points indicating moderate depression and 35-54 points indicating severe depression

    Measured: Baseline to post-treatment (10 weeks) and to 8-10 weeks post-partum

Secondary outcomes (15)
  1. Change in Edinburgh Postnatal Depression Scale (EPDS)

    Self-rated measure of antenatal depression (Cox, Holden \& Sagovsky, 1987) used for screening of perinatal depression and also as a severity measure. Scores range from 0 to 30 with 13 or more points being the cut off for depression during pregnancy. This scale is validated for Swedish pregnant women (Rubertsson et al., 2011).

    Measured: Baseline to post-treatment (10 weeks) and to 8-10 weeks post-partum

  2. Remission of major depression (DSM-5)

    Diagnostic assessment of major depression assessed by clinician in the same way as before treatment with the depression module of the SCID-I diagnostic interview based on DSM-5 (Spitzer et al., 1992).

    Measured: Post-treatment (10 weeks)

  3. Remission of major depression (DSM-5)

    Diagnostic assessment of major depression assessed by clinician in the same way as before treatment with the depression module of the SCID-I diagnostic interview based on DSM-5 (Spitzer et al., 1992).

    Measured: 8-10 weeks postpartum.

  4. Change in Generalized Anxiety Disorder-7 (GAD-7)

    7-item self-assessment measure of symptoms of anxiety and worry (Spitzer et al., 2006). Scores range from 0 to 21 points with 10 points and above indicating clinical levels.

    Measured: Screening to post-treatment (10 weeks) and to 8-10 weeks post-partum

  5. Change in self-rated Insomnia Severity Index (ISI)

    7-item, self-rated questionnaire measuring perceived severity of insomnia symptoms (Bastien, Vallières \& Morin, 2001). Validated as an outcome measure for insomnia research. The scale includes seven items, scored on a 0-4 scale, that are summed to a range of 0-28. The score can be divided into four categories: no clinical insomnia (0-7), subthreshold insomnia (8-14), clinical insomnia of moderate severity (15-21) and severe clinical insomnia (22-28) (Sarsour et al., 2010).

    Measured: Baseline to post-treatment (10 weeks) and to 8-10 weeks post-partum

  6. Change in Work and Social Adjustment Scale (WSAS)

    Self-rated measure of level of impairment caused by a condition (Mundt et al. 2002). In this study two versions are used asking about impairment due to depression and due to pregnancy. Scores range from 0 to 40 with scores below 10 points indicating sub clinical impairment and scores above 20 indicating moderately severe impairment or worse.

    Measured: Baseline to post-treatment (10 weeks) and to 8-10 weeks post-partum

  7. Change in Euroqol (EQ-5D-5L)

    Self-assessed, health related, quality of life questionnaire. 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression (Hinz et al., 2014).

    Measured: Screening to post-treatment (10 weeks) and to 8-10 weeks post-partum

  8. Change in Prenatal Attachment Inventory (PAI)

    Self-rated measurement of attachment and mentalisation from the mother to the unborn child (Muller 1993; Pallant et al., 2014). 21-items scored on a 1-4 scale.

    Measured: Screening to post-treatment (10 weeks)

  9. Change in Experience of close relationships (ENR)

    Self-reported measurement of adult attachment style (Brennon et al., 1998; Fraley et al., 2000; Strand \& Ståhl, 2008). 36 items scored on a 1-7 scale.

    Measured: Screening to 8-10 weeks post-partum

  10. Change in Valentine Scale

    7 item self-rated scale for measurement of satisfaction with the partner relationship (Burman et al., 2018). Range 0-21 with higher values indicating higher partner relationship satisfaction.

    Measured: Screening to 8-10 weeks post-partum

  11. Change in Fear of birth scale (FOBS)

    Self-assessment of fear and worry in relation to the approaching birth using two visual analogue scales (VAS)(Haines et al., 2015) with higher levels indicating increased fear and worry. Also used to assess fear and worry in relation to completed birth after delivery.

    Measured: Screening to post-treatment (after 10 weeks) and to 8-10 weeks post-partum

  12. Change in Multidimensional Scale of Perceived Social Support (MSPSS)

    Measures self-rated perceived social support (Zimet et al., 1988; Ekbäck et al., 2013). 12 items rated on a seven-point Likert-type response format (1 = very strongly disagree; 7 = very strongly agree). Range 12 to 84, with higher scores indicating higher perceived social support.

    Measured: Screening to 8-10 weeks post-partum

  13. Change in Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P)

    Measures healthcare consumption and productivity loss in patients with a psychiatric disorder (Bouwmans et al., 2013).

    Measured: Baseline to post-treatment (10 weeks) and to 8-10 weeks post-partum

  14. Change in Clinical Global Impression Severity Scale (CGI-S)

    7-item observer-rated scale that measures illness severity (CGI-S) (Guy 1976)

    Measured: Post-assessment and post treatment (after week 10).

  15. Change in Clinical Global clinical global improvement (CGI-I)

    7-item observer-rated scale that measures global improvement (CGI-I) (Guy 1976).

    Measured: Post-assessment and post treatment (after week 10).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Sep 2022
  2. Study start25 Feb 2021
  3. Primary completion31 Dec 2025 (estimated)
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Sequential
Model description
Multiple Assignment Randomized Trial
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
415 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05533138
Sponsor's protocol ID
2020-06049
Status last verified
Jun 2024
First submitted
27 Jun 2022
Last updated
25 Jun 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Forsell E, Bendix M, Hollandare F, Szymanska von Schultz B, Nasiell J, Blomdahl-Wetterholm M, Eriksson C, Kvarned S, Lindau van der Linden J, Soderberg E, Jokinen J, Wide K, Kaldo V. Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial. J Affect Disord. 2017 Oct 15;221:56-64. doi: 10.1016/j.jad.2017.06.013. Epub 2017 Jun 13.

    PubMed 28628768

Questions about this trial

What is this clinical trial studying?

A study testing Therapist Guided Internet-CBT for antenatal depression, Therapist Guided Internet-CBT for antenatal depression and perinatal extra support. and Diagnostic assessment by telephone, video or face-to face - Allocation by chance in people with Antenatal Depression, run by Karolinska Institutet at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 25 Jun 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Marie Bendix, PhD (+46 73 6370 864, marie.bendix@ki.se), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Montgomery Asberg Depression Rating Scale, self-rating version (MADRS-S) (time frame: Baseline to post-treatment (10 weeks) and to 8-10 weeks post-partum). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05533138, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jun 2024.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in