A self-guided interpersonal-therapy app did not change depressive symptoms in pregnancy but helped modestly after birth

Design

Randomised controlled trial, unblinded

Population

350 pregnant women in Japan, no minimum depression score

Primary outcome

Acceptability (CSQ-8J) and PHQ-9 change at 8 weeks

Effect

Acceptable in 90.2%; pregnancy SMD 0.11 (not significant); 1 month postpartum SMD 0.28

In this Japanese trial, 350 pregnant women recruited nationwide were randomised to a fully self-guided smartphone app based on interpersonal psychotherapy or usual care. Nobody needed a minimum depression score to join, so most were not depressed at entry. The design was not blinded.

The app was well liked: 90.2% of users scored it acceptable. It made no significant difference to PHQ-9 scores at 8 weeks during pregnancy (SMD 0.11), the primary efficacy measure. At one month postpartum, depressive symptoms were lower in the app group (SMD 0.28) — a small effect, measured at a secondary time point.

The result is encouraging for scalable, low-cost support, but the benefit landed after the primary outcome and in an unselected population. It supports recommending such tools as an adjunct, not as a replacement for screening and referral.

• Keep screening for depression at booking, in the third trimester and postpartum — an app is not a screening tool
• A self-guided app can be offered as a low-cost adjunct for women without access to in-person therapy
• Refer women with moderate or severe symptoms, or any thoughts of self-harm, to a clinician rather than an app
• The postpartum month is the window where this app showed effect; ask specifically about mood at the six-week check

Why it matters

It is some of the first randomised evidence that an unguided app can shift postpartum mood.

Don't overread it

The primary efficacy measure in pregnancy was null; the postpartum benefit is a secondary result in a mostly non-depressed group.

The statistics, in plain English

A standardised mean difference of 0.28 is small — roughly a quarter of the spread in scores between women. Because it was measured at a secondary time point in an unblinded trial, it needs confirmation.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.