Considering comorbidities and individual differences in testing a gaming Behavioral Activation app for perinatal depression and anxiety; A pilot study (Preprint)

BACKGROUND Mobile Behavioral Activation (BA) is efficacious for the treatment of perinatal depression, however, the effect of comorbidity on symptom trajectories remains underexplored which is important given that at least 10% of women in the perinatal period experience comorbid anxiety and depression (CAD). OBJECTIVE Our objective was to assess whether there are differences in symptom trajectories in pregnant participants with Comorbid Anxiety and Depression (CAD) as compared to those same with depression only (i.e., Major Depressive Disorder; MDD) during intervention with a Behavioral Activation (BA) mobile gaming app. METHODS Pregnant adults with either CAD (n = 10) or MDD (n = 7) used a BA app for 10 weeks and completed biweekly symptom severity questionnaires for depression and anxiety. We assessed whether baseline diagnoses were associated with differential symptom trajectories across the study with mixed effects longitudinal models. RESULTS When controlling for baseline symptoms, results revealed a significant interaction between baseline diagnosis and the quadratic component of study week on anxiety (β = 0.06, SE = 0.02, t(63) = 2.94, p = .005), revealing a tendency for anxiety in CAD group to increase initially and then decrease at an accelerated rate, whereas MDD symptoms were relatively stable across time. There was a significant effect of linear time on PHQ-9 (β = -0.39, SE = 0.11, t(68) = -3.51, p = .001), showing that PHQ-9 declined steadily across time for both groups. There was a significant effect of baseline diagnosis on PHQ-9 (β = -8.53, SE = 3.93, t(13) = -2.17, p = .05), suggesting that those with MDD had higher PHQ-9 scores post- treatment compared to those with CAD when holding other predictors constant. CONCLUSIONS Findings underscore the need to consider comorbidities and individual variations in participants when developing scalable mobile interventions for perinatal populations. CLINICALTRIAL Not applicable