Harnessing Gaming: A Groundbreaking Pilot Study on Combatting Perinatal Depression and Anxiety Amidst Comorbidities and Individual Differences

Background:

There is a growing interest in designing scalable digital mental health solutions for perinatal populations to enhance accessibility. Mobile behavioral activation (BA) has proven effective in managing perinatal depression; nonetheless, the influence of co-occurring anxiety and depression (CAD) on symptom trajectories remains inadequately explored. This is crucial considering that a minimum of 10% of women during the perinatal phase experience CAD.

Objective:

We investigated whether there were variations in symptom trajectories among pregnant participants with CAD in comparison to those with depression alone (i.e., major depressive disorder [MDD]) during the use of a BA mobile gaming application.

Methods:

Expectant adults with either CAD (n=10) or MDD (n=7) utilized a BA app for ten weeks and filled out biweekly symptom severity assessments for depression and anxiety. We examined if baseline diagnoses were related to different symptom trajectories throughout the study utilizing mixed effects longitudinal models.

Results:

After adjusting for baseline symptoms, the results demonstrated a significant interaction between baseline diagnosis and the quadratic aspect of study week concerning anxiety (β=.18, SE 0.07; t62=2.61; P=.01), indicating a trend for anxiety in the CAD group to initially rise and then fall at an accelerated pace, while MDD symptoms remained relatively constant over time. A significant effect of linear time on depression was found (β=-.39, SE 0.11; t68=-3.51; P=.001), illustrating a consistent decline in depression over time for both groups. Furthermore, a significant effect of baseline diagnosis on depression (β=-8.53, SE 3.93; t13=-2.17; P=.05) suggested that individuals with MDD had greater follow-up depression in comparison to those with CAD when keeping other predictors constant.

Conclusions:

The app proved helpful in alleviating depression symptoms in perinatal individuals with varying comorbidity profiles. However, regarding anxiety symptom trajectories, there existed more fluctuation. The app may be particularly effective in treating anxiety symptoms among individuals with CAD, as it promotes in-the-moment, ecologically relevant exposure to anxiety-inducing stimuli. Despite lacking a significant group difference in initial anxiety symptoms, the MDD group did not experience a notable reduction in their anxiety symptoms throughout the study duration, with some individuals showing an increase in anxiety. The findings may highlight opportunities for enhancing BA gaming applications for individuals with MDD to more effectively address anxiety symptoms. Overall, the results suggest that it may be beneficial to consider comorbidities and individual differences among participants when creating scalable mobile interventions for perinatal populations.