The impact of telemental health interventions on maternal mental health outcomes: a pilot randomized controlled trial during the COVID-19 pandemic

Figures & data

Figure 1. Consort flow chart of the study (n = 58).

Table 1. Baseline characteristics of the two groups of pregnant women attending the Women Wellness and Research Center in Qatar.

	Groups of pregnant women-at T0
	Group A Control		Group B Intervention			Between group Analysis
	n = 26	(%)	n = 21	(%)	P-value	CI
Sociodemographic characteristics
Nationalities
Arab	17	(60.7)	11	(39.3)	0.36	1.7 [0.5–5.5]
Non-Arab	9	(47.4)	10	(52.6)
Educational level
Secondary education	1	(25.0)	3	(75.0)	0.20	0.21 [0.02–2.4]
Higher education	25	(58.1)	18	(41.9)
Occupational level
Housewife	13	(50.0)	13	(50.0)	0.41	0.61 [0.19–1.9]
Employed	13	(61.9)	8	(38.1)
Household Income
Up to 10,000 QR	9	(50.0)	9	(50.0)
10,001–20,000 QR	9	(50.0)	9	(50.0)	0.41	…
> 20,001 QR	8	(72.7)	3	(27.3)
Pregnancy-related characteristics
Intended pregnancy
Yes	9	(42.9)	12	(57.1)	0.12	2.5 [0.77–8.11]
No	17	(65.4)	9	(34.6)
Nulliparous
Yes	4	(33.3)	8	(66.7)	0.076	0.29 [0.74–1.17]
No	22	(67.9)	13	(37.1)
History of abortion
Yes	8	(50.0)	8	(50.0)	0.59	1.38 [0.41–4.65]
No	18	(58.1)	13	(41.9)
History of stillbirth
Yes	2	(66.7)	1	(33.3)	0.68	0.60 [0.05–7.11]
No	24	(54.5)	20	(45.5)
Gestational Diabetes
Yes	5	(41.7)	7	(58.3)	0.27	2.11 [0.55–7.95]
No	21	(60.0)	14	(40.0)
Spontaneous pregnancy
Yes	24	(55.8)	19	(44.2)
No	2	(50.0)	2	(50.5)	0.82	1.26 [0.16–9.81]
Possible stressful factors
Confirmed COVID-19
Yes	1	(25.0)	3	(75.1)	0.20	4.1 [0.4–43.37]
No	25	(58.1)	18	(49.9)
Fitness
Fit	4	(80.0)	1	(20.0)	0.08	…
Active	1	(16.7)	5	(83.3)
Not fit	21	(58.3)	15	(41.7)
Acute stressful event
Yes	2	(33.3)	4	(66.7)
No	24	(58.5)	17	(41.5)	0.24	2.8 [0.46–17.2]
Gender-related stress
Not at all	20	(54.1)	17	(45.9)		… .
Very little	3	(60.0)	2	(40.0)
Sometimes	1	(50.0)	1	(50.0)	0.97
Great extent	2	(66.7)	1	(33.3)

n = frequency; % = percentage; SD = standard deviation; X = mean; CI = Confidence Interval; Group A = Control; Group B = intervention.

Table 2. Antenatal depression, anxiety, and COVID-19-specific phobia amongst the two groups of pregnant women attending the Women Wellness and Research Center in Qatar at T₀ and T₁.

Sessions	T0						T1
Groups	Per-protocol analysis			Per – intention-to-treat analysis			Per-protocol analysis			Per intention-to-treat analysis
	Group A	Group B		Group A	Group B		Group A	Group B		Group A	Group B
	Control	Intervention		Control	Intervention		Control	Intervention		Control	Intervention
	n = 26	n = 21	Mean difference [CI]; p-value	n = 29	n = 29	Mean Difference [CI]; p-value	n = 22	n = 11	Mean Difference [CI]; p-value	n = 29	n = 29	Mean Difference [CI]; p-value
EPDS scale X ± SD	11.1 ± 5.1	8.3 ± 6.2	2.8 [−0.4–6.2]; 0.09	11.0 ± 4.8	8.7 ± 5.3	2.3 [−0.4–1.2]; 0.42	9.4 ± 3.5	6.5 ± 5.7	2.8 [−0.3–3.2]; 0.08	9.4 ± 4.1	8.3 ± 5.0	1.1 [−1.1–3.5]; 0.37
EPDS-3A X ± SD	3.2 ± 1.7	2.7 ± 2.8	0.46 [−0.8–1.8]; 0.48	4.5 ± 2.2	3.2 ± 1.9	1.3 [−0.2 −0.5]; 0.51	4.2 ± 1.6	2.4 ± 2.2	1.8 [0.41–3.21]; 0.01*	4.2 ± 1.7	3.4 ± 2.0	0.7 [−0.2–1.7]; 0.13
COVID-19 specific phobia X ± SD	9.8 ± 4.3	8.0 ± 5.9	1.7 [−3.4 −1.26]; 0.23	9.2 ± 4.4	6.9 ± 5.3	2.3 [1.2–_0.2]; 0.68	8.1 ± 4.7	7 ± 6	1.1 [−2.7 −5.0]; 0.55	7.8 ± 4.7	8.6 ± 4.2	−0.7 [−3.1–1.6]; 0.52

n = frequency; % = percentage; SD = standard deviation; X = mean; CI = Confidence Interval; EPDS: Edinburgh Postnatal Depression; EPDS-3A = EPDS anxiety subscale; T₀= baseline session; T₁= follow-up session; p ≤ 0.05*.

Table 3. Antenatal depression, antenatal anxiety and COVID-19-specific phobia amongst the two groups of pregnant women attending the Women Wellness and Research Center in Qatar at T₀ and T₁

	T0								T1
	Per-protocol				Per intention-to-treat analysis				Per-protocol				Per intention-to-treat analysis
Antenatal Depression	Depressed	Not depressed	Between group analysis		Depressed	Not depressed	Between group analysis		Depressed	Not depressed	Between group analysis		Depressed	Not depressed	Between group analysis
	n; (%)	n; (%)	Total	P-value	n; (%)	n; (%)	Total	P – value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value
Group B-Intervention	7; (33.3)	14; (66.7)	21	0.85	7; (24.1)	22; (75.9)	29	0.76	2; (18.2)	9; (81.8)	11	1	23; (79.3)	6; (20.7)	29	0.73
Group A-Control	8; (33.8)	18; (69.2)	26		8; (27.6)	21; (72.4)	29		4; (18.2)	18; (81.8)	22		24; (82.8)	5; (17.2)	29
Antenatal Anxiety	Anxious	Not anxious	Between group analysis		Anxious	Not anxious	Between group analysis		Anxious	Not anxious	Between group analysis		Anxious	Not anxious	Between group analysis
	n; (%)	n; (%)	Total	P-value	n; (%)	n; (%)	Total	P-value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value
Group B-Intervention	6; (28.6)	15; (71.4)	21	0.13	6; (20.7)	23; (79.3)	29	0.09	2; (18.2)	9; (81.8)	11	0.1	6; (20.7)	23; (79.3)	29	0.14
Group A-Control	13; (50.0)	13; (50.0)	26		13; (44.8)	16; (55.2)	29		10; (45.5)	12;(54.5)	22		11; (37.9)	18; (62.1)	29
Covid-19 Specific phobia	Presence	Absence	Between group analysis		Presence	Absence	Between group analysis		Presence	Absence	Between group analysis		Presence	Absence	Between group analysis
	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value
Group B-Intervention	9; (42.9)	12; (57.1)	21	0.20	8; (26.7)	21; (72.4)	29	0.03	3; (27.3)	8; (72.7)	11	0.21	15; (51.7)	14; (48.3)	29	0.42
Group A-Control	10; (38.5)	16; (61.5)	26		16; (55.2)	13; (44.8)	29		11; (50.0)	11; (50.0)	22		18; (62.1)	11; (37.9)	29

n: frequency; %: percentage; T₀= baseline session; T₁= follow-up session; p ≤ 0.05*.

Table 4. Within group comparison for RCT.

	Group A Controls						Group B Intervention
	Per-protocol analysis			Per – intention-to-treat analysis			Per-protocol analysis			Per intention-to-treat analysis
Groups Sessions	T0	T1	Within group comparison	T0	T1	Within group comparison	T0	T1	Within group comparison	T0	T1	Within group comparison
	n = 26	n = 22	Mean difference [CI]; p-value	n = 29	n = 29	Mean difference [CI]; p-value	n = 22	n = 11	Mean difference [CI]; p-value	n = 29	n = 29	Mean difference [CI]; p-value
EPDS scale X ± SD	11.5 ± 4.5	9.4 ± 3.5	2.09 [0.7–3.4]; 0.001*	11 ± 4.8	9 ± 4.1	1.5 [0.5–2.6]; 0.05*	7 ± 6.7	6.5 ± 5.7	0.45 [−1.8–2.8]; 0.67	8.7 ± 5.3	8.3 ± 5.0	0.4 [−0.1–1.0]; 0.17
EPDS-3A X ± SD	4.8 ± 2.1	4.2 ± 1.6	0.54 [−0.09–1.1]; 0.09	4.5 ± 2.2	4.2 ± 1.7	0.3 [−0.1–0.8]; 0.2	2.5 ± 2	2.4 ± 2	0.09 [−0.8–1.01]; 0.83	3.2 ± 1.9	3.4 ± 2	−0.2 [−0.6–0.12]; 0.18
COVID-19 specific phobia X ± SD	10.6 ± 4.1	8.1 ± 4.1	2.4 [0.7–4.1]; 0.06	9.2 ± 4.4	7.8 ± 4.2	1.2 [−0.1–2.8]; 0.08	7 ± 6.3	6 ± 6.0	−0.9 [−2.6–0.87]; 0.28	8.6 ± 4.7	6.9 ± 5.3	1.72 [2.7–0.7]; 0.001*

n = frequency; % = percentage; SD = standard deviation; X = mean; CI = Confidence Interval; EPDS: Edinburgh Postnatal Depression; EPDS-3A = EPDS anxiety subscale; T₀= baseline session; T₁= follow-up session; p ≤ 0.05*.

Table 5. Antenatal depression, antenatal anxiety and COVID-19-specific phobia within the two groups of pregnant women attending the Women Wellness and Research Center in Qatar at T₀ and T₁.

	Group A Control								Group B Intervention
	Per-protocol				Per intention-to-treat analysis				Per-protocol				Per intention-to-treat analysis
Antenatal Depression	Depressed	Not depressed	Within group comparison		Depressed	Not depressed	Within group comparison		Depressed	Not depressed	Within group comparison		Depressed	Not depressed	Within group comparison
	n; (%)	n; (%)	Total	P-value	n; (%)	n; (%)	Total	P – value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value
T0	8; (30.8)	18; (69.2)	26	0.31	5; (17.2)	24; (82.8)	29	0.34	7; (33.3)	14; (66.7)	21	0.44	7; (24.1)	22; (75.9)	29	0.75
T1	4; (18.2)	18; (81.8)	22		8; (27.6)	21; (72.4)	29		2; (18.2)	8; (88.8)	11		6; (20.7)	23; (79.3)	29
Antenatal Anxiety	Anxious	Not anxious	Within group comparison		Anxious	Not anxious	Within group comparison		Anxious	Not anxious	Within group comparison		Anxious	Not Anxious	Within group comparison
	n; (%)	n; (%)	Total	P-value	n; (%)	n; (%)	Total	P – value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value
T0	13; (50.0)	13; (50.0)	26	0.7	13; (44.8)	16; (55.2)	29	0.59	6; (28.6)	15; (71.4)	21	0.51	6; (20.7)	23; (79.3)	29	1
T1	10; (45.5)	12; (54.5)	22		11; (37.9)	18; (62.1)	29		2; (18.2)	9; (81.8)	11		6; (20.7)	23; (79.3)	29
COVID-19 specific phobia	Presence	Absence	Within group comparison		Presence	Absence	Within group comparison		Presence	Absence	Within group comparison		Presence	Absence	Within group comparison
	n; (%)	n; (%)	Total	P-value	n; (%)	n; (%)	Total	P – value	n; (%)	n; (%)	Total	p-value	n; (%)	n; (%)	Total	p-value
T0	10; (38.5)	16; (61.5)	26	0.42	16; (55.2)	13; (44.8)	29	0.79	9;(42.9)	12; (57.1)	21	0.38	8; (27.6)	21; (73.4)	29	0.008*
T1	11; (50.0)	11; (50.0)	22		15; (51.7)	14; (48.3)	29		3; (27.3)	8; (72.7)	11		11; (37.9)	18; (62.1)	29

n: frequency; %: percentage; T₀= baseline session; T₁= follow-up session; p ≤ 0.05*.