Open Access Study protocol

The (cost) effectiveness of an online intervention for pregnant women with affective symptoms: protocol of a randomised controlled trial

Hanna M Heller1*, Annemieke van Straten2, Christianne JM de Groot3 and Adriaan Honig14

Author Affiliations

1 Department of Psychiatry, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

2 Department of Clinical Psychology, Faculty of Psychology and Education & EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands

3 Department of Obstetrics and Gynecology, VU University Medical Center, de Boelelaan 1117, 1181 HV, Amsterdam, The Netherlands

4 Sint Lucas Andreas hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands

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BMC Pregnancy and Childbirth 2014, 14:273  doi:10.1186/1471-2393-14-273

Published: 14 August 2014



Women in pregnancy and postpartum have an increased vulnerability to develop an affective disorder. Affective disorders in pregnancy are associated with an increased risk of prematurity, dysmaturity (foetal weight below the 10th percentile as determined by ultrasound) and the development of postpartum depressive disorder. Untreated affective disorders and their complications may also result in considerable costs. Recent meta-analyses showed that interventions during pregnancy are less effective than postpartum interventions probably because of high attrition due to the barriers pregnant women experience with attending sessions outside their homes. An internet-based self-help intervention may overcome these barriers as it can be followed at home, and also in one’s own time. Such internet interventions showed to be effective for decreasing affective symptoms in general.

This randomised clinical trial examines whether an internet-based self-help intervention is effective in the reduction of affective symptoms in pregnancy and postpartum and results in an improvement of the perinatal outcome. We will also determine the cost-effectiveness of the intervention.


We will investigate the effectiveness of a 6 week internet-based self-help problem solving treatment (PST) for affective symptoms in pregnancy. We aim to include 286 women with mild to severe affective symptoms who will be randomly assigned to the internet-based intervention or a waiting list control group. Primary outcome measures are affective symptoms and the perinatal outcome. Secondary outcome measures are quality of life, and economic costs. All assessments are based on self-report and will take place at baseline (T0), 10 weeks later (after completion of the intervention (T1), 4 weeks before the expected day of birth (T2), and 6 weeks after delivery (T3). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle.


If shown (cost) effective, internet-based PST will offer new possibilities to treat pregnant women for affective symptoms, to improve their perinatal outcome and to prevent the development of postpartum depressive disorders.

Trial registration

Nederlands Trial Register: NTR4321

Pregnancy; Affective symptoms; Internet; Perinatal outcome; Postpartum depressive disorder; Self-help intervention; Cost-effectiveness