Pregnancy Without Psychosocial Stress
Pregnancy Without Psychosocial Stress
The project is aimed at children who are exposed to the toxic psychosocial stress present in
 their mothers during pregnancy or after childbirth. Due to psychosocial stress in their
 mothers, these children are at risk of developing a mental disorder or having impaired
 psychosocial development.

 In Czechia, there is no prevention of psychosocial stress in women, which also plays a
 preventive role in the development of mental disorders in their children. Mental disorders in
 parents are stigmatized in Czechia, which prevents parents from seeking care.

 The investigators want to change this situation, so they will:

 1. create and pilot a screening program for psychosocial stress in perinatal women in
 gynecological clinics

 2. connect the screening program to the integrated step care system created by the
 investigators, including peer support, which the investigators will test
ACTIVITY 1 Objective of the activity: To increase the support of mental health and well-being
 of unborn children and children in the period soon after their birth by early detection of
 women experiencing psychosocial stress during pregnancy and after childbirth. Target group:
 Pregnant women and postpartum women and their children.

 Methods: Because the occurrence of symptoms of psychosocial stress in pregnancy is one of the
 main predictors of the development of mental disorders after childbirth, the investigators
 will test whether the introduction of screening in gynecological clinics during pregnancy
 reduces the incidence of untreated mental disorders in women 6 weeks after birth. Thanks to
 screening, the investigators want to capture women and their children who are exposed to
 toxic stress during pregnancy. Screening: Gynecological clinics will be equipped with a
 tablet with screening software (Czech version of the Edinburgh Perinatal Depression Scale;
 Perinatal Anxiety Screening Scale; Perinatal Psychosocial Profile). The software runs on the
 servers of the National Institute of Mental Health (NUDZ), secured against cybercrime. Work
 with data obtained during screening is subject to GDPR and the process is approved by the
 NUDZ Ethics Committee. The screening software is automated and sends the woman information
 about the results to her email.

 Evaluation: a randomized controlled study in 20 gynecological clinics in 3 regions of the
 Czech Republic (Prague, Central Bohemia and Olomouc Region). Participating gynecological
 outpatient clinics will be randomized in a 1: 1 ratio into two groups: Intervention
 outpatient clinics: Intervention outpatient clinics offer study participation to all pregnant
 women during their pregnancy. Furthermore, all women checked at the end of the sixth week.
 Intervention clinics will also be equipped with information materials on mental health during
 pregnancy and after childbirth. Control clinics: actively offer participation to all women
 only at the control at the end of the sixth week postpartum. The main checkpoint in both
 groups of outpatient clinics is the 6th week after delivery, when the woman comes to the
 gynecological outpatient clinic for a mandatory check-up in Czechia. All women who will
 participate in Activity 1 will be examined by telephone using a structured psychiatric
 examination by a psychiatrist at the end of the 6th week after childbirth so that we can
 determine the presence of mental disorders.

 Hypothesis: There are more women in control clinics who are not treated for a mental disorder
 at the end of the 6th week after delivery, even if they have been diagnosed, than in
 intervention clinics.

 ACTIVITY 2 Objective of the activity: To increase the support of mental health and well-being
 of unborn children and children soon after their birth through early intervention in women
 experiencing psychosocial stress during pregnancy and after childbirth. Target group: Women
 who experience psychosocial stress during pregnancy and after childbirth and their children.
 Methods: Activity 2 is directly related to activity 1 of the submitted project. As part of
 Activity 2, the investigators will provide the women captured by the screening intervention
 developed by them.

 Intervention: Mom supports Mom includes at least four telephone or other contacts - Skype,
 Zoom, WhatsApp, Facebook Messenger, ...) Between the project participant and a peer
 consultant trained by the National Institute of Mental Health and Mom´s Smile. Within peer
 support, the main methods are listening, psychoeducation, basic procedures of cognitive
 behavioral therapy and mindfulness, shared personal experiences with perinatal psychosocial
 stress and, if necessary, a reference to professional counseling (psychology, psychiatry).

 Evaluation: a randomized controlled study in gynecological clinics participating in Activity
 1 of the project. Women experiencing psychosocial stress, which we will screen through
 Activity 1, will be randomized 1: 1 into two groups: Intervention group: The peer consultant
 coordinator will connect the woman with the peer consultant who will carry out the
 intervention Mom supports mom. Control group: The woman will be sent automatic feedback with
 information on how to proceed if the participant wants to seek help herself. Evaluation of
 the effect of the intervention: The investigators evaluate depressive symptoms using the
 Edinburgh scale of perinatal depression; anxiety symptoms using the Perinatal Anxiety
 Screening Scale; psychosocial stress using the Perinatal Psychosocial Profile; quality of
 life using the 8-dimensional quality of life scale; and parental competences using the
 Parenting Sense of Competence Scale. The investigators collect data after the woman enters
 Activity 2 and one month after entering. The Investigators will evaluate the feedback from
 users using qualitative questions.

 Hypothesis: Intervention Mom supports mom, reduces depressive and anxiety symptoms and
 general psychosocial stress in women experiencing psychosocial stress. Intervention Mom
 supports mom, increases the quality of life and parental competencies of women experiencing
 psychosocial stress.

 Statistics: n = 120 (60 in each arm of the study). Sample size is calculated so that the
 investigators can detect a medium-to-large group difference in the scale of depressive
 symptoms (effect size = 0.6; t-test) at power 80%, significance level 5% (2-sided) and
 potential drop out 30 %.
Inclusion Criteria ACTIVITY 1:

 -  sex-female

 -  pregnancy

 -  woman is registered during and after pregnancy in one of 20 study gynecological
 outpatient clinics

 -  signing informed consent

 -  email address ownership

 -  age 18-45

 Inclusion Criteria ACTIVITY 2:

 -  Edinburgh Postpartum Depression Scale score ≥10.

 -  participant identified through the ACTIVITY 1 of the study

 Exclusion Criteria ACTIVITY 1:

 - acute medical illness or significant pregnancy complication (based on self-report)

 Exclusion Criteria ACTIVITY 2:

 -  acute suicidal behavior (based on self-report)