Frequently Asked Questions

The MOMitor app identified 13.6% of actively monitored pregnancies (202 of 1,481) as having symptoms indicative of perinatal depression. Across the full cohort, 2,307 pregnancies were enrolled and monitored during the first 6 weeks postpartum, and the authors noted that this rate paralleled the nearly 13% prevalence of perinatal depression reported in existing literature.

No. The study found that the single prescreening item functioned as a triage tool, not a replacement for the Edinburgh Postpartum Depression Scale (EPDS).

Using EPDS score 12 or higher as the reference standard, the prescreener had 65.7% sensitivity, 92.6% specificity, 54.2% positive predictive value, 95.3% negative predictive value, and 89.5% overall accuracy. Of 2,392 assessments with a “happy” response, 112 still had a positive EPDS screen, showing that some patients with depressive symptoms would have been missed if clinicians relied on the single-item question alone.

The study supported universal EPDS administration after postpartum week 2 because the single mood prescreener missed more positive screens later in the postpartum period. Prescreener sensitivity was 88.5% in weeks 1 and 2 but fell to 45.0% in weeks 3 through 6, while specificity rose from 49.1% to 97.2%.

The authors explained that in weeks 1 and 2, participants who answered “happy” did not complete the EPDS, which inflated sensitivity and lowered specificity in that period. After week 2, all participants completed the EPDS regardless of prescreener response, and some participants with positive EPDS scores still reported feeling “happy.”

App-triggered mental health alerts led to same-day nurse outreach and a range of follow-up actions, from continued monitoring to higher-acuity intervention. Among 475 nurse follow-up calls, outcomes included 4 psychiatric hospital admissions, 58 clinic visits for intervention, 11 lactation referrals, 3 emergency department referrals, and 3 in-home wellness checks by county officials.

In addition, 254 participants were continued on monitoring without further immediate action, 52 were offered appointments but declined, and 90 could not be reached by phone after app-generated alerts.

The program generated substantial follow-up activity. A total of 8,049 mental health screening assessments were completed across 2,307 enrolled pregnancies, and these assessments resulted in 475 nurse follow-up calls.

Follow-up calls were triggered by a positive EPDS screen, a self-harm response on EPDS question 10 regardless of total score, a participant request for a nurse call, or nonresponse to 3 consecutive app-delivered assessments. The study states that follow-up calls were made on the same day as assessment completion.

When a participant scored 12 or higher on the EPDS or indicated thoughts of self-harm on EPDS question 10, the app automatically notified a study nurse for same-day follow-up. During the phone call, the nurse gathered more information about mood symptoms and psychiatric history and assessed for active suicidal or homicidal ideation.

Nurses followed a physician-developed protocol to determine the appropriate next step, which could include continued monitoring, referral placement through the electronic medical record or by phone to an outside clinician, community resources, emergency department referral, psychiatric hospitalization, or a wellness check if safety concerns remained. Participants who could not be reached received a voicemail and up to 3 contact attempts before being considered lost to follow-up.

The two platforms showed broadly comparable prescreener performance, although they were not assigned randomly. Sensitivity was 60.3% for mobile Ecological Momentary Assessment by ilumivu (mEMA) and 72.3% for Epic Care Companion (ECC), while specificity was 94.4% for mEMA and 89.7% for ECC.

The authors cautioned that platform assignment depended on whether participants already had an active MyChart account, so direct causal comparisons between ECC and mEMA are limited.

The main limitations were lack of a control group, substantial attrition, nonrandom platform assignment, and limited generalizability. This was a cross-sectional study rather than a randomized controlled trial, so it cannot establish comparative effectiveness against usual postpartum care.

The overall attrition rate was 35.8% (826 of 2,307 pregnancies), including 30.2% lost to follow-up and 5.6% withdrawals. The study also excluded non-English speakers and people without smartphones, did not collect formal psychiatric diagnoses beyond self-reported depression and anxiety history, and monitored participants for only 6 weeks even though postpartum depression can occur up to 1 year postpartum.

The study enrolled postpartum women at a large academic hospital who were at least 18 years old, had delivered a liveborn infant, were proficient in English, owned a smartphone, and agreed to download the study app. Participants were recruited from November 2021 through June 2024 and monitored for 6 weeks postpartum.

There were 2,307 pregnancies among 2,269 unique participants, with 38 participants contributing a second pregnancy during the study period. The mean participant age was 29.92 years.