Mindfulness on the Go: A Study of Mobile App Usage and Mental Health in Pregnant Patients

Objective: Nearly 20% of pregnant individuals are diagnosed with an anxiety disorder or major depression during pregnancy, both of which have been associated with adverse outcomes such as preterm birth and low birth weight. Mindfulness meditation has been shown to effectively reduce symptoms of anxiety and depression in pregnancy. This study aims to assess the typical usage patterns of mobile applications offering mindfulness training and to identify characteristics of individuals who actively engage with these apps. Methods: We conducted a prospective study evaluating the impact of the Expectful meditation app on mental health and sleep in pregnant patients. Participants were enrolled during pregnancy and granted access to the app. Surveys assessing depression (Edinburgh Postnatal Depression Scale [EPDS], Hospital Anxiety and Depression Scale [HADS]), perceived stress (Perceived Stress Scale [PSS]), and sleep disturbance (PROMIS Sleep Disturbance Scale) were administered at enrollment, 30 days post-enrollment, and postpartum. Hours of usage were obtained through the application. Patient demographic information and pregnancy outcomes were collected. Participation in the study was voluntary and of no cost to the patients. Results: Forty-nine patients consented to the study, and 18% (n=9) of them used the meditation app at least once, with total usage ranging from 1 second to 107,713 seconds (approximately 29 hours). There were no significant differences in baseline demographics or pregnancy outcomes between app users and non-users. However, at baseline, app users reported significantly higher anxiety (HADS-anxiety score, p=0.011) and stress (PSS, p=0.025) compared to non-users. Baseline EPDS scores did not differ significantly between groups, with an average score of 9.33 among app users and 5.58 among non-users (p=0.0541). Postpartum, there was no difference in the rate of postpartum depression diagnoses between the groups. However, postpartum EPDS scores remained significantly higher among app users compared to non-users (7.67 vs. 3.38, p=0.023). Within-group comparisons of baseline and postpartum survey results showed no significant changes among app users. In a secondary analysis based on the presence of social determinants of health (SDoH), participants with reported SDoH (n=21) had significantly higher EPDS (p=0.0421), PSS (p=0.0495), and HADS-depression (p=0.0054) scores compared to those without SDoH (n=24). Conclusion: This study suggests that despite free access to a mindfulness-based mobile application, patients may not fully engage with it. The preference for in-person settings may stem from the structure they provide, including physical presence and dedicated time. While not statistically significant, patients affected by social determinants of health appeared to use the app more frequently than those without, possibly due to barriers limiting their participation in in-person programs. These findings highlight the potential value of mobile apps in offering accessible mindfulness resources, particularly for individuals facing social limitations.