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Introduciton: Depression is a common mental health disorders during pregnancy, with important consequences for mothers and their children. Despite this, it goes undiagnosed and untreated in many women attending antenatal care. Smartphones could help support the prompt dentification of antenatal depression in this setting. In addition, these devices enable the implementation of ecological momentary assessment techniques, which could be used to assess how mood is experienced during pregnancy. With this study, we will assess the feasibility of using a bespoke mobile application running on participants’ own handsets for the longitudinal (6 months) monitoring of antenatal mood and screening of depression. Methods and analysis: We will use a randomised controlled study design to compare two types of assessment strategies: retrospective + momentary (consisting of the Edinburgh Postnatal Depression Scale plus 5 momentary and 2 contextual questions), and retrospective (consisting of the Edinburgh Postnatal Depression Scale only). We will assess the impact that these strategies have on participant adherence to a pre-specified sampling protocol, drop-out rates and timeliness of data completion. We will evaluate differences in acceptance of the technology through a short quantitative survey and open ended questions. We will also assess the potential effect that momentary assessments could have on retrospective data. We will attempt to identify any patterns in app usage through the analysis of log data. Ethics and dissemination: This study has been approved by the South East Coast – Surrey Research Ethics Committee. Our findings will be disseminated through academic peer-reviewed publications, conferences and discussion with peers. Registration details: This study has been registered in ClinicalTrials.gov under the identifier NCT02516982. STRENGTHS OF THIS STUDY: This study will explore: (i) the role of mobile technology as a medium to address some of the practical barriers preventing depression screening in antenatal settings; (ii) how mood and depression are experienced throughout pregnancy (using momentary, experiential and ecological data); and ( iii) two critical success factors for the successful deployment of mobile technology in pregnancy: user engagement and adherence to a proposed sampling protocol • This study will provide baseline information regard ing the appropriateness of a sampling protocol (in terms of its duration, intensity and frequency) for the monitoring of mood and screening of depression during the antenatal period • The technology used in this study has been specific ally designed and developed to fit within the clinical context and the local care path ways in which it will be deployed LIMITATIONS OF THIS STUDY: • This study focuses on mood and antenatal depression. It does not consider other common mental health disorders that occur during pr egnancy, or the presence of potential triggers or risk factors (for example, do mestic violence) • The mood-related momentary questions used in this study have not been validated • This study relies on self-report measures. Research is being conducted to explore how smartphone and app usage data could be used to unobtrusively identify low mood and depression in the general population

Background: Mobile apps can operate as a delivery mode for many of the self-reported measures commonly used to gather patient data in healthcare. However, the incorporation of this technology in existing care pathways has the potential to influence the quality of the responses, as well as the routine activities of clinical services. This project evaluated the use of mobile apps for the delivery of depression screening scales and momentary questions during antenatal care. Methods: A systematic review assessed the impact that apps as a delivery mode can have on the quality of self-report survey responses, compared to other delivery modes. A subsequent study evaluated the feasibility of using tablet computers for administering the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) in the waiting area of antenatal clinics. Lastly, another study assessed the feasibility of using a bespoke app running on patients’ own devices for the screening and monitoring of mood and depression in the last two pregnancy trimesters. Results: The responses of surveys collected via apps are equivalent to those collected through traditional delivery modes. Moreover, it is feasible to use apps for depression screening in the waiting area of antenatal clinics. However, the adaptation of screening scales for use with an app could influence data quality, as suggested by a significant relationship between survey layout (i.e., the number of questions presented on a single screen) and scoring intervals on the EPDS. In addition, apps can assist in generating evidence of the diagnostic performance of screening scales in specific populations. Lastly, the development and deployment of apps for depression screening on patients’ own devices must be sensitive to the needs of both patients and clinicians in order to minimise the likelihood of any potential detrimental effect. Conclusions: Mobile technology is an innovative tool for supporting and complementing the role of healthcare practitioners, empowering patients, and enabling the reconfiguration of health services to better meet the needs of their users. Open Access