This section is intended for healthcare professionals
For general information about Mamma Mia just click the Mamma Mia logo.
1. Executive summary of Mamma Mia
2. Demo for healthcare professionals
3.The scientific background
4. Published RCTs and studies
5. Monitoring with EPDS for signs of perinatal depression
6. The cost of perinatal depression in the UK
7. List of references for the scientific background
Content:
1. Executive summary of Mamma Mia
Mamma Mia is an evidence based and documented effective selfhelp intervention, suitable for all pre- and postpartum women.
The tunneled programme follows the user’s journey with 44 interactive sessions during a periode from gestation week 21 until 6 months after birth. With 16 sessions prepartum and 28 sessions postpartum.
The users can sign up at any time during pregnancy and after birth. The programme flow is adapted to when the user registers during her pregnancy.
There are separate tracks for women with female partners and women with no involved partner.
The pictures in the programme show ethnic diversity and there is no advertising or other commercial content.
The programme does not collect last name, email address or phone number. The users are anonymised with a 24-character, randomly created UserID.
The users respond to The Edinburgh Perinatal Depression Scale (EPDS) 7 times during the course of the programme.
Based on the EPDS scores, the programme provides individualised follow up.
The programme focuses on the three most important areas that affect mental and physical health throughout pregnancy and after birth:
The mother and child relationship
The partner relationship and social relationships
The woman’s mental wellbeing
Mamma Mia has been developed by Changetech, Oslo, Norway.
Changetech also holds the international commercial rights for the programme.
The effects of Mamma Mia have been thoroughly documented in RCT’s and other studies shared on this site.
Mamma Mia is documented to increase subjective wellbeing during pre- and postpartum and to reduce the risk for perinatal depression with 25% in the risk group.
The Center for Children and Young People’s Mental Health (RBUP) in Norway has contributed with professional guidance to the content and has conducted research on results and effects.
The Norwegian Women’s Health Association has contributed to the funding of the development of the programme and the research.
The Research Council of Norway has funded the RCTs.
The RCT conducted by The Virginia Commonwealth University was funded by the National Institutes of Health, USA.
2. Demo for healthcare professionals
In this demo for healthcare professionals, we focus on the background, structure and the documented outcomes of Mamma Mia.
You will also see examples from selected sessions and a whole “live” session.
After the introduction you can choose more specific information and see a complete session.
To see the whole programme, please ask for the Open Version for healthcare professionals.
Please note that the demo only works on mobile phones, not PCs.
Scan with your mobile if you see this on your PC:
3. The scientific background for Mamma Mia
The theoretical foundation of Mamma Mia is based on Changetech’s evidence based platform for development of behavioural change interventions including:
Self-determination theory
Self-efficacy
Self-regulation theory
Positive psychology
Motivational interviewing
Cognitive behavioural theory
Metacognitive behavioural theory
Affect regulation and detached mindfulness.
For the development of Mamma Mia, the theoretical framework also included:
Prediction of perinatal depression
Perinatal depression and treatment
Therapeutic alliances
Couples therapy
The Edinburgh Perinatal Depression Scale (EPDS).
The development process followed the intervention mapping (IM) protocol as descriptive tool, which consists of the following 6 steps:
1. Needs assessment
2. Definition of change objectives
3. Selection of theoretical methods and practical strategies
4. Development of program components
5. Planning, adoption and implementation
6. Planning evaluation.
The theoretical framework is further described in:
Drozd, F., Haga, S. M., Brendryen, H., & Slinning, K. (2015). An Internet-based intervention (Mamma Mia) for postpartum depression: Mapping the development from theory to practice. JMIR Research Protocols, 4(4), e120.
A white paper describing the psychological basis for Changetech’s platform for the development of behavioural change interventions can be found here.
For a complete Lists of references for the scientific platform please see the bottom of the page.
4. Published RCTs and studies of Mamma Mia
Since the release of the first web-based version in 2011, a series of RCT’s and other studies have been conducted to measure and understand the effects of Mamma Mia.
We have also collected a big quantity of in-programme data on usefulness, likes / dislikes and free-text comments.
Based on this research and in-programme feedback, there has been many upgrades from the earliest web-based version to the existing modern mobile app.
Here is a selection of independent and published studies of Mamma Mia with short comments on the outcomes:
Published RCTs and studies by authors, study title and publication.
Haga SM, Drozd F, Lisøy C, Wentzel-Larsen T, Slinning K (2019). Mamma Mia – A randomized controlled trial of an internet-based intervention for perinatal depression. Psychological Medicine 49, 1850–1858. https://doi.org/10.1017/S0033291718002544
The RCT shows a reduction of symptoms and prevalence of perinatal depression of 25% (21,5-26,6%) in the risk group.
Haga, S. M., Kinser, P., Wentzel-Larsen, T., Lisøy, C., Garthus-Niegel, S., Slinning, K., & Drozd, F. (2021). Mamma Mia – A randomized controlled trial of an internet intervention to enhance subjective well-being in perinatal women. The Journal of Positive Psychology, 16(4), 446–454. https://doi.org/10.1080/17439760.2020.1738535
The RCT shows a significant increase in subjective well-being for users outside of the risk group.
Kinser, P. A., Moyer, S., Jones, H. A., Jallo, N., Popoola, A., Thacker, L., Russell, S., Olavesen, E. S., Sundrehagen, T., Hare, M. M., Xia, B., Garthus-Niegel, S., Haga, S. M., & Drozd, F. (2025). Perceptions of the Mamma Mia program, an internet-based prevention strategy for perinatal depression symptoms. PLOS Mental Health, 2(4), e0000138. https://doi.org/10.1371/journal.pmen.0000138
Participants found the program to be beneficial overall; they appreciated its guided content, focus on self-care, integration of mindfulness and educational components, trustworthiness, and activities such as breathing exercises and relaxation practices.
Drozd, F., Andersen, C. E., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2017). User experiences and perceptions of internet interventions for depression. In S. U. Langrial (Ed.), Web-based behavioral therapies for mental disorders (pp. 27–52). IGI Global. https://doi.org/10.4018/978-1-5225-3241-5.ch002
«Safe tutoring, with information tailored to my needs»
«It talks about the mental aspects in a good and natural way»
«I've become more aware and present»
«The exercises are comfortable, they help me find peace»
«You get information everywhere. This was easier to use»
«It's good to have something based on research and science»
«You get knowledge you can’t get anywhere else»
«I can use the meetings with health professionals much better»
«I really liked the techniques to get in touch with the baby»
«It's short, to the point and fun!»
Insights from the current review and study are used as a point of departure for discussing future directions in research on internet interventions for depression.
Drozd, F., Haga, S. M., Lisøy, C., & Slinning, K. (2018). Evaluation of the implementation of an internet intervention in well-baby clinics: A pilot study. Internet Interventions, 13, 1–7. https://doi.org/10.1016/j.invent.2018.04.003
The rate ratio indicated that when a clinic's e-HIT intervention mean score increased by one point, there was a 27% increase in women recruited.
The evaluation shows that Mamma Mia is well suited to fit into the maternity pathway.
Drozd, F., Haga, S. M., Brendryen, H., & Slinning, K. (2015). An Internet-based intervention (Mamma Mia) for postpartum depression: Mapping the development from theory to practice. JMIR Research Protocols, 4(4), e120. https://doi.org/10.2196/resprot.4858
The IM of Mamma Mia has made clear the rationale for the intervention, and linked theories and empirical evidence to the contents and materials of the program.
Valla, L., Haga, S. M., Niegel, S. G., & Drozd, F. (2023). Dropout or drop-in experiences in an internet-delivered intervention to prevent depression and enhance subjective well-being during the perinatal period: Qualitative study. JMIR Pediatrics and Parenting, 6, e46982. https://doi.org/10.2196/46982
More than two-thirds of users found Mamma Mia to be of high quality and would recommend Mamma Mia to others. By far, most also found the amount of information and frequency of the intervention schedule to be appropriate. Mamma Mia was perceived as a user-friendly and credible intervention.
5. Monitoring with EPDS for signs of perinatal depression
The Edinburgh Perinatal Depression Scale (EPDS) is a questionnaire used to identify patients with depression before, during or after childbirth.
It was originally developed by Professor John Cox in Edinburgh, has gained wide acceptance and is used in many countries.
The users of Mamma Mia are screened using EPDS 7 times during the full programme: In gestation weeks 23, 30 and 34, and in week 1, 5, 10 and 16 after birth.
The data from the EPDS are rated in three categories based on recommended cut-offs.
Users with scores in the first (low-risk) category do not receive additional support. Users with scores in the second (medium risk) category get additional in-programme support and a follow up in the next session. Users with scores in the third (strong risk) category get additional in-programme support and a recommendation to seek support from suggested healthcare services , with a follow up in the next session.
One of the purposes of Mamma Mia is to detect and prevent the further development of perinatal depression.
This graph shows the prevalence of users in group three (strong risk for perinatal depression) at given intervals during the course of the programme.
Both the RCTs and the in-programme data show a reduction in their risk of getting perinatal depressions as users progress in the programme.
In this graph this is shown as percentages of improvement from programme session 14 (gs week 35) and until programme session 30 (available from 5 weeks after birth).
The graph is based on data for 672 users over time.
NOTE. The data gathered in-programme indicates a significant increase in the prevalence of perinatal depression (in Norway) over the last years.
This graph shows the prevalence of perinatal depression in group three (strong risk) in 2024 compared with the data from the RCT on Mamma Mia users published in 2018.
This further emphasizes the need for an effective low-threshold service like Mamma Mia to prevent perinatal depression among new and expectant mothers and relieve an already heavily burdened healthcare system.
6. The costs of perinatal depression in the UK
Background.
15-20% of new and expectant mothers get depressed, and the number is believed to be increasing. Many don't get the help and support they need, with serious consequences for families, public healthcare and society.
It affects the child's development, leads to complications during pregnancy and mental health issues and to decreased workforce participation for the child later in life.
In the ground-breaking research from the London School of Economics (LSE), commissioned by The Maternal Mental Health Alliance (MMHA), the annual costs caused by perinatal depression was calculated to be £8.1 billion for each annual group of births in the UK.
That was in 2014. There are reasons to believe that the figures have increased since then.
The report from the London School of Economics (LSE). (2014)
Perinatal mental health problems cost the UK £8.1 billion each year, according to a new report released in 2014 by the London School of Economics and Political Science and the Centre for Mental Health.
The report, that was officially launched in Parliament on Tuesday 21 October 2014, calls for the NHS to spend £337 million a year to bring perinatal mental health care up to the level recommended in national guidance.
The costs of perinatal mental health problems' is part of the Maternal Mental Health Alliance’s ‘Everyone’s Business’ campaign, which is appealing to government and health commissioners to ensure that all women throughout the UK who experience perinatal mental health problems receive the care they and their families need, wherever and whenever they need it.
The key findings of the report, led by Annette Bauer and Professor Martin Knapp from LSE's Personal Social Services Research Unit (PSSRU) are:
• Perinatal depression, anxiety and psychosis together carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.
• Nearly three-quarters (72%) of this cost relates to adverse impacts on the child rather than the mother.
• Over a fifth of total costs (£1.7 billion) are borne by the public sector, with the bulk of these falling on the NHS and social services (£1.2 billion).
• Other costs include loss of earnings/impact on someone’s ability to work and quality of life effects.
There is clear guidance from the National Institute for Health and Care Excellence (NICE) and other national bodies on the treatment of mental illness during and after pregnancy. Yet the current provision is best described as patchy, with significant variations in coverage around the country:
• About half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.
• Specialist perinatal mental health services are needed for women with complex or severe conditions, but less than 15% of localities provide these at the full level recommended in national guidance and more than 40% provide no service at all.
The follow-up report from the London School of Economics (LSE). (2022)
The Follow-up report, “The economic case for increasing access to treatment for women with common mental health problems during the perinatal period”, outlined the economic and organisational pathway to increase the treatment of perinatal depression.
This report also includes a cost / benefit analyses and an analyses of workforce and budget required if governments were to decide to invest in the integrated service provision.
Click on the images to download the full reports.
8. List of references for the scientific background
Perinatal depression and treatment.
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Prediction of perinatal depression
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