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 RCT and studies
5. Monitoring with EPDS for symptoms 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 self-help intervention suitable for all perinatal women.
The tunneled programme follows the woman’s journey with 44 interactive sessions during a period from gestation week 21 until 6 months after birth. With 16 sessions prepartum and 28 sessions postpartum.
The women can sign up at any time during pregnancy and after birth.
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 women are anonymised with a 24-character, randomly created UserID.
The women complete the Edinburgh Perinatal Depression Scale (EPDS) 7 times during the programme.
Based on the EPDS scores, the programme provides individualised follow-up.
The programme focuses on three important areas that influence mental and physical health throughout pregnancy and after birth:
The mother and child relationship
The partner relationship and social relationships
The woman’s mental well-being
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 one randomized controlled trial and other studies shared on this site. Two ongoing randomized trials, one in Norway and one in the U.S., are currently replicating and examining the effects of Mamma Mia using various support models.
Mamma Mia is documented to increase subjective well-being during pre- and postpartum and to reduce the risk for perinatal depression by 25% in the risk group.
The Regional Center for Children and Adolescents Mental Health (RBUP), Eastern and Southern Norway, has contributed with professional guidance to the content and has conducted research on the 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 full “live” session.
After the introduction you can choose more specific information.
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:
Risk and protective factors 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 this page.
4. Published RCTs and studies of Mamma Mia
Since the release of the first web-based version in 2011, an RCT and other studies have been conducted to measure and understand the effects of Mamma Mia.
We have also collected a large quantity of in-programme data on usefulness, likes/dislikes, and free-text comments.
Based on this research and other feedback from the users, there have been many upgrades of the user interface and functionality from the early versions to the current phone app.
Here is a list 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 21,5% to 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 decrease in negative affect for women 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 the women found Mamma Mia to be of high quality and would recommend Mamma Mia to others. Most also found the amount of information and frequency of the intervention schedule appropriate. Mamma Mia was perceived as a user-friendly and credible intervention.
5. Monitoring depressive symptoms using the EPDS
The Edinburgh Perinatal Depression Scale (EPDS) is a questionnaire used to assess perinatal depressive symptoms during the past 7 days.
It was originally developed by Professor John Cox in Edinburgh, has gained wide acceptance, and is used in many countries.
In Mamma Mia, the women complete the EPDS 7 times during the full programme: In gestational week 23, 30, and 34, and in weeks 1, 5, 10, and 16 after birth.
Each woman is placed in one of three categories based on her EPDS scores.
Women with scores in the “low-risk” category do not receive additional support. Women with scores in the “medium-risk” category get additional in-programme support and a follow-up in the next session. Women with scores in the “high-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 women in group three (high risk for perinatal depression) at given intervals during the programme.
Both the RCT and the in-programme data show a reduction in the risk of perinatal depression at each timepoint.
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 women over time.
NOTE. The data gathered in-programme indicates an increase in the prevalence of perinatal depression (in Norway) over the last years. (Data for sessions after S30 were not available at the time of publication.)
This graph shows the increase in high risk of perinatal depression (group three) in 2025 compared to data from the randomized controlled trial on Mamma Mia users published in 2018.
This increase 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 health system.
6. The costs of perinatal depression in the UK
Background.
An estimated 15–20% of new and expectant mothers experience depression, and this number is believed to be rising. (LSE 2014). Many do not receive the necessary help and support, leading to serious consequences for families, public healthcare, and society. Maternal depression can impact a child's development, contribute to pregnancy complications and mental health challenges, and even reduce the child's workforce participation later in life.
Groundbreaking research from the London School of Economics (LSE), commissioned by The Maternal Mental Health Alliance (MMHA), estimated that perinatal depression costs the UK £8.1 billion annually for each year's births.
The report from the London School of Economics (LSE). (2014)
This report, published in 2014 by LSE and the Centre for Mental Health, was officially launched in Parliament on 21 October 2014. It highlighted the urgent need for increased investment in perinatal mental health care, recommending that the NHS allocate £337 million annually to meet national care standards.
The findings are a core part of the Maternal Mental Health Alliance’s ‘Everyone’s Business’ campaign, which urges government and health commissioners to ensure that all women in the UK experiencing perinatal mental health challenges receive the necessary care and support, regardless of location or circumstances.
Since its release, there is reason to believe these figures have continued to rise.
The key findings of the report, led by Annette Bauer and Professor Martin Knapp from LSE's Personal Social Services Research Unit (PSSRU), are as follows:
• The long-term societal cost of perinatal depression, anxiety, and psychosis is estimated at £8.1 billion for each annual birth cohort in the UK. • Nearly three-quarters (72%) of this cost stems from adverse effects on the child rather than the mother. • Over one-fifth (£1.7 billion) of the total cost is borne by the public sector, with the majority (£1.2 billion) impacting the NHS and social services. • Additional costs include loss of earnings, reduced work capacity, and diminished quality of life.
Despite clear guidance from the National Institute for Health and Care Excellence (NICE) and other national bodies on the treatment of perinatal mental illness, care provision remains inconsistent, with significant regional disparities:
• Around half of all cases of perinatal depression and anxiety go undetected, and many of those identified do not receive evidence-based treatment. • Specialist perinatal mental health services are crucial for women with complex or severe conditions, yet fewer than 15% of localities offer these at the recommended level, while 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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