Navigating the crossroads between early motherhood and mental health: exploring the role of eHealth in addressing mental health and at-risk substance use among a stigmatized and understudied population

Abstract

Individuals with co-occurring mental health concerns and at-risk substance use (ARSU+) face barriers to accessing effective treatments. eHealth treatments may offer an alternative to address unmet needs, particularly for underserved populations such as mothers of young children. However, most treatments address mental health or substance use in isolation, which may limit accessibility and relevance for those with ARSU+. Alcohol and cannabis use were the focus of this dissertation due to their high prevalence, legal status, and frequent mental health comorbidity. This dissertation aimed to evaluate the feasibility, clinical utility, and effectiveness of eHealth treatments in general populations and/or mothers of young children. In Study 1, I conducted a meta-analysis and systematic review of 93 randomized controlled trials (RCTs; N = 51,833) to assess eHealth treatment effectiveness. Small effects were shown for alcohol use at post-treatment and cannabis use at follow-up. Moderator analyses revealed larger effects in studies with older samples, non-college/university samples, and those that targeted individuals with at-risk substance use. Treatment components associated with greater alcohol use reductions included relapse prevention, motivational interviewing, cognitive strategies, and emotion regulation and mental health support. In Study 2, I conducted a secondary data analysis of two RCTs evaluating the Building Emotional Awareness and Mental health program, a mental health and parenting treatment for mothers with young children. Feasibility and symptom trajectories were compared among those with ARSU+ (n = 33) and those with mental health concerns without at-risk substance use (ARSU-; n = 77). Significant reductions in depression, anxiety, anger, sleep disturbances, and parenting stress were observed over time in mothers with ARSU+. These improvements were comparable to those observed in the ARSU- group, even after adjusting for enrollment symptom severity. Together, findings suggest eHealth treatments are associated with reductions in alcohol and cannabis use in the general population and may be feasible and support symptom improvements in mothers with ARSU+. Results underscore that single-focus eHealth treatments targeting mental health or substance use alone may still offer preliminary benefit for individuals with ARSU+. These findings highlight the potential value of flexible and inclusive approaches to treatment development and implementation.