<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04496115</url>
  </required_header>
  <id_info>
    <org_study_id>Pro00102522</org_study_id>
    <nct_id>NCT04496115</nct_id>
  </id_info>
  <brief_title>Mindfulness in High Risk Pregnancies</brief_title>
  <official_title>The Impact of Mindfulness on Prenatal Depression, Anxiety and Stress in Mothers at Risk of Preterm Delivery</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Alberta</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>University of Alberta</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Anxiety, depression and stress are common during pregnancy. These have been found to&#xD;
      negatively impact mother and child outcomes. When anxiety, depression, and stress are present&#xD;
      in pregnant women, it is therefore important to manage them to improve the outcome of the&#xD;
      mother and her child.&#xD;
&#xD;
      Although pregnancy itself has been shown to increase anxiety, depression and stress, these&#xD;
      issues are further elevated in high-risk pregnancy groups. Mothers at risk of preterm&#xD;
      delivery (less than 37 weeks gestational age), have been found to have higher rates of&#xD;
      depression, anxiety and stress compared to uncomplicated term pregnancies. In addition,&#xD;
      anxiety, depression and stress symptoms themselves increase the risk for preterm delivery,&#xD;
      creating a vicious cycle for this high-risk group.&#xD;
&#xD;
      Mindfulness is a tool that has been during pregnancy to reduce depression, anxiety, and&#xD;
      stress. Many studies have found mindfulness to be an appropriate management option in normal&#xD;
      term pregnancies.&#xD;
&#xD;
      To date, there have been no studies that have looked at Mindfulness as a tool for mothers&#xD;
      admitted due to risk of preterm delivery. This study will explore the impact of teaching&#xD;
      mindfulness skills to inpatient mothers at risk of preterm delivery and studying its effects&#xD;
      on maternal depression, anxiety, and stress.&#xD;
&#xD;
      This study involves providing Mindfulness strategies during the mother's inpatient admission&#xD;
      for the risk of preterm delivery for four consecutive weeks. Participants will be enrolled&#xD;
      through informed consent. All participants will be given pre and post participation&#xD;
      questionnaires to examine the impact of mindfulness on anxiety, depression and stress. The&#xD;
      participants will also be encouraged to maintain a weekly mindfulness log. The results of&#xD;
      this research may lead to future studies looking at the impact of mindfulness practice for&#xD;
      high-risk pregnancies. This will also help open up the possibility of offering such courses&#xD;
      for inpatient and outpatient high-risk pregnancies in the future.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      BACKGROUND&#xD;
&#xD;
      Anxiety and depression are two of the most common psychological symptoms that manifest in&#xD;
      pregnant women. A recent systematic review found the prevalence of prenatal anxiety to be&#xD;
      18.2% in the first trimester, 19.1% in the second trimester and 24.6% in the third trimester.&#xD;
      A separate systematic review found rates of depression in the prenatal period to be 16.4%.&#xD;
      These symptoms have been found to negatively impact maternal health as well as fetal and&#xD;
      childhood development. It is therefore imperative that anxiety and depression be assessed in&#xD;
      all pregnant mothers and to further implement interventions to improve outcomes for both the&#xD;
      mother and fetus.&#xD;
&#xD;
      Pregnant mothers with admission to an inpatient ward due to increased risk for preterm&#xD;
      delivery have been found to experience elevated levels of anxiety, depression and stress&#xD;
      compared to term pregnancies. Furthermore, increased anxiety and depression have been linked&#xD;
      to the risk of preterm labor, creating a vicious cycle. A 2017 study that assessed anxiety&#xD;
      and depression in a population of pregnant mothers at risk of preterm labor found 35.1% to&#xD;
      have anxiety and 69.8% having depressive symptoms. By managing the psychological symptoms&#xD;
      experienced in this cohort of pregnant mothers, the rationale is that the risks associated&#xD;
      with them might be reduced, providing improved maternal and fetal outcomes.&#xD;
&#xD;
      There have been several studies that have assessed the benefits of mindfulness as a tool in&#xD;
      reducing anxiety, stress and depression specifically in pregnancy. A 2016 meta-analysis found&#xD;
      that mindfulness-based interventions are effective at reducing pregnancy related depression,&#xD;
      stress, and anxiety. A randomized controlled trial assessed pregnant women with high levels&#xD;
      of stress and anxiety after six weeks of mindfulness practice with results demonstrating&#xD;
      larger decreases in pregnancy specific anxiety as compared to the control group.&#xD;
&#xD;
      Mindfulness has been implemented as an intervention prior to delivery with encouraging&#xD;
      results. It has also been used in the post-partum period in environments such as the Neonatal&#xD;
      Intensive Care Unit (NICU), where parental anxiety, depression and stress are elevated due to&#xD;
      admission of their newborn after birth. Recent studies have shown that when mindfulness is&#xD;
      used in the NICU environment, it assists with reduction of depressive, anxiety and trauma&#xD;
      symptoms as well as improving maternal sleep Mindfulness also helped mothers deal with acute&#xD;
      stressors more appropriately and promoted awareness and reduced stress related emotions.&#xD;
&#xD;
      To date, there have been no studies that have looked at Mindfulness as a tool for mothers&#xD;
      admitted due to risk of preterm delivery. The study being proposed here, would assess the&#xD;
      impact of mindfulness in the prenatal period, in a group of mothers who are experiencing&#xD;
      elevated levels of depression, anxiety and stress due to the risk of preterm delivery.&#xD;
&#xD;
      HYPOTHESIS&#xD;
&#xD;
      The investigators hypothesize that pregnant women will experience less depression, anxiety&#xD;
      and stress with mindfulness and will increase their mindful awareness.&#xD;
&#xD;
      MATERIALS AND METHODS&#xD;
&#xD;
      This study is a non blinded, prospective randomized controlled trial.&#xD;
&#xD;
      Following recruitment of participants, randomization into either the mindfulness group or the&#xD;
      control group will occur.&#xD;
&#xD;
      Mindfulness Group (MG)&#xD;
&#xD;
      Participants within the mindfulness group will be instructed by a mindfulness&#xD;
      practitioner/coach once a week for four weeks in one-on-one sessions. Weekly journals will be&#xD;
      provided to measure adherence. Optional mindfulness audio files may be used to continue&#xD;
      mindfulness practice in between guided mindfulness sessions.&#xD;
&#xD;
      Control Group (CG)&#xD;
&#xD;
      Participants within the control group will receive care as usual without any additional&#xD;
      mindfulness techniques provided during the four-week period.&#xD;
&#xD;
      Instruments&#xD;
&#xD;
        -  General Demographic Form: A researcher created maternal demographic data form (age,&#xD;
           educational level, number of gestations, parity, prior experience with mindfulness,&#xD;
           history of depression and anxiety) to be completed by the mother at enrolment.&#xD;
&#xD;
        -  Depression, Anxiety and Stress Scale: 21 item Depression, Anxiety, Stress Scale to be&#xD;
           completed by the mother at enrolment and at the end of the four weeks.&#xD;
&#xD;
        -  Pregnancy Related Anxiety Scale: 10 item Pregnancy Related Anxiety Scale to be completed&#xD;
           by the mother at enrolment and at the end of the four weeks.&#xD;
&#xD;
        -  Mindfulness Scales: 15 item Mindfulness Attention Awareness Scale and the 13 item&#xD;
           Toronto Mindfulness Scale will be completed by the mother at enrolment and at the end of&#xD;
           the four weeks.&#xD;
&#xD;
        -  Mindfulness Weekly Journal: Document recording the duration of mindfulness practice&#xD;
           every day during the four-week intervention to assess adherence.&#xD;
&#xD;
      COVID-19 info&#xD;
&#xD;
      There will be in-person recruitment and data collection, but all in-person interactions will&#xD;
      be put on hold until social distancing requirements have been lifted.&#xD;
&#xD;
      DATA ANALYSIS&#xD;
&#xD;
      Study data will be managed using Research Electronic Data Capture, a secure, web-based&#xD;
      software platform, hosted at the University of Alberta. Group demographics were compared with&#xD;
      t-test, chi-square and Mann-Whitney U as appropriate. The scores of the four questionnaires&#xD;
      will be analyzed with the Wilcoxon Signed-Rank test for within group comparison and the&#xD;
      Mann-Whitney U test for between group comparisons. The Spearman correlation test will be used&#xD;
      in the mindfulness group for correlation between the mindfulness scores and the stress,&#xD;
      anxiety and depression scores. 2-tailed p-values will be used.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Not yet recruiting</overall_status>
  <start_date type="Anticipated">September 1, 2023</start_date>
  <completion_date type="Anticipated">June 2024</completion_date>
  <primary_completion_date type="Anticipated">December 2023</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Supportive Care</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in stress symptoms</measure>
    <time_frame>Change from recruitment to 4 weeks after</time_frame>
    <description>using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). A high score means a higher level of stress symptoms. Minimum score is 0. Maximum score is 21.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in anxiety symptoms</measure>
    <time_frame>Change from recruitment to 4 weeks after</time_frame>
    <description>using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Minimum score is 0. Maximum score is 21.&#xD;
And using the Pregnancy Related Anxiety Scale. Scores for individual question range from 1 (Not at all) to 5 (Very much). Minimum score is 10. Maximum score is 50.&#xD;
A high score in both scales means a high level of anxiety symptoms.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in depression symptoms</measure>
    <time_frame>Change from recruitment to 4 weeks after</time_frame>
    <description>using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). A high score means a higher level of depression symptoms. Minimum score is 0. Maximum score is 21.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in mindful awareness</measure>
    <time_frame>Change from recruitment to 4 weeks after</time_frame>
    <description>using the Mindfulness Attention Awareness Scale. Scores for individual question range from 1 (Almost Never) to 6 (Almost Always). Minimum score is 15. Maximum score is 90.&#xD;
And using Toronto Mindfulness Scale. Scores for individual question range from 0 (Not at all) to 4 (Very much). This scale has 2 subscales. Minimum score is 0. Maximum score is 24 for the first subscale and 28 for the second subscale.&#xD;
A high score in both scales (and subscales)means a high mindful awareness level.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Mindfulness practice</measure>
    <time_frame>4 weeks</time_frame>
    <description>Duration of mindfulness practice</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Gestational age</measure>
    <time_frame>variable (less than 20 weeks from recruitment)</time_frame>
    <description>Gestational age of the newborn (in weeks and days) at the time of delivery</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">60</enrollment>
  <condition>Stress</condition>
  <condition>Anxiety</condition>
  <condition>Depression</condition>
  <condition>Mindfulness</condition>
  <arm_group>
    <arm_group_label>Mindfulness Intervention</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Mindfulness training</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Control</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Standard of Care</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Mindfulness</intervention_name>
    <description>Mindfulness training</description>
    <arm_group_label>Mindfulness Intervention</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Pregnant mothers admitted to the antepartum ward at the Lois Hole Hospital for risk of&#xD;
             preterm delivery (&lt; 34 weeks GA) are eligible for the study.&#xD;
&#xD;
          -  if they speak, read and write English,&#xD;
&#xD;
          -  if their inpatient stay is anticipated to be at least 4 weeks following recruitment&#xD;
&#xD;
          -  if they are willing and able to attend the mindfulness sessions.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  if they are experiencing current mental illness issues&#xD;
&#xD;
          -  if they are experiencing current or prior substance abuse&#xD;
      </textblock>
    </criteria>
    <gender>Female</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Marc-Antoine Landry, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Alberta</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Marc-Antoine Landry, MD</last_name>
    <phone>780-613-5861</phone>
    <email>marc-antoine.landry@ualberta.ca</email>
  </overall_contact>
  <verification_date>December 2022</verification_date>
  <study_first_submitted>July 28, 2020</study_first_submitted>
  <study_first_submitted_qc>July 30, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">August 3, 2020</study_first_posted>
  <last_update_submitted>December 16, 2022</last_update_submitted>
  <last_update_submitted_qc>December 16, 2022</last_update_submitted_qc>
  <last_update_posted type="Actual">December 20, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Mindfulness</keyword>
  <keyword>Antepartum</keyword>
  <keyword>High Risk Pregnancy</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Depression</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04496115
org study id: Pro00102522
nct id: NCT04496115
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Anxiety, depression and stress are common during pregnancy. These have been found to
      negatively impact mother and child outcomes. When anxiety, depression, and stress are present
      in pregnant women, it is therefore important to manage them to improve the outcome of the
      mother and her child.

      Although pregnancy itself has been shown to increase anxiety, depression and stress, these
      issues are further elevated in high-risk pregnancy groups. Mothers at risk of preterm
      delivery (less than 37 weeks gestational age), have been found to have higher rates of
      depression, anxiety and stress compared to uncomplicated term pregnancies. In addition,
      anxiety, depression and stress symptoms themselves increase the risk for preterm delivery,
      creating a vicious cycle for this high-risk group.

      Mindfulness is a tool that has been during pregnancy to reduce depression, anxiety, and
      stress. Many studies have found mindfulness to be an appropriate management option in normal
      term pregnancies.

      To date, there have been no studies that have looked at Mindfulness as a tool for mothers
      admitted due to risk of preterm delivery. This study will explore the impact of teaching
      mindfulness skills to inpatient mothers at risk of preterm delivery and studying its effects
      on maternal depression, anxiety, and stress.

      This study involves providing Mindfulness strategies during the mother's inpatient admission
      for the risk of preterm delivery for four consecutive weeks. Participants will be enrolled
      through informed consent. All participants will be given pre and post participation
      questionnaires to examine the impact of mindfulness on anxiety, depression and stress. The
      participants will also be encouraged to maintain a weekly mindfulness log. The results of
      this research may lead to future studies looking at the impact of mindfulness practice for
      high-risk pregnancies. This will also help open up the possibility of offering such courses
      for inpatient and outpatient high-risk pregnancies in the future.
BACKGROUND

      Anxiety and depression are two of the most common psychological symptoms that manifest in
      pregnant women. A recent systematic review found the prevalence of prenatal anxiety to be
      18.2% in the first trimester, 19.1% in the second trimester and 24.6% in the third trimester.
      A separate systematic review found rates of depression in the prenatal period to be 16.4%.
      These symptoms have been found to negatively impact maternal health as well as fetal and
      childhood development. It is therefore imperative that anxiety and depression be assessed in
      all pregnant mothers and to further implement interventions to improve outcomes for both the
      mother and fetus.

      Pregnant mothers with admission to an inpatient ward due to increased risk for preterm
      delivery have been found to experience elevated levels of anxiety, depression and stress
      compared to term pregnancies. Furthermore, increased anxiety and depression have been linked
      to the risk of preterm labor, creating a vicious cycle. A 2017 study that assessed anxiety
      and depression in a population of pregnant mothers at risk of preterm labor found 35.1% to
      have anxiety and 69.8% having depressive symptoms. By managing the psychological symptoms
      experienced in this cohort of pregnant mothers, the rationale is that the risks associated
      with them might be reduced, providing improved maternal and fetal outcomes.

      There have been several studies that have assessed the benefits of mindfulness as a tool in
      reducing anxiety, stress and depression specifically in pregnancy. A 2016 meta-analysis found
      that mindfulness-based interventions are effective at reducing pregnancy related depression,
      stress, and anxiety. A randomized controlled trial assessed pregnant women with high levels
      of stress and anxiety after six weeks of mindfulness practice with results demonstrating
      larger decreases in pregnancy specific anxiety as compared to the control group.

      Mindfulness has been implemented as an intervention prior to delivery with encouraging
      results. It has also been used in the post-partum period in environments such as the Neonatal
      Intensive Care Unit (NICU), where parental anxiety, depression and stress are elevated due to
      admission of their newborn after birth. Recent studies have shown that when mindfulness is
      used in the NICU environment, it assists with reduction of depressive, anxiety and trauma
      symptoms as well as improving maternal sleep Mindfulness also helped mothers deal with acute
      stressors more appropriately and promoted awareness and reduced stress related emotions.

      To date, there have been no studies that have looked at Mindfulness as a tool for mothers
      admitted due to risk of preterm delivery. The study being proposed here, would assess the
      impact of mindfulness in the prenatal period, in a group of mothers who are experiencing
      elevated levels of depression, anxiety and stress due to the risk of preterm delivery.

      HYPOTHESIS

      The investigators hypothesize that pregnant women will experience less depression, anxiety
      and stress with mindfulness and will increase their mindful awareness.

      MATERIALS AND METHODS

      This study is a non blinded, prospective randomized controlled trial.

      Following recruitment of participants, randomization into either the mindfulness group or the
      control group will occur.

      Mindfulness Group (MG)

      Participants within the mindfulness group will be instructed by a mindfulness
      practitioner/coach once a week for four weeks in one-on-one sessions. Weekly journals will be
      provided to measure adherence. Optional mindfulness audio files may be used to continue
      mindfulness practice in between guided mindfulness sessions.

      Control Group (CG)

      Participants within the control group will receive care as usual without any additional
      mindfulness techniques provided during the four-week period.

      Instruments

        -  General Demographic Form: A researcher created maternal demographic data form (age,
           educational level, number of gestations, parity, prior experience with mindfulness,
           history of depression and anxiety) to be completed by the mother at enrolment.

        -  Depression, Anxiety and Stress Scale: 21 item Depression, Anxiety, Stress Scale to be
           completed by the mother at enrolment and at the end of the four weeks.

        -  Pregnancy Related Anxiety Scale: 10 item Pregnancy Related Anxiety Scale to be completed
           by the mother at enrolment and at the end of the four weeks.

        -  Mindfulness Scales: 15 item Mindfulness Attention Awareness Scale and the 13 item
           Toronto Mindfulness Scale will be completed by the mother at enrolment and at the end of
           the four weeks.

        -  Mindfulness Weekly Journal: Document recording the duration of mindfulness practice
           every day during the four-week intervention to assess adherence.

      COVID-19 info

      There will be in-person recruitment and data collection, but all in-person interactions will
      be put on hold until social distancing requirements have been lifted.

      DATA ANALYSIS

      Study data will be managed using Research Electronic Data Capture, a secure, web-based
      software platform, hosted at the University of Alberta. Group demographics were compared with
      t-test, chi-square and Mann-Whitney U as appropriate. The scores of the four questionnaires
      will be analyzed with the Wilcoxon Signed-Rank test for within group comparison and the
      Mann-Whitney U test for between group comparisons. The Spearman correlation test will be used
      in the mindfulness group for correlation between the mindfulness scores and the stress,
      anxiety and depression scores. 2-tailed p-values will be used.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Supportive Care
masking: None (Open Label)
measure: Change in stress symptoms
time frame: Change from recruitment to 4 weeks after
description: using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). A high score means a higher level of stress symptoms. Minimum score is 0. Maximum score is 21.
measure: Change in anxiety symptoms
time frame: Change from recruitment to 4 weeks after
description: using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Minimum score is 0. Maximum score is 21.
And using the Pregnancy Related Anxiety Scale. Scores for individual question range from 1 (Not at all) to 5 (Very much). Minimum score is 10. Maximum score is 50.
A high score in both scales means a high level of anxiety symptoms.
measure: Change in depression symptoms
time frame: Change from recruitment to 4 weeks after
description: using the Depression Anxiety Stress Scale -21. Scores for individual question range from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). A high score means a higher level of depression symptoms. Minimum score is 0. Maximum score is 21.
measure: Change in mindful awareness
time frame: Change from recruitment to 4 weeks after
description: using the Mindfulness Attention Awareness Scale. Scores for individual question range from 1 (Almost Never) to 6 (Almost Always). Minimum score is 15. Maximum score is 90.
And using Toronto Mindfulness Scale. Scores for individual question range from 0 (Not at all) to 4 (Very much). This scale has 2 subscales. Minimum score is 0. Maximum score is 24 for the first subscale and 28 for the second subscale.
A high score in both scales (and subscales)means a high mindful awareness level.
measure: Mindfulness practice
time frame: 4 weeks
description: Duration of mindfulness practice
measure: Gestational age
time frame: variable (less than 20 weeks from recruitment)
description: Gestational age of the newborn (in weeks and days) at the time of delivery
arm group label: Mindfulness Intervention
arm group type: Experimental
description: Mindfulness training
arm group label: Control
arm group type: No Intervention
description: Standard of Care
intervention type: Behavioral
intervention name: Mindfulness
description: Mindfulness training
arm group label: Mindfulness Intervention
criteria: 
gender: Female
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Marc-Antoine Landry, MD
role: Principal Investigator
affiliation: University of Alberta
last name: Marc-Antoine Landry, MD
phone: 780-613-5861
email: marc-antoine.landry@ualberta.ca
responsible party type: Sponsor
mesh term: Depression
sharing ipd: No