A brief, manualized psychotherapy provided by trained and supervised nonspecialists was just as effective at helping perinatal women resolve their depression and anxiety as the same care delivered by mental health professionals in person, according to a study published in Nature Medicine.
“One in five women experience depression or anxiety during the perinatal period (pregnancy up to the year following childbirth). Treatment is essential, given the negative, long-term, and intergenerational impact on maternal and child developmental outcomes,” wrote Daisy R. Singla, Ph.D., of the University of Toronto, and colleagues. “However, access is limited, with barriers including cost, stigma, and the inequitable distribution of mental health professionals. As a result, only 10% of affected perinatal patients in high-income countries receive psychotherapy.”
Singla and colleagues recruited 1,230 racially diverse pregnant or postpartum women from five sites across North America from January 2020 to October 2023. All participants scored 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS), indicating at least minor depression; the average score at baseline was 16, indicating moderate depression.
The participants each received six to eight weekly, manualized behavioral activation (BA) sessions; however, they were randomized to receive care either from trained, nonspecialist health care providers, such as nurses or midwives, via telehealth (472) or in person (145); or from mental health professionals via telehealth (469) or in person (144). Participants’ depressive and anxiety symptoms were assessed three months post-randomization with the EPDS and Generalized Anxiety Disorder-7 (GAD-7), respectively.
After three months, EPDS scores dropped by an average of seven points, regardless of type of provider or delivery. A change of four points on the EPDS is generally considered to represent a real and clinically meaningful difference in depression symptoms. Similarly, participants’ GAD-7 scores dropped by an average of six points (from a baseline average of 12), regardless of specialist type or delivery.
“The key to this success was the rigorous training and structured supervision throughout the study that was provided by experienced mental health professionals, who in this case had five years of experience, at minimum,” study co-author Samantha Meltzer-Brody, M.D., M.P.H., director of the University of North Carolina Center for Women’s Mood Disorders and executive dean at UNC School of Medicine, told Psychiatric News Alert. She added that one mental health professional can provide training and supervision to many nurses, doulas, and midwives. “This structure allows us to markedly expand the reach of perinatal mental health care in a powerful way.”
For related information, see the Psychiatric News article “Perinatal Treatment Requires Careful Risks, Benefit Consideration.”
(Image: Getty Images/iStock/SolStock)
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