Depression and anxiety symptoms pose a significant burden and lead to high costs among mothers worldwide. Psychological treatments—also known as talk therapies, including behavioral, cognitive and interpersonal therapies—have a robust evidence base and are preferred by women and their families over pharmacological treatments.
Unfortunately, as few as one in five women can access these effective treatments due to a dearth of available specialists and barriers including cost, transportation, and access. There is therefore a need for widely accessible, low-cost, and innovative psychological treatments for depression and anxiety during pregnancy and postpartum.
Scalable solutions are available and have been tested. Nonspecialist providers—individuals without formal training in psychiatry or psychology including nurses, midwives, lay counsellors, and undergraduate students—have been successfully trained to deliver one brief psychological treatment known as behavioral activation (BA). BA is as effective as longer courses of cognitive behavioral therapy among perinatal populations. In addition, delivering talk therapies using telemedicine has been proven to be as effective as in-person treatments; similarly, nonspecialists including nurses, peers, and lay counselors have been trained to deliver brief treatments and have shown to be as effective as specialists in reducing perinatal depressive and anxiety symptoms.
In a noninferiority randomized controlled trial, the project team seeks to determine how to optimize limited resources. Specifically, the team will test whether nonspecialist providers—in this case, nurses—can deliver BA as effectively as specialist psychiatrists, psychologists, and social workers. In addition, the researchers will test whether telemedicine is as effective as in-person treatment. Finally, the team will study relevant barriers and facilitators related to the program delivery, long-term sustainability, and determining for whom these strategies work best.
The study will take place over the course of five years across Toronto, Canada; Chapel Hill, North Carolina; and Chicago, Illinois—cities with large, ethnically diverse, urban and rural populations. During the study, 1,368 pregnant or postpartum women will receive the brief BA treatment in one of four conditions: in person by a specialist, telemedicine by a specialist, in person by a nurse, or telemedicine by a nurse. Examining these innovative strategies within real-world settings will allow the researchers to inform existing healthcare services and potentially increase access to talk therapies. In doing so, more mothers and their children may benefit from access to effective treatments and suffer less from the longstanding impact of depression and anxiety.
This research will be patient centered, which means that a range of stakeholders including mothers with lived experience, patient advocacy groups, a range of clinicians (nurses, family physicians, pediatricians, obstetricians, psychologists, and psychiatrists), academics, and policy makers will collaborate to inform the study’s development, implementation, and dissemination. In sum, this research has the potential to increase the accessibility, scalability, and cost effectiveness of evidence-based psychological treatments to address the burden of perinatal depression and anxiety worldwide.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.