Depression and anxiety are extremely common during pregnancy and postpartum, which is also known as the perinatal period. Perinatal low-income women and women of color are even more likely to experience depression/anxiety than the general population in the perinatal period but are less likely to receive treatment. This can lead to poor outcomes and decreased quality of life. There is a serious need for healthcare payers and providers to offer behavioral health support to perinatal women experiencing depression/anxiety to help patients achieve better health and quality of life.
Maternity care management (MCM) programs can support high-risk perinatal women by screening for depression/anxiety and facilitating linkages to behavioral health providers. However, barriers such as difficulty finding a provider, lack of childcare, and long appointment wait times can limit women’s ability to obtain care in a timely manner. Other potential options exist for supporting the behavioral health care of perinatal women. For example, the addition of digital behavioral health (DBH) applications to existing MCM programs can be a low-cost and accessible way to provide symptom relief. More recently, DBH tools have combined human coaching (DBH+HC) into the application to increase user engagement through user–coach messaging, by sending educational information, and by providing content to the user that is specific to her needs and preferences. Even though both DBH and DBH+HC are promising options, more information is needed about which behavioral health supports have the best outcomes and meet individual patient needs and preferences.
The goal of this study is to compare the impact of (1) traditional MCM, (2) MCM with DBH support, and (3) MCM with DBH+HC support. We will enroll 900 perinatal women over the course of 2.5 years who have Medicaid insurance, are participating in the MCM program, and screen positive for depression and/or anxiety. The interventions will be delivered for approximately six months, and participants will be asked to complete study measures four times (when they enroll in the study and again at three, six, and nine months). Some participants will also be asked to participate in three telephone interviews to understand their experiences and satisfaction with the interventions.
Patient partners and other stakeholders have and will continue to contribute to all phases of our work. Our study team includes two stakeholder investigator consultants, an advisory board consisting of perinatal women and caregiver partners with experiences similar to those who will be enrolled in this study, community organizations, and others who are committed to improving care experiences for perinatal women experiencing depression/anxiety. In addition, we will work closely with our steering committee and will conduct three community engagement sessions to obtain stakeholder guidance on key aspects of the study.
*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.