Background: Pregnancy is not a time of joy for a staggering number of women. Women often struggle with stress, depression, and anxiety during pregnancy. Their maternal mental health distress may even persist a year after giving birth. According to the Centers for Disease Control and Prevention, depression rates among new mothers increased sevenfold from 2000 to 2015. Twice as many low-income African-American (AA) women experience maternal mental distress (e.g., stress, depression, anxiety)—a health disparity magnified by the current COVID-19 pandemic. Experiencing these concerns leads to negative effects on the mental and physical health for both a mother and her baby and changes the infant’s developing brain in worrisome ways. Yet, low-income AA women are less likely to receive screening or have available treatment during this critical period, especially in the District of Columbia (DC). Even when stress, anxiety, or depression are identified in women, many are not adequately treated because they face daily obstacles in their lives, and distrust healthcare providers or the system. Fortunately, we have the tools to effectively find and treat these women, and early intervention can help DC babies enjoy the strongest start at life.
Objectives: Our overall goal is to partner with former patients, mothers with experience giving birth in DC, and other members of low-income AA communities to develop and test different approaches to support behavioral wellness. By providing effective mental health screening and care, patients may overcome obstacles and achieve health equity. For the first of our two major aims, we will work to personalize plans that combine patient navigation and a culturally adapted cognitive-behavioral intervention for low-income AA pregnant women. This plan is designed to boost recruitment and retention within the healthcare system. For our second aim, our prospective randomized controlled study design will compare usual care with care guided by a patient navigator that includes culturally adapted cognitive-behavioral interventions and peer support. Women will choose the type of support that best fits their lifestyle, either virtual or in person. Our patient partners informed us that it is too difficult to get mental health care in DC, and that when that care is available, it ends too quickly. Participants will thus remain in the study for up to 12 months after delivery. Our study will also include women who do not yet meet criteria for being diagnosed with major depression or anxiety. Beginning early in pregnancy, we’ll track the health—including mental health—of mothers and will monitor how their newborns develop.
Methods: In four prenatal care centers that serve the largest number of AA women in DC, we will ask 1,000 low-income AA women to complete a brief questionnaire about their stress, anxiety, and depression when they arrive for prenatal care. We expect to find 700 women with moderate or severe stress, anxiety, or depression to participate in the study (350 women randomized in each study group condition: usual prenatal care or patient navigator and adapted cognitive behavioral therapy and peer support group, per patient preference). Women will remain in the study throughout pregnancy and until their baby is 1 year old. These women will answer questions at regular intervals about their health and well-being during pregnancy, as well as about their infants’ development and behavior during well-baby visits.
Patient Outcomes: Patient-/family-centered outcomes will include rates and levels of maternal stress, anxiety, and depression; what helps women become more resilient; health experiences and healthcare utilization; and infant outcomes, including newborn health, behavioral and developmental outcomes, and mother–baby attachment.
Partnerships: Our diverse team will include patients, community leaders, midwives and doctors who treat women during pregnancy and their infants after birth, psychologists, and advisers skilled at transforming health care to better meet patient’s unique needs, ensuring insurance covers it, and ramping up software so it can be used by more people nationwide.
*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.