Project Summary

Mental health conditions are now the leading cause of death during pregnancy and the postpartum period in the United States. One in five individuals who are pregnant or one year or less postpartum experience a mood or anxiety disorder. Despite these risks and the availability of evidence-based treatments for mood and anxiety disorders that occur during this time, most do not receive adequate treatment, if any at all. Gaps in care loom largest for individuals who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander. Thus, it is recommended that, in order to detect and address perinatal mood and anxiety disorders and related social inequities, screening be implemented in both healthcare and community settings. 

In response, the study team has developed approaches for addressing mood and anxiety disorders in both healthcare and community settings caring for pregnant and postpartum individuals. These programs have been adopted across the United States. The study’s community partner, Postpartum Support International (PSI), developed a national Peer Support Program that pairs individuals in need of support with a trained volunteer who has also experienced and fully recovered from a perinatal mood and anxiety disorder. The study’s research partner, UMass Chan, developed: 

  • A statewide program that offers support to patients and their medical providers to help them both address mental health during pregnancy and the postpartum period 
  • A national network of similar statewide programs to coordinate their efforts across the United States 
  • A comprehensive approach to help obstetric practices address mental health concerns among their patients 

Despite their progress, however, we have learned that none of these programs is sufficient to address mental health challenges on their own. 

In response, this study will examine what happens when healthcare- and community-based teams partner to deliver care for perinatal mood and anxiety disorders. The research has three aims. The first aim is to ensure that researchers engage with obstetric practices that are in greatest need. Researchers will use systematic methods to ensure they enroll the practices that serve patients in greatest need. 

The second aim is to test the effectiveness of the study’s partnership. Thirty-two obstetric practices across the United States will implement either a 1) health system-focused approach or 2) healthcare-community partnership approach to mental health. In the health system-focused approach, obstetric practices will integrate screening, assessment, and treatment of mood and anxiety disorders into prenatal and postpartum care. The Healthcare-Community Partnership approach will include that and PSI Peer Support. Thus, all patients getting obstetric care at the 32 practices will be offered the intervention. The study team will then look at patient charts to see if patients receive treatment and/or peer support and whether depression and anxiety symptoms improve. Researchers will also look at how well obstetric practices implement mental health care such as screening for depression, anxiety and social determinants of health; how often they identify patient needs; and how often they help patients find services to address those needs. The study team will also conduct surveys to look at racial bias and discrimination and burnout among the providers and peers who are delivering the approaches. 

The third aim is to prepare to spread what the study team learns to other obstetric practices. Having learned that even proven approaches sometimes need to be adapted to make them work in new settings with new groups of people, the study team will meet and talk with patients, providers and peer mentors who participate in the study to learn about their experiences. The study’s goal is to identify barriers and facilitators to using these approaches on a wider scale. 

The researcher-community partnership will be led by PSI, a community-based organization promoting mental health awareness, support, and treatment for pregnant and postpartum individuals worldwide, and UMass Chan Medical School. The team includes experts in their own lived experience, psychiatry, psychology, obstetrics, health equity, public health, advocacy, statistics, social work and health services research. The study hub will be at UMass Chan Medical School/PSI, with spokes at Downstate Health Sciences, University of Illinois and University of Colorado. The research team will also work with a network of programs across the United States that aim to increase access to mental health care for pregnant and postpartum individuals. 

To foster the growth of other researchers in this area, the study team will start a research mentorship program, focusing on individuals who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander. To amplify the voices of individuals central to the study, researchers will also partner with the study’s three advisory councils. The first council includes individuals with lived experience of mental health challenges and oppression. The second council includes the professionals and providers serving these populations. The third council involves members of teams working to increase access to mental health care. The study team will meet with the advisory councils every other month to discuss its approaches, study procedures and findings. 

The study is designed to answer the question, “Should we put our resources into a healthcare system approach or a healthcare-community partnership approach to mental health care?” The results of this study will help states and healthcare systems decide how to develop pathways for increasing access to mental health care for pregnant and postpartum women.

Project Information

Nancy Byatt, B.A., D.O., MBA, M.S.
Wendy Davis, Ph.D.
UMass Chan Medical School
$20,999,999 *

Key Dates

60 months *
November 2023
2023

*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.

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Last updated: November 28, 2023