Mental health conditions are now the leading cause of death during pregnancy and the
postpartum period (the perinatal 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 professionals
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 care settings address mental health
concerns among their patients.
Despite the benefits of these programs, investigators have learned that none of them is
sufficient to address mental health challenges on their own.
In response, investigators will conduct this study to examine what happens when
healthcare- and community-based teams' partner to deliver care for perinatal mood and
anxiety disorders.
One of the aims of the study is to test the effectiveness of the Healthcare-Community
Partnership between PSI and UMass Chan. Thirty-two perinatal care settings (e.g.,
clinics, practices, and health centers providing care to pregnant and postpartum
individuals) 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, perinatal care settings will integrate screening, assessment,
and treatment of mood and anxiety disorders into prenatal and postpartum care. The
Healthcare-Community Partnership approach will include the health system-focused approach
and PSI Peer Support. Thus, all patients getting perinatal care at the 32 clinical sites
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 perinatal care settings
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 perinatal care
professionals and peer mentors who are delivering the approaches.
Another aim is to prepare to spread what the study team learns to other perinatal care
settings. 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, perinatal care professionals, 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 is 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 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 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.
