Pregnant and postpartum patients deal with specific depression and anxiety symptoms, which when left untreated, can lead to pregnancy complications, fetal development issues, and even fetal loss or maternal death.
A Canadian-U.S. team recently came together to study the importance of task-sharing and telemedicine when it comes to addressing depression and anxiety in pregnant and postpartum patients.
Their findings are shared in Nature Medicine in a paper called “Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial.” The paper reports the results from the SUMMIT (Scaling Up Maternal Mental healthcare by Increasing access to Treatment) randomized trial.
Among the primary investigators are Richard Silver, MD, a maternal-fetal medicine physician and chair of obstetrics and gynecology at Endeavor Health, and Laura La Porte, LCSW, PMH-C, clinical research manager with the Perinatal Depression Program at Endeavor Health.
Part of the intent of the study was to determine the outcomes for patients when their mental health needs are addressed by non-specialist providers.
Dr. Silver said, “The SUMMIT trial was conducted on the platform of our long-standing (2003-25) Endeavor Perinatal Depression Program, which brings together a multidisciplinary team to screen and treat patients with depression, anxiety and trauma, both before and after delivery.”
The study
The SUMMIT study included 1,230 participants at hospitals across the Endeavor Health system, The Mount Sinai Hospital in New York City, Women’s College Hospital and St. Michael’s Hospital in Toronto, and the University of North Carolina at Chapel Hill’s N.C. Women’s Hospital and N.C. Neuroscience Hospital. Fifty percent of the participants identified themselves as racialized minorities.
All participants received 6-8 weekly sessions of talk therapy called Behavioral Activation, provided in person or via telemedicine. The sessions were conducted by either mental health specialists or doulas, midwives and nurses who were trained by the study personnel but had no prior mental health expertise. Behavioral Activation encourages people to engage in meaningful activities aligned with their values and has been shown to alleviate symptoms of depression and anxiety.
Dr. Silver noted the importance of choosing talk therapy instead of prescription medications for many people, most notably pregnant and postpartum women.
“Finding effective ways to treat these patients is critical — and specifically, ways that don’t involve medication, which some would rather avoid while pregnant or breastfeeding. We need a safe and effective alternative treatment,” Dr. Silver said. “Talk therapy can help fill this gap and can be delivered at scale using the SUMMIT protocol.”
Future initiatives
The SUMMIT trial demonstrated that nurses, midwives and doulas who are trained in talk therapy can ultimately deliver that treatment as effectively as psychologists and psychiatrists. These sessions do not replace therapy sessions with a trained specialist, especially for those with severe symptoms or for whom this approach is deemed inappropriate.
This same research team is studying the impact of this therapy on child development among the study participants and is also completing an economic evaluation to confirm that this approach can be cost-effective as well.
The next goal will be to conduct an implementation trial: taking the findings from SUMMIT and applying them as part of routine care throughout the Endeavor Health system (15,000 deliveries per year) as the new standard of mental healthcare in obstetrics.
La Porte said, "The SUMMIT trial underscores the power of task-sharing and telemedicine in closing the treatment gap for perinatal mental health. By equipping nurses, midwives and doulas with the skills to deliver Behavioral Activation, we can dramatically expand access to effective care. This model has the potential to transform how we support pregnant and postpartum patients, ensuring that mental health treatment is both accessible and integrated into routine obstetric care.”
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