Nurses, midwives can deliver effective therapy to pregnant and postpartum individuals: Study

Nurses, midwives and doulas can be just as effective as psychologists and psychiatrists when it comes to providing talk therapy to pregnant and postpartum individuals, according to a study involving researchers at Sinai Health and the University of Toronto’s Temerty Faculty of Medicine.

In a paper published in Nature Medicine, the team shared results from the Scaling Up Maternal Mental health care by Increasing access to Treatment (SUMMIT) trial, which sought to investigate if talk therapy can be effectively delivered by non-mental-health specialists and telemedicine.

They found that patients receiving up to eight treatment sessions reported significant improvement in symptoms of depression and anxiety, regardless of the type of treatment provider. The trial also found that online therapy was equally beneficial as in-person sessions.

The study reveals promising strategies to expand mental health supports and treatment for pregnant and postpartum people – approximately one in five of whom experience depression and anxiety, with less than 10 per cent receiving proper treatment due to a shortage of specialist providers.

“Talk therapy is effective but largely inaccessible. As our health systems grapple with a shortage of specialists and the rising costs of care, many pregnant and post-partum individuals suffer in silence,” said SUMMIT’s lead principal investigator Daisy Singla, a clinician-scientist at the Lunenfeld-Tanenbaum Research Institute (LTRI) at Sinai Health, senior scientist at the Centre for Addiction and Mental Health (CAMH) and an associate professor of psychiatry at Temerty Medicine. “Leveraging simple, pragmatic solutions of task-sharing and telemedicine has the potential to transform health care and improve access to essential mental health services.”

The psychotherapy trial, conducted by an interdisciplinary team of researchers in hospitals in Canada and the U.S., was among the largest in the world, involving 1,230 participants – nearly half of whom identified as racial minorities.

Participants received between six and eight weekly sessions of behavioral activation, a form of talk therapy that encourages engagement in meaningful activities aligned with personal values and has been shown to alleviate symptoms of depression and anxiety. 

Non-specialist providers received 20 to 25 hours of training on behaviour activation, including comprehensive instruction followed by supervision by mental health specialists and practical role-play exercises.

Following treatment, depression scores decreased from an average of 16 to 9 on the Edinburgh Postnatal Depression Scale, moving below the mild depression threshold of 10. Anxiety scores also fell from an average of 12 to 7 on the General Anxiety Disorder-7 scale, dropping below the clinical threshold of 8. These improvements occurred regardless of symptom severity before the treatment.

The results hold important implications for tackling depression and anxiety which, left untreated, can lead to severe consequences including maternal mortality, obstetrical complications and developmental problems in children.

“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,” said Richard Silver, chair of obstetrics and gynecology at the University of Chicago and site lead at Endeavor Health. “We need a safe and effective alternative treatment – talk therapy can help fill this gap.”

Most of the participants were recruited from Mount Sinai Hospital and others were recruited from Women’s College Hospital and St. Michael’s Hospital in Toronto, N.C. Women's Hospital and N.C. Neuroscience Hospital associated with the University of North Carolina in Chapel Hill, and Endeavor Health in Chicago. 

“Sinai Health has global reputation for perinatal health care, and we are grateful to our patients for being part of this research,” added Anne-Claude Gingras, director of LTRI, vice-president of research at Sinai Health and professor of molecular genetics at Temerty Medicine. “By demonstrating that trained non-specialists can deliver effective psychotherapy via telemedicine, it has the potential to reduce wait times for new parents struggling with mental health – and create a healthier future for their children.”

While research continues to determine whether the benefits of therapy delivered by non-specialists extend beyond three months, the team is also conducting a separate economic evaluation of these innovations within the Canadian and U.S. health-care systems.  

The research was supported by funding from the Patient-Centered Outcomes Research Institute.