The stats are sobering. Roughly one out of five women wrestle with anxiety or depression in the year after childbirth – but only 10 percent of them receive adequate treatment.
But there appears to be hope. New research offers up compelling evidence that a combination of task-sharing and telemedicine can dramatically boost psychotherapy access for new mothers struggling with their mental health.
The Scaling Up Maternal Mental Healthcare by Increasing Access to Treatment (SUMMIT) trial, a five-year international research project, showed that non-specialists can deliver behavioral activation therapy just as effectively as mental health specialists. This persisted regardless of whether providers delivered that care via telemedicine or in person.
A Critical Need for Perinatal Mental Health Care
The mental health challenges new moms face can have with far-reaching consequences for those women and their newborns.
Effective, evidence-based psychotherapies – such as behavioral activation (BA) – have emerged as reliable first-line treatments. Proponents include heavyweights such as the UK National Institute for Health and Clinical Excellence and the United States Preventive Task Force.
But those treatments don’t do much good when so few women can access those treatments, whether it’s because of the high cost, social stigma, and a shortage of qualified mental health professionals.
“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. Leveraging simple, pragmatic solutions of task-sharing and telemedicine has the potential to transform health care and improve access to essential mental health services,” Daisy Singla, PhD, SUMMIT’s lead principal investigator and clinician scientist at the Lunenfeld-Tanenbaum Research Institute, said in a press release.
Study Design and Participants
In a bid to close that gap, SUMMIT trial researchers wanted to find out if non-specialist providers — such as nurses and midwives — could deliver BA therapy as successfully as mental health specialists.
The researchers also wanted to understand whether telemedicine could be a viable alternative to in-person therapy.
Conducted across three university-affiliated networks in Canada and the United States, the SUMMIT trial recruited 1,230 pregnant and postpartum participants between January 2020 and October 2023. Researchers sorted the participants into one of four randomly assigned treatment groups:
- Non-specialist telemedicine.
- Non-specialist in-person.
- Specialist telemedicine.
- And specialist in-person.
Each participant received weekly BA therapy sessions for three months.
The researchers gauged success (for the most part) by the reduction in anxiety and depression symptoms. But they also explored other relevant factors, such as treatment adherence, patient satisfaction, and the reliability of therapy delivery.
Are Non-Specialists and Telemedicine Equally Effective?
The SUMMIT trial’s results were a revelation.
- Non-specialists provided BA therapy just as well as the trained specialists. At three months post-randomization, EPDS scores showed no notable difference between the non-specialist and specialist groups.
- Similarly, telemedicine performed just as effectively as in-person therapy. The same pattern showed up in the anxiety cases.
- Crucially, the telemedicine patients attended significantly more sessions than those in the in-person group, suggesting that telemedicine breaks down historical treatment barriers, such as childcare and transportation issues.
- Additionally, therapy fidelity scores were higher among non-specialists than specialists. The authors suggest it could be because of the structured supervision and training the non-specialists receive.
Maternal Mental Health Care Implications
The SUMMIT trial’s findings could have widespread implications for maternal mental health care. Task-sharing allows non-specialists to benefit from psychotherapy training, expanding the mental health workforce. This approach increases access to care, especially in areas with a shortage of mental health professionals.
By illustrating that non-specialists can provide effective therapy, the research team behind the study argue that it justifies integrating these providers into more mainstream mental health services.
Telemedicine, which most participants preferred, also offered a scalable and patient-centered solution. With its ability to remove logistical barriers, telemedicine could become a mainstream alternative to standard perinatal psychotherapy.
That being said, the authors insist that policymakers must take action to ensure continued insurance reimbursement for telemedicine-based psychotherapy, especially in light of the movement toward scaling back telehealth coverage.
A Maternal Mental Health Care Model
The SUMMIT trial sheds light on a promising model for expanding mental health care access through task-sharing and telemedicine. The study’s results support a multi-step approach, where non-specialists provide the initial level of care via telemedicine, reserving specialist intervention for more severe cases. Additionally, the researchers argue that caregivers could expand this model beyond perinatal care to address a wide swath of mental health needs.
Given the prevalence of untreated perinatal mental health conditions (and their lasting consequences), the trial’s findings underscore the urgency of scalable solutions like this. Task-sharing and telemedicine aren’t just viable alternatives. They’re increasingly essential tools for closing the mental health treatment gap for new moms.
Further Reading
Mental Health Issues Threaten Maternal Mortality Numbers
