Sonia Muliyil: Perinatal Mental Health Care Must Reach Women Before Crisis

Sonia Muliyil, Editor-in-Chief at The Lancet Obstetrics, Gynaecology and Women’s Health, shared on LinkedIn:

“Perinatal mental health care must reach women before crisis.

The October Editorial of The Lancet Obstetrics, Gynaecology, and Women’s Health reflects on the recent Lindsay Clancy case and the renewed public attention it has brought to postpartum psychosis, while stressing the importance of distinguishing this rare but severe condition from the much more common challenge of perinatal depression.

Perinatal depression is one of the most common mental-health challenges encountered during pregnancy and after birth. It affects a substantial number of people, yet only a minority receive evidence-based treatment.

This gap is often framed as a problem of individual resilience or motivation, which is not always the case.

The barriers are often structural: too few mental-health specialists, fragmented referral systems, transport and childcare difficulties, cost, geography, and the practical impossibility of attending regular appointments while caring for a newborn.

In other words, this is a systems problem.

That is why the SUMMIT trial from Daisy Singla and colleagues is so important. In this large, multicentre study, 1230 pregnant or postpartum adults with depressive symptoms received the same manualised behavioural-activation intervention.

The treatment was delivered in four different ways: by mental-health specialists or trained non-specialists, and through telemedicine or in-person care.

The primary findings showed that care delivered by non-specialists, and care delivered remotely, was no worse than specialist or in-person care at three months.

The prespecified 12-month analysis is equally encouraging: depressive and anxiety symptoms improved substantially across all groups, with no meaningful differences according to who delivered the intervention or how it was delivered.

These findings still need replication in other countries and health systems. But the economic results make the implementation case stronger.

Non-specialist delivery was more likely to be cost-effective than specialist delivery, and telemedicine more likely to be cost-effective than in-person care.

The right interpretation is not that specialists are unnecessary. It is that specialist expertise may be used more intelligently.

Specialists can train and supervise non-specialist providers, advise on difficult cases, manage complexity, and provide rapid escalation when risk changes.

This is task-sharing as a way of expanding capacity not lowering standards. Findings of this study suggest that we can widen the front door to care for perinatal depression through trained providers and telemedicine while preserving clear pathways to specialist and emergency services.”

Title: Perinatal mental health care must reach women before crisis

Author: The Lancet Obstetrics, Gynaecology, and Women’s Health

You can read the Full Article in The Lancet Obstetrics, Gynaecology, and Women’s Health.

Title: Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial

Authors: Daisy R. Singla, Richard K. Silver, Simone N. Vigod, Nour Schoueri-Mychasiw, J. Jo Kim, Laura M. La Porte, Paula Ravitz, Crystal E. Schiller, Andrea S. Lawson, Alex Kiss, Steven D. Hollon, Cindy-Lee Dennis, Tara S. Berenbaum, Holly A. Krohn, Jamie E. Gibori, Jaime Charlebois, David M. Clark, Ariel K. Dalfen, Wendy Davis, Bradley N. Gaynes, Molyn Leszcz, Sarah Rachel Katz, Kellie E. Murphy, John A. Naslund, Mae Lynn Reyes-Rodríguez, Alison M. Stuebe, Claire Zlobin, Benoit H. Mulsant, Vikram Patel, Samantha Meltzer-Brody

You can read the Full Article in Nature Medicine.

Title: Sustained clinical and cost-effectiveness of task-sharing and telemedicine for perinatal depression: a secondary analysis of a pragmatic, factorial, randomised controlled trial

Authors: Daisy R. Singla, Claire de Oliveira, Richard K. Silver, Sean M. Murphy, Samantha Meltzer-Brody, Margaret Jamieson, Alex Kiss, Sandeep Shelly, Andrea S. Lawson, Simone N. Vigod, Aditya Anand, Cindy-Lee Dennis, Laura M. La Porte, Paula Ravitz, Maya Zaidan, Tara S. Berenbaum, Jaime Charlebois, David M. Clark, Wendy Davis, Sona Dimidjian, Steven D. Hollon, Sarah Rachel Katz, Holly A. Krohn, Paul Kurdyak, Rina Lamba, Benoit H. Mulsant, Kellie E. Murphy, John A. Naslund, Danielle A. Ryan, Crystal E. Schiller, Alison M. Stuebe, Sharon Szmuilowicz, Claire Zlobin, Sarah Byford, Vikram Patel

You can read the Full Article in The Lancet Obstetrics, Gynaecology, and Women’s Health.

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