talk therapy emerges as key mental health treatment for pregnant and postpartum women
5 minute read
mental health is a significant and common struggle for expectant and new mothers, with statistics in canada revealing that nearly one in every four pregnant and postpartum women report symptoms of depression and anxiety, yet fewer than 10 per cent receive proper treatment.
getty images
stay up to date on this topic
life as a new mom can turn your world upside-down. there’s the sleep deprivation, pressure to be a great parent (often with plenty of unsolicited advice from family and friends), along with a gigantic shift from self-care to all-encompassing baby care. with many women leaving the workforce for parental leave, there’s also an identity loss—you’re no longer on the clock with work and social obligations, so there can be feelings of isolation and loneliness.
“one thing that i hear often from patients is they don’t know what’s gotten into them. they can feel really high levels of anxiety and they just don’t feel like themselves anymore,” says clinical psychologist dr. daisy singla who specializes in maternal mental health. she is a senior scientist with the institute for mental health policy research at the centre for addiction and mental health in toronto and associate professor in psychiatry at the university of toronto.
mental health is a significant and common struggle for expectant and new mothers, with statistics in canada revealing that nearly one in every four pregnant and postpartum women report symptoms of depression and anxiety, yet fewer than 10 per cent receive proper treatment.
“these symptoms can manifest differently in different people,” she says. “but what we hear women saying is that they experience really, really low mood.” more than the episodic “baby blues” that can happen, these mental health symptoms last longer and can be extremely debilitating.
she says the issue of poor mental health not only affects the mom, but the child, the partner and family, so there’s a ripple effect. more broadly, untreated maternal mental health costs are estimated at a loss of roughly $2 billion per year in our canadian market because we have a loss of economic productivity. in addition, “with reduced resilience in our healthcare, we have increased use of our healthcare services particularly in this population when these conditions are left untreated.”
advertisement
talk therapy as a key solution for pregnant and postpartum women
dr. singla is working to change the landscape for these women with answers about the most effective treatment and promoting access to care. she is the lead principal investigator of the summit trial (scaling up maternal mental healthcare by increasing access to treatment), one of the world’s largest psychotherapy trials, that recently published results of its mental health research in the journal nature medicine. the research team is proposing tangible solutions to address the gap in perinatal mental healthcare—solutions that dr. singla hopes to see put into practice.
psychotherapy, often called talk therapy, is “arguably the most effective intervention in mental healthcare,” she points out. and yet the majority of people who need access to these therapies can’t access them, whether it’s because of cost of providers, lack of awareness and education of services, remote location, or simply not wanting to talk about these issues. there is still shame and guilt about living with mental health struggles. moms typically are expected to be filled with joy about the gift of a baby.
“there are so many biological changes that happen, including in the brain with hormones and the body with hormones. and this is psychologically and socially a very significant transition in the time of the person having the baby, but also the partner, and so many expectations about what to do.”
“one thing that i hear often from patients is they don’t know what’s gotten into them. they can feel really high levels of anxiety and they just don’t feel like themselves anymore,” says clinical psychologist dr. daisy singla who specializes in maternal mental health
supplied
the summit trial looked at 1,230 participants across canada and the u.s. to show how they responded to a series of talk therapy sessions. what is novel about the research is that it demonstrated that trained, non-mental health specialists such as nurses, midwives and doulas can deliver talk therapy as effectively as psychologists and psychiatrists. the study also confirmed that online therapy is as effective as in-person treatment, which validates telemedicine as a solution to address system barriers.
advertisement
the big win? participants reported significant improvement in symptoms of depression and anxiety, regardless of the treatment provider.
the median depression score on the edinburgh postnatal depression scale decreased from 16 to 9, falling below the clinical threshold that indicates depression (10).
the median anxiety score on the general anxiety disorder-7 scale dropped from 12 to 7, falling below the clinical threshold that indicates anxiety (8). symptom improvements were seen regardless of symptom severity prior to treatment.
“the good news is that we actually know that talk therapies are effective and really work,” says dr. singla. “this is built on hundreds of randomized control trials, rigorously conducted studies, and there’s no question now based on all the clinical and international guidelines that psychotherapy is effective. it’s recognized as the first line of treatment.”
the canadian network for mood and anxiety treatments (canmat), here in canada for example, publishes clinical practice guidelines for mood and anxiety disorders, providing clinical comprehensive guidance for the pregnancy and postpartum management of mood, anxiety and related disorders.
“talk therapy is recommended as the first line of treatment and specifically behavioural activation,” she says, explaining that the treatment is a shorter version of cognitive behavioural therapy. in this case, for the summit trial, therapy was provided in eight sessions that focused on identifying negative behaviours that led to negative thoughts, and then working to replace them with more positive ones and therefore have improved mood.
working to change behaviours that lead to negative thoughts
“a simple mantra would be, in order to feel differently, we need to do differently,” she says of encouraging women to be active physically and socially, and leaning into supportive networks of friends, family and community organizations.
advertisement
the study showed that task sharing and telemedicine will build capacity into the healthcare system where non-mental health professionals can provide the therapy. “you don’t need a specialist like me, a clinical psychologist, to implement these brief evidence-based talk therapies.” task sharing is training individuals who have no prior experience delivering mental health care. also, pregnant and postpartum women prefer receiving talk therapy virtually because it helps overcome some of those barriers that get in the way, like childcare, arranging transportation, and trying to accommodate a stringent schedule based on a specialist provider who may be downtown toronto, for example.
interesting to note as well in the summit trial, almost 50 per cent of participants identified as black, indigenous or persons of colour, which reflects the ethnic diversity of canada and is often missing in medical research, dr. singla adds. “there’s a misconception that certain folks should be getting certain treatments while others shouldn’t. and what we found is that through a culturally sensitive model and through the great training that non-specialists received, they really were able to offer a treatment that yielded high satisfaction, regardless of the patient’s ethnic and racial background.”
another important part to highlight is the interdisciplinary nature of the research team that included a range of clinicians, policymakers, community partners like the insurance payers, and people with lived experience.
“we were all sitting at the same table, ultimately informing not just the development of the study, but the implementation, and now the dissemination [of results],” she says. “i hope the findings really offer hope to new parents and their partners and their communities that there are solutions out there. we need to do better in terms of improving access to these robustly effective interventions.”
share story
