Cognitive behavioral therapy can reduce stress, improve mood in pregnant women

Perinatal depression has soared during the pandemic. But many mental health professionals are overwhelmed and can't take on new clients.

Good news comes from a new Northwestern Medicine study finding paraprofessionals generated similar reductions in depressive symptoms as mental health professionals when delivering a group-based cognitive-behavioral therapy intervention.

The study findings are based on adding home health visits by trained lay health professionals to low-income pregnant women in a national project called Mothers & Babies. Mothers and Babies is an intervention using cognitive behavioral therapy that aims to reduce stress and improve mood among pregnant women and new mothers.

But since in-person home-visits are no longer possible during the pandemic, the program has recently pivoted to deliver the therapy virtually to pregnant women.

The response to Mothers and Babies delivered virtually has been incredibly positive from providers and clients. In this COVID environment, the need for mental health services is so great that providers and perinatal women who have stress in their lives are really valuing the ability to receive help remotely."

Darius Tandon, Study Lead Author and Associate Professor, Medical Social Sciences, Feinberg School of Medicine, Northwestern University

One in five women will develop postpartum depression, and both mother and child are adversely affected by postpartum depression.

"Preventing postpartum depression before it starts is critical in promoting the health and well-being of new mothers and their children," Tandon said.

"With appropriate training and supervision, lay health workers can do a good job," Tandon noted. "We don't have to rely on mental health professionals. We can go another route."

The paper will be published March 3 in Archives of Women's Mental Health.

This is the first study to the researchers' knowledge that has used lay home visitors to deliver a postpartum depression preventive intervention. Previous studies using lay health workers have focused on postpartum depression treatment.

Researchers say there is a growing interest in the notion of "task shifting", or moving care from more specialized (e.g., mental health professionals) to less specialized health workers.

"This study suggests that it is possible to 'task shift' the delivery of interventions aimed at preventing postpartum depression to paraprofessional home visitors, said Tandon, who is also co-director of the Center for Community Health at Feinberg. "This is notable given the lack of available mental health professionals in many communities, as well as stigma associated with seeing 'formal' mental health providers."

The use of paraprofessional home visitors – rather than costlier mental health professionals — also may minimize cost associated with delivering interventions, he noted.​