Scaling Up Maternal Mental healthcare by Increasing access to Treatment
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Funding: Patient Centered Outcomes Research Institute (PCORI)  

Principal Investigators: 

  • Daisy Radha Singla, PhD, Sinai Health, University of Toronto (Study & Site Principal Investigator)
  • Samantha Meltzer-Brody, MD, MPH, University of North Carolina (Co-Principal & Site Principal Investigator) 
  • Richard Silver, MD, NorthShore University HealthSystem (Site Principal Investigator)
  • Cindy-Lee Dennis, PhD, St. Michael's Hospital University of Toronto (Site Principal Investigator)
  • Simone Vigod, MD, Women's College Hospital, University of Toronto

Harvard Co-Investigators (other Investigators can be found here): 

  • Vikram Patel, MBBS, PhD, Harvard Medical School
  • John Naslund, PhD, Harvard Medical School


Depression and anxiety symptoms pose a significant burden and lead to high costs among mothers worldwide. Psychological treatments — also known as talk therapies, including behavioral, cognitive and interpersonal therapies — have a robust evidence base and are preferred by women and their families over pharmacological treatments. Unfortunately, as few as one in five women can access these effective treatments due to a dearth of available specialists and barriers including cost, transportation, and access. There is therefore a need for widely accessible, low-cost, and innovative psychological treatments for depression and anxiety during pregnancy and postpartum.



Scalable solutions are available and have been tested. Non-specialist providers — individuals without formal training in psychiatry or psychology including nurses, midwives, lay counsellors, and undergraduate students — have been successfully trained to deliver one brief psychological treatment known as behavioral activation (BA). BA is as effective as longer courses of cognitive behavioral therapy among perinatal populations. In addition, delivering talk therapies using telemedicine has been proven to be as effective as in-person treatments; similarly, non-specialists including nurses, peers, and lay counselors have been trained to deliver brief treatments and have shown to be as effective as specialists in reducing perinatal depressive and anxiety symptoms.




In a noninferiority randomized controlled trial, the project team seeks to determine how to optimize limited resources. Specifically, the team will test whether non-specialist providers — in this case, nurses — can deliver BA as effectively as specialist psychiatrists, psychologists, and social workers. In addition, the researchers will test whether telemedicine is as effective as in-person treatment. Finally, the team will study relevant barriers and facilitators related to the program delivery, long-term sustainability, and determining for whom these strategies work best.



The study will take place over the course of five years across Toronto, Ontario; Chapel Hill, North Carolina; and Chicago, Illinois — cities with large, ethnically diverse, urban and rural populations. Examining these innovative strategies within real-world settings will allow the researchers to inform existing healthcare services and potentially increase access to talk therapies. In doing so, more mothers and their children may benefit from access to effective treatments and suffer less from the longstanding impact of depression and anxiety.