Non-Specialist Providers May Be Effective in Perinatal Mental Health Care

Daisy Singla, PhD

A new study suggested that non-specialist providers may be effective at preventing and treating symptoms related to perinatal depression and anxiety.

These providers may include lay counselors, nurses, midwives, and teachers with no formal training in counseling interventions.

“Counseling interventions, notably cognitive, behavioral, and interpersonal therapies, are widely effective in preventing and treating major depression and anxiety disorders in perinatal women,” the study investigators wrote.

“Although the US Preventive Services Task Force has endorsed counseling interventions for women at risk of perinatal mood disorders, fewer than 20% of women with perinatal depression have access to these interventions,” they continued.

Led by Daisy Singla, PhD, Department of Psychiatry, Sinai Health, Department of Psychiatry, Toronto, Canada, the investigative team conducted a systematic review of 46 trials (18,321 participants) and meta-analysis of 44 trials (18,101 participants).

Many of these counseling interventions were implemented in Australia, the UK, and the United States (in addition to 9 other high-income countries) and demonstrated great heterogeneity. Some interventions were conducted in person while others were done so by telephone, or combined. Only 2 interventions were delivered online.

Any trials that used interventions with specialists as the active control group were excluded from the study.

Non-Specialist Interventions

Analyses were conducted independently by 4 researchers, and 2 rated the quality of the included studies. The investigators used random-effects meta-analysis to estimate the benefits of the intervention.

Effectiveness was thus determined according to primary and secondary outcome data of depression, anxiety, or both.

The population among all trials included adult women between 18-45 years of age; however, 9 trials also included adolescents as young as 14 years.

Singla and her team found that 65% of counseling interventions were provided by nurses and midwives and lasted a mean of 11.2 weeks (95% CI, 6.4-16.0 weeks). As many as 67.4% of these interventions were conducted face-to-face.

When compared with the trial controls (no counseling), counseling interventions were associated with lower depressive symptoms (standardized mean difference [SMD], 0.24 [95% CI, 0.14-0.34]; 42 trials; I² = 81%) and anxiety scores (SMD, 0.30 [95% CI, 0.11-0.50]; 11 trials; I² = 80%).

Treatment interventions were also reported to be effective for depressive symptoms (SMD, 0.38 [95% CI, 0.17-0.59]; 15 trials; I² = 69%) and anxiety (SMD, 0.34 [95% CI, 0.09-0.58]; 6 trials; I² = 71%).

Nevertheless, the investigators acknowledged that information was scarce regarding implementation processes, such as supervision, fidelity, and participant sociodemographic characteristics. Furthermore, the high heterogeneity among trials was considered a limitation.

“We highlight that non-specialist providers can be trained to fulfill an important gap in the provision of effective psychological interventions for both depression and anxiety treatments," Singla and colleagues wrote.

They also noted that observed data suggested that nurses and midwives were considered to be the preferred non-specialist providers to deliver counseling for perinatal interventions.

“In sum, this study synthesizes a compelling evidence base that suggests that non-specialist providers effectively deliver preventive and treatment interventions to manage perinatal depression and anxiety symptoms in high-income countries.

Thus, this strategy may help close the gap in mental health care through increased access to evidence-based counseling interventions for this patient population.

The study, “Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries,” was published online in JAMA Psychiatry.