(PS10-93) Bridges to Patient Satisfaction: Exploring the Role of Trauma and Ethnicity Among Perinatal Women Receiving Behavioural Activation

Background: Post-traumatic stress (PTS) symptoms are prevalent within the perinatal population, particularly among Black, Indigenous and People of Colour (BIPOC), and can have serious consequences for both mother and offspring (e.g., developmental impairments, poor maternal-infant relationship, comorbid depression/anxiety). Current guidelines suggest that trauma-focused psychotherapy treatments are amongst the most effective interventions for PTS and other comorbid symptoms. Patient satisfaction is an important process indicator in psychotherapy research and predictor of patient outcomes, in that individuals with higher satisfaction scores are more adherent to treatment, benefit more from treatment, and have a better quality of life than their less satisfied counterparts. Therefore, tailoring psychotherapy interventions to enhance patient satisfaction, particularly among vulnerable populations, may help to improve the efficacy and patient centeredness of treatments. Surprisingly, factors that impact patient satisfaction with psychotherapy remain largely unexplored in perinatal populations, and particularly for those suffering from PTS.

Objectives: The current study examines: 1) the relation between baseline PTS severity and patient satisfaction post-treatment among perinatal women receiving behavioural activation (BA) psychotherapy, and 2) barriers and facilitators to patient satisfaction, while taking into account differing levels of baseline PTS severity and ethnicity (White vs BIPOC).

Methods: This study is embedded within The Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial, a multi-site, pragmatic, non-inferiority trial. Perinatal women with depressive symptoms (EPDS≥10) were recruited across healthcare settings in Toronto, Chicago, and Chapel Hill, and randomized to receive BA psychotherapy via telemedicine or in-person, provided by specialists or non-specialists. In this mixed methods sub-study to the larger trial we will examine whether baseline PTS severity (PCL-6) predicts post-treatment patient satisfaction scores (CSQ-8) among perinatal participants (N = 1,230) receiving BA using linear regression. Multiple linear regression will be used to examine whether ethnicity, perceived social support, and perinatal period at baseline moderates the relationship between PTS severity and patient satisfaction. We will also qualitatively analyze responses to open-ended questions regarding facilitators and barriers to patient satisfaction with BA using content analysis. Differences and similarities in the frequency of responses will be compared among participants with high (≥17) and low (≤16) PTS scores, and across ethnically diverse groups (White [n=614], BIPOC [n=578]). A potential limitation of the study is a lack of a control condition.

Results: Analysis is ongoing and will be completed by April 2024. Implications: PTS and ethnicity may play an important role in shaping patient satisfaction. By accounting for these factors providers can make more informed decisions regarding psychotherapeutic options, thus enhancing the efficacy and personalization of pre-existing treatments such as BA.