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Evaluation ViewAttendees 5

Spotlight Research Presentations

Health Care System / Public Policy

Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT): Findings from a large, multi-site psychotherapy trial for perinatal populations

Spotlight Research 5 - Scaling up Maternal Mental Healthcare by Increasing Access to Treatment (SUMMIT): findings from a Large, Multi-site Psychotherapy Trial for Perinatal Populations

Friday, November 15, 2024
2:30 PM – 3:30 PM EST
Location: Congress B, Fourth Floor, Loews Hotel
Earn 1 Credit
Keywords: Clinical Trial, Behavioral Activation, Perinatal
Recommended Readings: Singla, D. R., Lawson, A., Kohrt, B. A., Jung, J. W., Meng, Z., Ratjen, C., Zahedi, N., Dennis, C. L., & Patel, V. (2021). Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis. JAMA psychiatry, 78(5), 498–509.,   Dimidjian, Sona, Sherryl H. Goodman, Nancy E. Sherwood, Gregory E. Simon, Evette Ludman, Robert Gallop, Stacy Shaw Welch, Jennifer M. Boggs, Christina A. Metcalf, Sam Hubley, J. David Powers, and Arne Beck. 2017. “A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women.” Journal of Consulting and Clinical Psychology 85(1):26.,   Patel, Vikram, Benedict Weobong, Helen A. Weiss, Arpita Anand, Bhargav Bhat, Basavraj Katti, et al. 2017. “The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: A randomised controlled trial.” Lancet 389(10065):176–85.,   ,  

    Chair(s)

  • Dorian A. Lamis, ABPP, Ph.D.

    Associate Professor
    Emory University School of Medicine
    Atlanta, Georgia, United States

    • Panelist(s)

  • Daisy R. Singla, Ph.D.

    Senior Scientist, Associate Professor
    University of Toronto; Center of Addiction and Mental Health, Lunenfeld Tanenbaumn Research Institute
    Toronto, Ontario, Canada

Access to brief psychological treatments remains limited, despite the demonstrated effectiveness of non-specialist providers (NSPs; individuals without formal mental health training), the rise of telemedicine and their preference over medications among perinatal populations. This presentation showcases results from healthcare by treatment (SUMMIT)—the largest psychotherapy trial for perinatal populations worldwide. SUMMIT is a pragmatic, non-inferiority trial that compares provider type (specialist vs. non-specialist) and delivery mode (telemedicine vs. in-person) of a brief, 8-session behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms.
Adult, pregnant, and postpartum women (N=1230) with depressive (EPDS≥10) symptoms were recruited across healthcare settings in Toronto, Chicago, and Chapel Hill and randomized to receive BA by either a trained NSP (nurse, midwife or doula) or specialist (psychiatrist, psychologist or social worker), via telemedicine or in-person. The primary outcome was depressive (EPDS) symptoms at 3-months post-randomization. Secondary outcomes included anxiety (GAD-7) symptoms, treatment dosage, and client satisfaction scores (CSQ-8). Randomization began in January 2020 and 3-month data analysis will be completed by April 2024.
On average, participants were 33.27 years (SD=4.95) and either pregnant (49.76%) or postpartum (50.24%). Most were partnered (85.53%), primiparous (54.23%%) and almost half (49.76%) were Black, Indigenous or Persons of Colour. At baseline, participants reported moderate symptoms of depression (EPDS=15.73, SD=3.91) and anxiety (GAD=11.78, SD=4.91). Participants attended 6.20 (SD=2.77) treatment sessions and reported high satisfaction (CSQ=3.42, SD=0.63). We will present: (1) primary results comparing NSPs vs. specialists and telemedicine vs. in-person; (2) culturally-sensitive and measurement-based training and supervision models; and (3) process data that examined barriers and facilitators from a multistakeholder perspective. The results of this landmark trial will answer key questions about how to deliver and scale patient-centered psychotherapy in pragmatic settings.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Explain the rationale for task sharing and the use of telemedicine in mental healthcare.
  2. Describe methods to assess treatment provider competence and how competence can impact patient outcomes.
  3. Summarize barriers and facilitators to treatment delivery from a multistakeholder perspective.
  4. List best practices (regarding training, supervision, and treatment delivery) to ensure quality, culturally sensitive care.
  5. Discuss brief structured psychotherapies delivered by NSPs and via telemedicine can help reduce barriers to mental healthcare.