Nonspecialist-delivered perinatal mental health interventions effective

Nonspecialist providers appeared to be effective in the prevention and treatment of perinatal depressive and anxiety symptoms in high-income countries, according to results of a systematic review and meta-analysis published in JAMA Psychiatry.

“Nonspecialist providers (NSPs) — individuals with no formal training in mental health, such as lay counselors, nurses, midwives and teachers — have been trained to prevent and treat perinatal depressive and anxiety symptoms worldwide,” Daisy R. Singla, PhD, of the department of psychiatry and at the University of Toronto, and colleagues wrote. “In low- and middle-income countries, task sharing has wide currency, with NSPs considered an important human resource because they are widely available, are cost-effective and have regular, frequent contact with mothers.”

In high-income country contexts, NSPs have been successfully trained to treat perinatal mental health and may thus potentially be able to address the significant treatment gap for depression and anxiety, according to the researchers. In the current study, they sought to pinpoint the relevant implementation processes, as well as to evaluate the effectiveness of, counseling interventions delivered in high-income countries delivered by NSPs for perinatal depression and anxiety. They searched seven databases and included randomized clinical trials of counseling interventions that assessed depression or anxiety after intervention, which NSPs for adults delivered, and that targeted perinatal populations in a high-income country. They excluded self-help interventions that did not feature a provider component. Main outcomes and measures for implementation processes included the estimated frequencies represented by a total or percentage. They evaluated effectiveness using primary and secondary outcome data of depression, anxiety or both symptoms.

The systematic review included data of 18,321 participants and the meta-analysis of 18,101 participants. Data were available from 11 countries, with the majority from Australia, the U.K. and the U.S. Results showed nurses and midwives provided 65% of counseling interventions, which lasted a mean of 11.2 weeks and most of which were delivered face to face; two were delivered online. The researchers noted a lack of information related to important implementation processes, including supervision, fidelity and participant sociodemographic characteristics, in many articles. They observed an association between counseling interventions and lower depressive symptoms (standardized mean difference (SMD) = 0.24; 95% CI, 0.14-0.34) and anxiety scores (SMD = 0.3; 95% CI, 0.11-0.5) vs. controls. For both depressive symptoms and anxiety symptoms, treatment interventions appeared to be effective; however, among the trials included in the analysis, heterogeneity was high.

“This study synthesizes a compelling evidence base that suggests that NSPs effectively deliver preventive and treatment interventions to manage perinatal depression and anxiety symptoms in [high-income countries],” Singla and colleagues wrote. “The potential for such approaches is now widely accepted for mental health care globally and increasingly being advocated for in high-resource contexts. This delivery strategy may address one of the most significant gaps in mental health care (ie, access to evidence-based counseling interventions) to influence perinatal populations worldwide.”