1 - (SYM 72) Scaling up Maternal Mental Healthcare by Increasing Access to Treatment (SUMMIT): Task-sharing and Telemedicine to Improve Access to Mental Healthcare

Depression and anxiety impact up to 1 in 5 perinatal women worldwide, yet there is limited access to brief psychological treatments. The limited number of mental health providers and issues accessing in-person care are central barriers to treatment. Brief, evidence-based treatments delivered by non-specialist providers (NSPs; individuals without formal mental health training) receiving training and supervision from psychiatrists could help scale up access to treatment at the population health level. Likewise, treatment delivered via telemedicine could also improve access, but may not be an available option globally. 

This presentation showcases the primary results from the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT)—the largest psychotherapy trial for perinatal populations worldwide. SUMMIT is a pragmatic, non-inferiority trial comparing provider type (specialists vs. NSPs) and delivery mode (telemedicine vs. in-person) of a brief, 8-session behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. The trial was implemented in real-world healthcare settings in Toronto, Canada; Chapel Hill, NC; and Chicago, IL. NSPs were trained and supervised by mental health experts at each site.  The trial included adult, perinatal women (N=1230) with depressive (EPDS≥10) symptoms. Starting in January 2020, perinatal participants were randomized to receive BA by either a trained NSP (nurse, midwife or doula) or a specialist provider (psychiatrist, psychologist or social worker). They were randomized to receive the treatment 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). 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). Both trial methodology and findings will be discussed as a novel contribution to the science of behavioral health. This landmark trial demonstrates the potential for emerging approaches to improve access to quality mental healthcare.