A groundbreaking clinical trial published today in Nature Medicine demonstrates that nurses, midwives, and doulas, when trained in short-term behavioural activation therapy, can deliver evidence-based treatment for perinatal depression and anxiety with outcomes comparable to those achieved by psychiatrists and psychologists. Conducted under the SUMMIT (Scaling Up Maternal Mental health care by Increasing access to Treatment) initiative, this research offers a scalable solution to address the pervasive access barriers to psychotherapy in Canada and the United States.
Led by Dr. Daisy Singla, Psychologist-Scientist at the Centre for Addiction and Mental Health (CAMH) and Mount Sinai Hospital, the study underscores the prevalence of perinatal mental health challenges, affecting approximately 20% of pregnant and postpartum women across North America. The trial enrolled 1,230 participants across Toronto institutions—Mount Sinai Hospital, Women’s College Hospital, and St. Michael’s Hospital—and U.S. sites at the University of North Carolina and Endeavor Health, randomizing them to receive eight sessions of behavioural activation therapy. This modality, recognized within clinical guidelines for its efficacy in reframing negative cognitions into actionable positives, was delivered by either mental health specialists or non-specialist providers trained for over 20 hours, via in-person or telemedicine channels.
Results, assessed three months post-intervention, revealed equivalent reductions in depressive and anxiety symptomology across provider types and delivery methods. This parity validates the potential of task-shifting—delegating specialized interventions to non-traditional clinicians—to enhance mental healthcare capacity. “Expanding the cadre of providers capable of delivering evidence-based psychotherapy addresses critical gaps in availability and affordability,” Dr. Singla stated, noting that current systemic constraints, such as limited specialist availability and out-of-pocket costs, render such care “widely inaccessible.”
The findings also affirm telemedicine’s equivalence to in-person delivery, mitigating logistical barriers such as childcare and transportation—persistent challenges for new parents. “This dual-modality efficacy broadens the reach of perinatal mental health support, aligning with patient-centered care principles,” Dr. Singla added.
Participants, recruited between January 2020 and October 2023, included Andrea Fagundez, a 38-year-old Torontonian who entered the trial two months postpartum in March 2022. Facing anxiety during pregnancy and subsequent postpartum depression exacerbated by breastfeeding difficulties, Fagundez received virtual therapy from a psychiatrist. The intervention equipped her with cognitive reframing tools, enabling her to view breast pump use as a constructive contribution to her daughter’s care. “The structured approach provided tangible strategies I continue to apply,” she said, endorsing the potential efficacy of trained non-specialists based on the therapy’s robust framework and the importance of empathetic delivery.
Funded in part through a partnership with the Canadian Medical Association, this cross-border study positions nurses, midwives, and doulas as viable frontline providers, leveraging their interpersonal competencies to democratize access to perinatal mental health interventions. As healthcare systems grapple with rising demand, these findings offer a blueprint for integrating non-specialist clinicians into mental health service delivery, enhancing both equity and efficiency.