Grant: Prize: IHSPR Article of the Year Award

Depression and anxiety during pregnancy and after childbirth are common, affecting up to one in five individuals. Talk therapies are effective and recommended in all clinical guidelines but they remain inaccessible because of high costs, few mental health specialists and in-person appointments can be difficult to attend, especially for those living in rural or remote areas or caring for young children. The SUMMIT Trial was designed to test whether two strategies—task-sharing (training nurses, midwives, and doulas to deliver psychotherapy) and telemedicine (offering therapy through a secure audio-visual platform)—could effectively increase access to care. SUMMIT was a large study conducted at five major health networks in Canada and the United States. 1,230 pregnant and postpartum adults with symptoms of depression were randomly assigned to one of four groups: therapy delivered by a non-specialist provider or by a mental-health specialist, and either by telemedicine or in person. All participants were offered weekly sessions of a brief, evidence-based talk therapy called behavioral activation. Upon completion, SUMMIT is among the largest psychotherapy trials in the world. The study found compelling evidence that: (1) therapy delivered by trained non-specialist providers worked just as well as therapy delivered by specialists; and (2) telemedicine was just as effective as in-person care. Participants also reported high satisfaction, and no trial-related serious adverse events occurred. Importantly, almost 50% of participants were Persons of Colour who reported equally high satisfaction rates. Task-sharing and telemedicine offer practical, effective ways to reduce barriers to mental-health care during the perinatal period and to reach more families who need support.