After giving birth, approximately one in seven women in the U.S. will experience postpartum depression, making it a common and detrimental health concern, according to researchers. It can cause a parent to feel disconnected from their baby for weeks or months at a time, along with feelings of hopelessness, sadness, and anxiety.
A team of researchers from Providence-based Care New England Health System, Henry Ford Health, and Michigan State University is collaborating on a $6.2 million mental health research study from the National Institutes of Health (NIH), looking into the “ROSE” program.
The Reach Out, Stay Strong, Essentials for mothers of newborns (ROSE) program is funded through the end of 2022, and has served low-income women at 98 prenatal clinics. The study’s findings show that ROSE prevents half of the cases of postpartum depression, which health care and community agencies say is more feasible to provide as a universal prevention for all women.
Dr. Caron Zlotnick, the director of research for the Department of Medicine at Women and Infants Hospital, said the newly-funded program will be the first study to look at the effectiveness of postpartum depression among a general population of women, as well as women screening negative for postpartum depression.
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“If we find the intervention is effective, we can work to scale up the program, strengthen families while supporting moms, and reduce costs within the healthcare system,” said Zlotnick, who is one of two investigators on the grant. She’s also a professor of psychiatry, OB/GYN, and internal medicine at the Warren Alpert Medical School of Brown University.
Q: How does the ROSE program work and what is it like for pregnant women?
Zlotnick: During pregnancy, there are four sessions that are based on interpersonal therapy. It’s a psychoeducation on postpartum depression, on how to manage stress and transition to motherhood, and provides relevant postpartum resources. Then there’s a teaching component: We teach [these women] communication skills like how to ask for what you need by a role play and stress management. Within a month after delivery, we have a booster session, which reinforces all the skills that were taught during the ROSE program while checking in with new moms, working through difficulties, and providing additional resources if they’re needed.
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These sessions can be done in a group [setting], at an office visit, during a home visit, via Zoom for a telehealth appointment, or even by phone. And it does not need to be provided by a provider with mental health expertise. We showed in one of our trials that paraprofessionals can also deliver ROSE.
Who is accessing the ROSE program in your research right now?
The research we have done is with pregnant women on public assistance. Then we just started wrapping up this large implementation study; so instead of pregnant women being the study participants, it’s actual sites, clinics and agencies that serve predominantly low-income pregnant women. We have trained different types of providers in order to implement ROSE at their site.
Explain why being low-income could put some women “at risk” of having postpartum depression.
One in seven women will be impacted by postpartum depression. But among financially disadvantaged women, it’s one in every four. There are a lot more risks that financially disadvantaged women face and they have more stress in their life as it is.
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Studies show that women of color disproportionately suffer from adverse life experiences that can lead to chronic stress, depression, and anxiety. And many women of color struggle to even access the mental health care they need due to implicit bias among providers or the stigma around mental health in some communities of color. So far in your data collection, have you seen any differences with race or ethnicity on outcomes?
So far in our study, we have not seen a difference in terms of race and ethnicity. But different sites did adopt different ways of presenting ROSE depending on the population of women they worked with. Some of our sites would not present ROSE as a prevention intervention to reduce postpartum depression because there is that stigma of mental health that leads to many women asking, “Why are you telling me this? Why am I doing this?” Many of these women will fear that child welfare will get involved. So instead, we tried to present it as this scientific tool to sort of “survive motherhood” or as “coming together with other women,” to support one another in a way that was an educational experience rather than emphasizing that it could prevent postpartum depression.
The data is still true: The studies show that ROSE reduces postpartum depression by 50 percent compared to the women that do not go through the program.
What are the ramifications of not addressing postpartum depression?
For a woman, it really impacts her pain, but it also affects the family function in general. There’s robust literature to show that it does impact the cognitive and language development of infants and right up until they are about 11 or 12 years old.
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Other places around the country, such as New York City, are adopting a version of the ROSE program in their shelters and the research coming out of it shows that women are responding well to it.
What are the challenges that implementing the ROSE program universally could potentially face in today’s health care landscape?
Anecdotally, especially since the start of the pandemic, clinics and providers are facing serious staff turnover and burnout. It may be one of the largest issues the health care industry currently faces. When one or two people from a clinic leave — which could already be short staffed — it puts much more stress on the staff that is left there. As for families and these pregnant women, they are stressed as it is, have less access to resources, and they are less likely [without the program] to be screened for postpartum depression.
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