A groundbreaking Canadian-led study has found that addressing anxiety and depression in pregnant and postpartum women can be just as effective when care is provided by trained midwives, doulas, and nurses—and that delivering this care remotely is just as beneficial as in-person therapy.
With one in five pregnant and postpartum women experiencing depression and anxiety, but fewer than 10% receiving proper treatment, access to care remains a critical issue. The Scaling Up Maternal Mental health care by Increasing access to Treatment (SUMMIT) Trial, published in Nature Medicine, is the largest study of its kind and provides compelling evidence that innovative solutions can bridge this gap.
Expanding Mental Health Care with Midwives, Doulas, and Nurses
Traditionally, talk therapy has been delivered by psychologists and psychiatrists, but the SUMMIT Trial found that trained midwives, nurses, and doulas can provide equally effective care. After up to eight sessions of Behavioral Activation therapy, participants experienced significant reductions in symptoms of depression and anxiety, regardless of whether they were treated by a specialist or a trained non-specialist.
This finding is particularly critical in Canada, where shortages of mental health professionals often lead to long wait times, leaving many new and expecting mothers without the support they need. By integrating trained non-specialists into mental health care, access can be significantly expanded—without compromising quality.
Virtual Therapy: Just as Effective, More Accessible
Another major revelation from the study is that telemedicine is just as effective as in-person therapy for treating maternal mental health conditions. This is especially important for new mothers, who often struggle with the logistics of attending appointments while caring for their newborns. Virtual therapy eliminates barriers such as travel time, childcare, and geographic location, making it a game-changer for those in rural and remote areas.
“Talk therapy is effective but largely inaccessible. As our health system grapples with a shortage of specialists and the rising costs of care, many pregnant and postpartum individuals suffer in silence. Leveraging pragmatic solutions like telemedicine and task-sharing with trained non-specialists has the potential to transform maternal mental health care,” said Dr. Daisy Singla, the study’s Lead Principal Investigator and a Clinician Scientist at the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health.
Canadian-Led Study with Global Impact
The SUMMIT Trial was conducted across hospitals in North America, with key Canadian institutions including Mount Sinai Hospital, Women’s College Hospital, and St. Michael’s Hospital in Toronto. Of the 1,230 pregnant and postpartum participants, nearly half identified as racialized minorities, making the study one of the most diverse and inclusive of its kind.
Following treatment, depression scores on the Edinburgh Postnatal Depression Scale dropped from an average of 16 to 9, falling below the mild depression threshold of 10. Anxiety scores on the General Anxiety Disorder-7 scale also dropped from an average of 12 to 7, below the clinical threshold of 8—regardless of the severity of symptoms before treatment.
“Our research shows that a collaborative model—where specialists work alongside trained non-specialists—could significantly reduce wait times and expand access to high-quality mental health care,” said Dr. Samantha Meltzer-Brody, co-Principal Investigator of SUMMIT and Site Lead at the University of North Carolina at Chapel Hill.
A Safer Alternative to Medication
For many pregnant and postpartum individuals, talk therapy is the preferred treatment for anxiety and depression over medication, which some may wish to avoid while pregnant or breastfeeding.
“Finding effective, non-medication-based treatments for maternal mental health is critical,” said Dr. Richard Silver, Chair of Obstetrics & Gynecology at Endeavor Health and Site Lead for the study. “Talk therapy can help fill this gap, providing a safe, accessible, and proven option.”
Investing in Maternal Mental Health for a Healthier Future
Untreated maternal depression and anxiety can have severe consequences, including increased risks of maternal mortality, obstetrical complications, and developmental issues in children.
“Investing in perinatal mental health means investing in a healthier, more equitable future for parents, their children, and communities at large,” said Dr. Singla.
The research team is now conducting an economic evaluation of these innovative approaches within the Canadian and U.S. health-care systems to determine their long-term benefits and cost-effectiveness.
The SUMMIT Trial’s findings send a clear message: we have the tools to improve maternal mental health care. Now, it’s time to implement them.
~Read more from The Health Insider~
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