Addressing perinatal mood and anxiety disorders (PMADs) through a doula intervention
NIH
UNIVERSITY OF MONTANA
Perinatal mood and anxiety disorders (PMADs) have intergenerational negative impacts on the physical  and mental health of women and their families and are the most frequently experienced childbirth  complication. PMADs are particularly common in rural populations, who experience additional obstacles in  accessing maternal and child health (MCH) and mental health services. Doulas, non-medically trained  childbirth and postpartum companions, have been proposed as one way to address existing healthcare  gaps, and as a way to improve mental health outcomes, along with additional MCH outcomes such as  decreased substance use, increased prenatal and postpartum healthcare visit attendance, and  improvements in overall maternal physical wellbeing. The aims of this research are: 1) Explore the use of  doulas to improve self-efficacy and maternal mental health outcomes for rural populations; 2) Develop a  doula intervention to improve self-efficacy and maternal mental health in rural populations; and 3) Pilot a  doula-led intervention to improve self-efficacy and maternal mental health outcomes. Using the NIM....'s  experimental therapeutics approach, I will explore the underlying mechanism impacting these outcomes  by focusing on how doulas improve self-efficacy among their clients. Following Whitbeck's (2006) model  for adaptation of interventions, and community-based participatory research (CBPR) best practices, I will  use formative and exploratory research approaches to address knowledge gaps about the use of doulas  to improve PMADs and secondary maternal and infant health outcomes. Through this project we will first  collect primary qualitative data regarding the feasibility of using doulas to improve PMAD health outcomes  and will identify the needs and barriers in accessing mental health care, as well as social and emotional  support that could be addressed by doulas (N=40). The proposed research will then synthesize  quantitative data on the use of doulas and peer-support models with qualitative data collected from  semi-structured interviews to develop and test a doula-led intervention through adapting an existing  doula-training. A mixed-methods approach will be used to analyze findings from study participants (N=75)  and doulas and providers (N=20). This project will provide preliminary data for the cultural adaptation of  the intervention for use with other marginalized groups and rural populations, including Indigenous  communities, who experience heightened PMADs and other negative MCH outcomes. In addition to being extremely common, PMADs are frequently undiagnosed and are negatively  associated with a broad range of negative outcomes. Of particular concern are findings that PMADs are  increasing. Rural populations are estimated to have PMADs rates that are more than double those in  non-rural areas and higher suicide rates.These negative MCH health outcomes are particularly prominent  in Montana. Research indicates that the use of doulas can improve a wide-range of pregnancy and
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