Developing and testing a multi-component intervention to improve Perinatal Mental Health

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Depression and anxiety are the most common complications of pregnancy and the postpartum period, affecting one in five birthing people. Despite effective interventions for prevention and treatment, most perinatal depression and anxiety is unprevented and untreated, especially among marginalized communities. The proposed research will work with doulas, perinatal people, and clinicians to co-develop and pilot test a multi- component intervention called “Doula Link for Perinatal Mental Health (Doula Link).” Doula Link builds from a national model of perinatal psychiatric access programs to create links to the community and direct delivery of behavioral support. This community-based participatory research will center the experiences and voices of marginalized communities with the goal of fostering high quality equitable care. In line with NIMH Strategic Goal 4, the overall goal for the proposed project is to develop and test an innovative service delivery model to reduce symptoms of perinatal depression and anxiety. This will be accomplished through three research aims: 1) To adapt and define the intervention components through iterative mixed-methods research with doulas, mental health specialists, and perinatal people who are representative of marginalized communities; 2) To administer and refine the intervention with doulas who will then offer the psychosocial intervention to their pregnant clients; 3) Assess the feasibility and accessibility of Doula Link using a pilot cluster-randomized controlled feasibility trial. This research will be conducted in tandem with advanced training and mentorship for the candidate. Training will target four specific training goals: 1) intervention development for perinatal mental health, 2) advanced qualitative methods for community-engaged research, 3) advanced methods for implementation science, and 4) leadership and professional development to lead multi-site studies. At the end of the proposed project, the candidate will have developed and piloted a version of Doula Link, which will include the following products: 1) doula-specific toolkit for Psychiatric Access Programs, 2) training manual for doulas to implement the psychosocial intervention, 3) fidelity measures, 4) critical data on intervention feasibility and acceptability, 5) recruitment, retention, and assessment response rates, and 6) estimates of intra-cluster correlation coefficient and effect size. The goal of this K01-Mentored Research Scientist Development Award is to prepare the candidate for an independent research career dedicated to developing and testing acceptable, feasible, scalable, equitable, and effective interventions to improve perinatal mental health. With the research, training, and mentorship gained during this K01, the candidate will acquire the data and advanced skills needed to develop an R01 application for a fully-powered trial and be positioned to become a leader in perinatal mental health implementation science research.