Text, phone-based virtual care boosts maternal mental health screening

New research reveals that a text message and telephone-based virtual care approach can improve rates of screening, identification, and treatment of maternal mental health conditions.

Published in Health Affairs, the study assessed an intervention that addresses various barriers to adopting maternal mental health screening and referral to treatment. Medical University of South Carolina researchers noted that perinatal mental health disorders, perinatal substance use disorders (SUDs), and intimate partner violence are common during pregnancy and the postpartum year. According to data from the Mental Health Leadership Alliance, maternal mental health conditions affect 800,000 families each year in the United States.

The Listening to Women and Pregnant and Postpartum People (LTWP) is a multilevel intervention that uses a combination of text messaging and telephone-based outreach to increase screening and treatment rates for perinatal mental health disorders, SUDs, and intimate partner violence, according to the study. Following a screening via text message, a care coordinator calls those who screen positive and completes a brief assessment to refer patients to treatment and resources, if needed.

The researchers conducted a randomized controlled trial from January 2021 to April 2023 comparing outcomes between a group participating in the LTWP program and those receiving usual care with in-person screenings and referrals.

They included English-speaking 18-to-41-year-olds who were currently pregnant or postpartum and receiving perinatal care within a large academic health system in the southeastern US. Of 789 people considered for the study, 415 were included. Participants were randomly assigned to the LTWP program (224) or usual care (191).

A little over half of the participants (59 percent) self-identified as White, 34 percent as Black, and 4.8 percent as Hispanic. Most participants (71.1 percent) characterized their residence as partially rural, and 34.9 percent of participants, on average, self-reported having a psychiatric diagnosis.

The study shows that participants assigned to LTWP were three times more likely to be screened, 9.4 times more likely to screen positive, 13.2 times more likely to be referred to treatment, and 17.1 times more likely to attend treatment than those receiving usual care.

Among participants screened, those in the LTWP program were 3.1 times more likely to screen positive, 4.4 times more likely to be referred to treatment, and 5.7 times more likely to attend treatment compared with the usual care group. However, researchers noted this was likely because fewer participants assigned to usual care completed the screenings “and, therefore, would not be eligible for subsequent outcomes.”

Further, the effects of the LTWP population were consistent across racial groups compared with in-person screening and referral practices. Thus, it is possible that the intervention components can help address the barriers that Black and rural populations face during pregnancy and postpartum that are not being addressed with in-person screening and referrals.

“This study represents a step forward in informing strategies for improved screening for and identification of perinatal mental health disorders and perinatal SUDs and attendance to treatment for peripartum people,” the researchers concluded. “These findings are important, given that improving the detection and treatment of maternal mental health conditions has the potential to reduce preventable causes of maternal morbidity and mortality.”

The study aligns with prior research on how virtual care can enhance maternal mental healthcare.

A systematic literature review published in 2023 found that while telehealth can help treat common maternal mental health conditions, there is no one-size-fits-all approach. For the study, researchers examined 44 randomized controlled trials that had pregnant women or new mothers as participants, involved a telehealth intervention, and addressed mental health-related outcomes such as depression, anxiety, and others.

They found that 62 percent of these trials reported improvements in the mental health outcomes of participants receiving telehealth-based interventions compared to the control group. However, the review also revealed room for improvement and a need to develop targeted telehealth interventions.