(WITHDRAWN) Promotion and Prevention of Perinatal Mood and Anxiety Disorders: Collaborative Initiatives between Social Workers and Doulas

Background and Purpose

Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy. However, only 50% of mothers with PMADs symptoms will seek mental health treatment (Woolhouse et al., 2015). Many women use Doulas before, during, and shortly after childbirth. Nonetheless, little research has been done on doulas’ role in mental health assessment and prevention, and their training to identify components related to PMADs. Expanding on the topic can improve maternal mental health and well-being of mothers and infants.

This study focuses on the role of doulas in identifying symptoms of PMADs and providing referrals to mental health services. It aims to answer the following questions: (1) Does doula training include sufficient information on how to identify PMADs and how to support women with PMADs? (2) Do doulas have a protocol for identifying PMADs and referring women who exhibit PMADs symptoms to mental health services? (3) What are doulas’ field experiences of working with clients with PMADs, and do they practice a collaborative approach?

Method

An explanatory sequential mixed methods design included a survey and a semi-structured interview. One hundred and fifty-seven doulas filled out the survey, which included questions regarding their training, professional education, work experience, and assessment of and intervention for PMADs. Thirty doulas participated in a semi-structured interview (n = 30).

Results

Nearly all of the participants agreed that it is within the scope of their role as a doula to look out for PMADs symptoms and refer clients to mental health treatment. Only 49% reported that their training offered best practices for supporting clients who are experiencing symptoms of PMADs.

While 70% of the participants reported feeling confident in supporting clients exhibiting signs of PMADs, only 29% of them consistently used a structured screening tool to assess for PMADs symptoms. The qualitative data revealed the following themes. (1) A lack of coordination of care between doulas and medical providers: The participants expressed their desire to effectively coordinate care with obstetricians, pediatricians, night nurses, and mental health providers. (2) Diagnostic and screening tools: The participants had mixed opinions on whether it is appropriate for doulas to administer screening tools (e.g., the Edinburgh Depression Scale). (3) Gaps in training: Most participants believed that doula training should incorporate a focus on PMADs. (4) Peer-to-peer mentorship: The participants agreed that they would benefit from additional education, mentorship, and peer-to-peer support opportunities in order to support clients with PMADs.

Conclusions

The study indicates that doulas confidently support women with PMADs, but they feel ill-prepared to use screening tools and refer their clients to the appropriate services. We recommended developing and testing a specific training curriculum for doulas addressing the following elements: (1) assessment; (2) short-term treatment; and (3) coordination of care and referral processes for women who experience PMADs.