🔒Helping mothers: UMass Chan has been tapped by the Department of Defense to test a better way of treating postpartum depression

UMass Chan Medical School is working to combat an alarming trend: Mental health is one of the most lethal threats to the lives of postpartum women. The Worcester university has been selected by the U.S. Department of Defense to participate in a nationwide clinical trial, testing the efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) on postpartum depression. UMass Chan was awarded $2.4 million from DoD and has already begun recruiting patients. “The data to date suggests that this treatment is as effective as ECT (electroconvulsive therapy), which, by the way, is one of the most effective treatments we have,” said Dr. Kimberly Yonkers, Katz Family chair in psychiatry for both UMass Chan and UMass Memorial Health, who serves as the trial’s lead investigator. With the therapy already approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, UMass Chan’s trial aims to obtain FDA approval specifically for postpartum depression, increasing the likelihood of insurance coverage for patients. Mental health conditions account for 23% of pregancy-related deaths between seven days and one year after pregnancy, including suicides and overdoses, according to the U.S. Centers for Disease Control and Prevention. The study by UMass Chan is part of a greater effort across the region and the state to help postpartum mothers, particularly those from at-risk communities.

UMass Chan’s trial

SAINT serves as a potential alternative for mothers who are reluctant to take medication out of fear of harming their baby when pregnant or breastfeeding, a concern Yonkers said she commonly hears. While certain antidepressants, antianxiety, and antipsychotic medications have been shown to be safe to use while breastfeeding by organizations including the CDC and the Academy of Breastfeeding Medicine, fears persist in part due to stigma, medical misinformation, and cultural differences. “Just for people's peace of mind, if they don't need to take something, then we don't want them to. Because God forbid there be a complication, then they may be blaming themselves for years,” Yonkers said. SAINT delivers results far more quickly than ECT, a crucial factor when dealing with acute PPD. Typically, patients undergoing ECT will receive three treatments a week for between four and five weeks. On the other hand, SAINT is a very intensive, five-day program, in which patients receive 10 SAINT treatments over a 10-hour time period each day. To make the trial accessible to those with limited means, UMass Chan is providing a $450 reimbursement and assisting mothers with child care. “What we're trying to do is just make this as easy as possible for people, whether or not they have means,” said Yonkers. “We all know that people who have greater means have access to more treatments than people that have less.”

Access disparities

In Massachusetts, people of color and those with lower levels of traditional education are more likely to report PPD symptoms, yet they’re less likely to be screened for them, according to data collected by the Massachusetts Department of Public Health, through its Pregnancy Risk Assessment Monitoring System surveys.

At 7.2%, white birthing parents are less likely to report PPD symptoms than their Black and Asian counterparts, who report symptoms 16.3% and 20.0% of the time, respectively, according to PRAMS data. However, 87.9% of white birthing parents are likely to be screened for PPD symptoms compared to 77.9% of Black parents and 77.1% of Hispanic parents. “The data show that Black and brown moms, folks who are economically disadvantaged, tend to have higher rates of perinatal mood and anxiety disorders and are less likely to access care,” said Jessie Colbert, coordinator of advocacy group Massachusetts Mind the Gap Coalition. These mothers can often hesitate to disclose their PPD in the first place, sometimes due to fear of the Mass. Department of Children and Families. “People don't want to be labeled by the system as incompetent or unable to care for their kids. There's lots of horror stories about the state getting involved and taking children away,’ said Dr. Missy Gleckel, perinatal lead at Edward M. Kennedy Community Health Center in Worcester. The American Bar Association reports one out of every 41 Black children in the nation will have their relationship with their parent or parents terminated, juxtaposed by the national average of one out of every 100 children. This is in part due to the conflation of poverty with neglect, according to the ABA. Fears and struggles like these can contribute to PPD symptoms in the first place, said Gleckel. Especially today, many parents are concerned about paying their rent, keeping the lights on, and struggling to collect their government benefits. “This is not a setup that screams success,” said Gleckel.

Path forward

In August 2024, Gov. Maura Healey signed the state’s maternal health bill, which was supported by Colbert and Massachusetts Mind the Gap Coalition, to create a grant program for nonprofits community health centers supporting maternal mental health and substance use. This was a big win, said Colbert. “For many people, social support is really important,” she said. “Some of the improvements in care around midwifery and doula care just will do a lot.” Diversifying the maternal health workforce is a way to both help identify PPD symptoms in the community and treat them, including with providers who speak multiple languages, said Gleckel. Many patients don’t want to sit with a translator and instead want to communicate directly with their provider. These forms of advocacy, fiscal investments in treatment, and purposeful efforts to broaden diverse care for mothers all go into ensuring that they have equitable access to treatment of PPD symptoms, whether through medication, talk therapy, or non-drug therapies, like SAINT. “A stable parent is the safest thing for a baby,” Gleckel said. Mica Kanner-Mascolo is a staff writer at Worcester Business Journal, who primarily covers the healthcare, manufacturing, and higher education industries.