Multicomponent Program Improved Perinatal Mental Health in an Urban Cohort During COVID-19
Key findings
- This single-arm proof-of-concept study evaluated the impact of a novel multicomponent, community-based intervention on perinatal mental health in a racially and ethnically diverse urban population during the COVID-19 pandemic
- Specifically, the Helping Us Grow Stronger (HUGS)/Abrazos program incorporated emergency relief, patient navigation, and behavioral healthcare
- The most clinically relevant finding was a significant reduction in the proportion of participants who screened positive for depression (42% at baseline vs. 31% post-program; P=0.003)
- Participants with significant life stressors (food insecurity, COVID-19 during pregnancy, and/or experience of discrimination) showed greater improvement in mental health scores after program completion than participants without these exposures
- Multifactorial interventions such as the HUGS/Abrazos program are a promising approach for addressing the mental health effects of health inequities and adverse social determinants of health during the perinatal period
In Spring 2020, during the first COVID-19 surge in Boston, researchers at Massachusetts General Hospital launched Helping Us Grow Stronger (HUGS)/Abrazos. This community-based program, which incorporated emergency relief, patient navigation, and behavioral healthcare, was designed to foster resilience and mitigate the negative effects of COVID-related stress on pregnant women and families with children under age 6.
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Later, in a single-arm proof-of-concept study, the team observed that HUGS/Abrazos improved stress and depression scores among pregnant and postpartum individuals, particularly those with life stressors such as food insecurity and discrimination that were amplified by the COVID-19 pandemic.
Molly R. Siegel, MD, an obstetrician gynecologist and maternal-fetal medicine specialist in the Mass General Department of Obstetrics & Gynecology, Andrea G. Edlow, MD, MSc, a maternal–fetal medicine specialist in the Department and an investigator in the Vincent Center for Reproductive Biology, and colleagues report the findings in the American Journal of Obstetrics & Gynecology MFM.
Methods
The current analysis included 178 pregnant adults or up to 1 year postpartum when referred to the HUGS/Abrazos program between August 1, 2021, and August 30, 2022. 82% had public insurance, 52% were born outside the U.S., and 63% identified as Hispanic or Latinx. Participants received:
- Up to three contacts with a community health worker to navigate resources targeting adverse social determinants of health (if indicated during screening)
- Up to four contacts with a behavioral health professional (if indicated during screening), with referral to ongoing care if needed
- A care package including a $50 gift card for groceries, family activity kits, language-concordant children's books, masks, and hand sanitizer
Both English- and Spanish-speaking community health workers and behavioral health professionals were available through the program, and participants who spoke other languages had access to certified hospital interpreters via telephone.
Following the program, all participants completed the Edinburgh Postnatal Depression Scale (EPDS), the 10-item Perceived Stress Scale (PSS), the PROMIS Anxiety Scale, the two-item Food Insecurity Screen, and the 19-item Major Experiences of Discrimination and Day-to-Day Unfair Treatment Scale. Pregnant participants completed the 10-item Pregnancy-Related Anxiety Questionnaire (PRA). 133 of the 178 participants completed the same measures pre-program.
Mental Health Scores
The program was associated with significant improvements in:
- EPDS scores overall: mean 8.44 at baseline vs. 6.77 post-program (P=0.0001)
- EPDS scores among those who screened positive for depression: score ≥10 in 42% at baseline vs. 31% post-program (P=0.003)
- PSS scores: 15.2 at baseline vs. 14.0 post-program (P=0.035)
35% of the 133 individuals who completed the EPDS before and after program participation reported clinically significant improvement (a decrease of ≥4 points).
As the number of program contacts increased, there was significantly greater improvement in EPDS scores (r, 0.22; P=0.01) and PROMIS anxiety scores (r, 0.24; P<0.05).
Effects of High-Risk Exposures
Of the 133 participants who completed both baseline and post-program surveys, 56% reported food insecurity, 59% screened positive for at least one lifetime or everyday experience of discrimination, and 62% reported COVID-19 during pregnancy.
Participants who had these high-risk exposures had higher baseline scores on the EPDS, PROMIS, and/or PSS than participants without such exposures and were more likely to demonstrate improvements in these measures after the program.
Satisfaction With the Program
72% of participants reported that the program met their needs "very well" or "extremely well." When asked to rate on a scale of 0 to 10 how likely they would be to recommend the program to others, the average response was 9.23.
Supplementing Clinical Care
The high rates of food insecurity and experiences of racism and discrimination in this cohort are probably typical of urban U.S. obstetrical populations but have not been described previously.
This study is also the first to rigorously evaluate the impact of a program that combines resource navigation with behavioral health support, how such a program could benefit pregnant patients with significant life stressors during the COVID-19 pandemic, and the effect of COVID-19 on mental health before and after such a program.
The results suggest HUGS/Abrazos and other multicomponent interventions could supplement clinical care by addressing perinatal mental health concerns, especially among individuals exposed to adverse social determinants of health.
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