Skip to main content
SpringerLink
Log in

The Role of Peer Providers to Scale Up Psychological Treatments for Perinatal Populations Worldwide

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Psychological treatments remain largely inaccessible to perinatal populations despite their robust effectiveness. This gap is partly due to the limited number of available treatment providers. In this review, we critically evaluate recent literature on task-sharing to peer providers and propose future directions.

Recent Findings

There is a growing evidence base demonstrating that peer providers can effectively deliver psychological treatments for perinatal populations, as well as engage in processes critical to quality assurance, such as measurement-based peer supervision. Findings have also highlighted some benefits of peers over licensed healthcare providers, such as enhanced collaborative relationships, reduced stigma, provision of social comparisons, and increased accessibility.

Summary

Peer providers may be one solution to improve access to psychological treatments for perinatal populations. However, there is a need to address clinical, professional, and health-system level barriers to effectively leverage this cadre of treatment providers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Interventions to prevent perinatal depression: US preventive services task force recommendation statement. JAMA. 2019;321(6):580–7.

    Article  PubMed  Google Scholar 

  2. Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clin Psychol Rev. 2018;66:136–48.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Li X, Laplante DP, Paquin V, Lafortune S, Elgbeili G, King S. Effectiveness of cognitive behavioral therapy for perinatal maternal depression, anxiety and stress: a systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev. 2022;92:102129.

    Article  PubMed  Google Scholar 

  4. Dimidjian S, Goodman SH. Preferences and attitudes toward approaches to depression relapse/recurrence prevention among pregnant women. Behav Res Ther. 2014;54:7–11.

    Article  PubMed  Google Scholar 

  5. Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323–31.

    Article  PubMed  Google Scholar 

  6. Dennis CL, Hodnett ED. Psychosocial and psychological interventions for treating postpartum depression. The Cochrane Library. 2007. https://doi.org/10.1002/14651858.CD006116.pub2.

  7. Singla DR, Savel K, Dennis C-L, Kim J, Silver RK, Vigod S, et al. Scaling up mental healthcare for perinatal populations: is telemedicine the answer? Curr Psychiatry Rep. 2022. https://doi.org/10.1007/s11920-022-01389-2.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(2):119–24.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Byatt N, Biebel K, Lundquist RS, Moore Simas TA, Debordes-Jackson G, Allison J, et al. Patient, provider, and system-level barriers and facilitators to addressing perinatal depression. J Reprod Infant Psychol. 2012;30(5):436–49.

    Article  Google Scholar 

  10. Singla DR, Lawson A, Kohrt BA, Jung JW, Meng Z, Ratjen C, et al. Implementation and effectiveness of nonspecialist-delivered interventions for perinatal mental health in high-income countries: a systematic review and meta-analysis. JAMA Psychiatry. 2021;78(5):498–509. https://doi.org/10.1001/jamapsychiatry.2020.4556.

    Article  PubMed  Google Scholar 

  11. Wang TH, Pai LW, Tzeng YL, Yeh TP, Teng YK. Effectiveness of nurses and midwives-led psychological interventions on reducing depression symptoms in the perinatal period: a systematic review and meta-analysis. Nurs Open. 2021;8(5):2117–30. https://doi.org/10.1002/nop2.764.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low-and middle-income countries. Ann Rev Clin Psychol. 2017;13:149–81.

    Article  Google Scholar 

  13. Barbui C, Purgato M, Abdulmalik J, Acarturk C, Eaton J, Gastaldon C, et al. Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review. Lancet Psychiatry. 2020;7(2):162–172. https://doi.org/10.1016/s2215-0366(19)30511-5

  14. Dennis CL, Grigoriadis S, Zupancic J, Kiss A, Ravitz P. Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial. Br J Psychiatry. 2020;216(4):189–96. https://doi.org/10.1192/bjp.2019.275.

    Article  PubMed  Google Scholar 

  15. Singla DR, Meltzer-Brody SE, Silver RK, Vigod SN, Kim JJ, La Porte LM, et al. Scaling Up maternal mental healthcare by increasing access to treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial. Trials. 2021;22(1):186. https://doi.org/10.1186/s13063-021-05075-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Dennis C-L. Peer support within a health care context: a concept analysis. Int J Nursing Stud. 2003;40(3):321–32. https://doi.org/10.1016/S0020-7489(02)00092-5.

    Article  Google Scholar 

  17. Dennis C-L, Hodnett E, Kenton L, Weston J, Zupancic J, Stewart DE, et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ. 2009;338:a3064.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dukhovny D, Dennis CL, Hodnett E, Weston J, Stewart DE, Mao W, et al. Prospective economic evaluation of a peer support intervention for prevention of postpartum depression among high-risk women in Ontario, Canada. Am J Perinatol. 2013;30(8):631–42. https://doi.org/10.1055/s-0032-1331029.

    Article  PubMed  Google Scholar 

  19. Fang Q, Lin L, Chen Q, Yuan Y, Wang S, Zhang Y, et al. Effect of peer support intervention on perinatal depression: a meta-analysis. Gen Hosp Psychiatry. 2022;74:78–87. https://doi.org/10.1016/j.genhosppsych.2021.12.001.

    Article  PubMed  Google Scholar 

  20. White S, Foster R, Marks J, Morshead R, Goldsmith L, Barlow S, et al. The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis. BMC Psychiatry. 2020;20(1):534. https://doi.org/10.1186/s12888-020-02923-3.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Singla DR, Ratjen C, Krishna RN, Fuhr DC, Patel V. Peer supervision for assuring the quality of non-specialist provider delivered psychological intervention: lessons from a trial for perinatal depression in Goa, India. Behav Res Ther. 2020;130:103533.

    Article  PubMed  Google Scholar 

  22. • Kaaya S, Siril H, Fawzi MCS, Aloyce Z, Araya R, Kaale A, et al. A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options: a cluster-randomized controlled trial. PLOS Med. 2022;19(12):e1004112. https://doi.org/10.1371/journal.pmed.1004112. This two-arm trial which compared (1) enhanced usual depression care (EUDC) to (2) EUDC plus the “Healthy Options” intervention, which included group-based problem-solving therapy prenatally and group-based cognitive behavioral therapy for participants still experiencing depressive symptoms postnatally. Trained peer counselors delivered the intervention to perinatal women living with HIV (N=742). The Healthy Options intervention was associated with reduced depressive symptoms at 6 weeks post-birth, suggesting peers were effective in their delivery of group-based problem-solving therapy and offering treatment antenatally reduces the impact of depressive symptoms postnatally.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rice C, Ingram E, O’Mahen H. A qualitative study of the impact of peer support on women’s mental health treatment experiences during the perinatal period. BMC Pregnancy Childbirth. 2022;22(1):689. https://doi.org/10.1186/s12884-022-04959-7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fallin-Bennett A, Elswick A, Ashford K. Peer support specialists and perinatal opioid use disorder: someone that’s been there, lived it, seen it. Addict Behav. 2020;102:106204.

    Article  PubMed  Google Scholar 

  25. Caramlau I, Barlow J, Sembi S, McKenzie-McHarg K, McCabe C. Mums 4 Mums: structured telephone peer-support for women experiencing postnatal depression. Pilot and exploratory RCT of its clinical and cost effectiveness. Trials. 2011;12(1):88.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Singla D, Lazarus A, Atif N, Sikander S, Bhatia U, Ahmad I, et al. “Someone like us”: delivering maternal mental health through peers in two South Asian contexts. J Affect Disord. 2014;168:452–8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Magidson JF, Rose AL, Regenauer KS, Brooke-Sumner C, Anvari MS, Jack HE, et al. “It’s all about asking from those who have walked the path”: patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa. Addict Sci Clin Pract. 2022;17(1):1–12.

    Article  Google Scholar 

  28. Watson H, Harrop D, Walton E, Young A, Soltani H. A systematic review of ethnic minority women’s experiences of perinatal mental health conditions and services in Europe. PLoS One. 2019;14(1):e0210587. https://doi.org/10.1371/journal.pone.0210587.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Satinsky EN, Doran K, Felton JW, Kleinman M, Dean D, Magidson JF. Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City. Plos one. 2020;15(1): e0228084.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Shalaby RAH, Agyapong VI. Peer support in mental health: literature review. JMIR Mental Health. 2020;7(6): e15572.

    Article  PubMed  PubMed Central  Google Scholar 

  31. O'Hara M. Peer-delivered psychotherapy for postpartum depression: has its time come? J Clin Psychiatry. 2021;83(1). https://doi.org/10.4088/jcp.21com14209

  32. Magidson, J. Peer-delivered behavioral activation intervention to improve adherence to MAT among low-income, minority individuals with OUD. National Institutes of Health. Project Number: 5R33DA057747-03. https://reporter.nih.gov/search/H4KvIDCy5kOAL30DVeSnjw/project-details/10662567. Accessed 21 Sep 2023

  33. Magidson J, Kattakuzhy S. Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention (PRISM). ClinicalTrials.gov identifier: NCT05973838. Updated 14 July 2023. https://clinicaltrials.gov/study/NCT05973838. Accessed 21 Sep 2023

  34. Magidson J. Project Khanya: Peer-Delivered Intervention to Improve HIV Medication Adherence and Substance Use in South Africa. ClinicalTrials.gov identifier: NCT05933226. Updated 11 July 2023. https://clinicaltrials.gov/study/NCT05933226. Accessed 21 Sep 2023

  35. • Magidson JF, Joska JA, Belus JM, Andersen LS, Regenauer KS, Rose AL, et al. Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa. J Int AIDS Soc. 2021;24:e25720. https://doi.org/10.1002/jia2.25720. This pilot randomized hybrid type 1 effectiveness-implementation trial demonstrated that peer providers were effective in delivering Khanya, a brief (6 session) evidence-based behavioral intervention to improve antiretroviral therapy adherence among individuals living with HIV. Khanya included elements of structured psychological treatments, including behavioral monitoring, activity scheduling, mindfulness practice, and relapse prevention, and demonstrated gains in treatment outcomes compared to enhanced treatment as usual.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Magidson JF, Kleinman MB, Bradley V, Anvari MS, Abidogun TM, Belcher AM, et al. Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: results from an open-label, type 1 hybrid effectiveness-implementation pilot trial. Int J Drug Policy. 2022;108:103813.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Felton J, Kleinman M, Doran K, Satinsky E, Tralka H, Dean D, et al. Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment. J Psychosoc Nurs Ment Health Serv. 2023. https://doi.org/10.3928/02793695-20230523-02

  38. Anvari MS, Hampton T, Tong MP, Kahn G, Triemstra JD, Magidson JF, et al. Behavioral activation disseminated by non-mental health professionals, paraprofessionals, and peers: a systematic review. Behav Ther. 2023;54(3):524–38. https://doi.org/10.1016/j.beth.2022.12.007.

    Article  PubMed  Google Scholar 

  39. Lu M, Jiang M, Gu Y, Li H, Hou Y, Yu X, et al. Mom’s good mood: screening and management of perinatal depression within primary healthcare system in China-protocol for an effectiveness-implementation design study. BMJ Open. 2023;13(5):e063593. https://doi.org/10.1136/bmjopen-2022-063593.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Fuhr DC, Weobong B, Lazarus A, Vanobberghen F, Weiss HA, Singla DR, et al. Delivering the thinking Healthy programme for perinatal depression through peers: an individually randomised controlled trial in India. Lancet Psychiatry. 2019;6(2):115–27.

    Article  PubMed  Google Scholar 

  41. Sikander S, Ahmad I, Atif N, Zaidi A, Vanobberghen F, Weiss HA, et al. Delivering the thinking healthy programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan. Lancet Psychiatry. 2019;6(2):128–39.

    Article  PubMed  Google Scholar 

  42. • Harris RA, Campbell K, Calderbank T, Dooley P, Aspero H, Maginnis J, et al. Integrating peer support services into primary care-based OUD treatment: lessons from the Penn integrated model. Healthc (Amst). 2022;10(3):100641. https://doi.org/10.1016/j.hjdsi.2022.100641. Peer providers were integrated into primary care practices to support an opioid use disorder treatment program. Integration efforts included providing the necessary clinical support (e.g., regular meetings with a larger care team) and logistical resources (e.g., office resources and tech). This program offers critical insights into the level of integration required to ensure peers are adequately supported in their roles.

    Article  PubMed  Google Scholar 

  43. Magidson JF, Regan S, Powell E, Jack HE, Herman GE, Zaro C, et al. Peer recovery coaches in general medical settings: changes in utilization, treatment engagement, and opioid use. J Subst Abuse Treat. 2021;122:108248. https://doi.org/10.1016/j.jsat.2020.108248.

    Article  CAS  PubMed  Google Scholar 

  44. Matthews A, Ziegler M, Mayberry M, Owen-DeSchryver J, Carter EW. Scaling up a peer-mediated program statewide: lessons learned through peer to peer. Intellect Dev Disabil. 2022;60(4):334–44. https://doi.org/10.1352/1934-9556-60.4.334.

    Article  PubMed  Google Scholar 

  45. Acri M, Hooley CD, Richardson N, Moaba LB. Peer models in mental health for caregivers and families. Community Ment Health J. 2017;53(2):241–9. https://doi.org/10.1007/s10597-016-0040-4.

    Article  PubMed  Google Scholar 

  46. Postpartum Support International. https://www.postpartum.net/. Accessed 23 May 2023.

  47. The Policy Center for Maternal Mental Health. https://www.2020mom.org/. Accessed 23 May 2023.

  48. A significant solution for maternal mental health: certified peer specialists. Policy Center for Maternal Mental Health. 2023. https://www.issuelab.org/resources/40014/40014.pdf. Accessed 23 May 2023

Download references

Funding

Some of the research reported in this publication was supported by the National Institutes of Health (National Institute on Drug Abuse) under award numbers R01DA056102, R01DA057443, and R33DA057747 (PI: JM), the Canadian Institutes of Health Research under award number MCT66874 (PI: CLD), and the Patient Centered Outcome Research Institute under award number PCS-2018C1-10621 (PI: DRS). SNV receives royalties from UpToDate Inc. for authorship of materials related to depression and pregnancy.

Author information

Authors and Affiliations

  1. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada

    Daisy R. Singla

  2. Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada

    Daisy R. Singla, Katarina A. Savel & Cindy-Lee Dennis

  3. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

    Daisy R. Singla, Simone N. Vigod & Cindy-Lee Dennis

  4. Center for Substance Use, Addiction & Health Research, University of Maryland, College Park, MD, USA

    Jessica F. Magidson

  5. Department of Psychology, University of Maryland, College Park, MD, USA

    Jessica F. Magidson

  6. Women’s College Hospital, Toronto, Canada

    Simone N. Vigod

  7. Women’s College Research Institute, Toronto, Canada

    Simone N. Vigod

  8. Lawerence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

    Cindy-Lee Dennis

Authors
  1. Daisy R. Singla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katarina A. Savel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica F. Magidson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simone N. Vigod
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cindy-Lee Dennis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daisy R. Singla.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singla, D.R., Savel, K., Magidson, J. et al. The Role of Peer Providers to Scale Up Psychological Treatments for Perinatal Populations Worldwide. Curr Psychiatry Rep 25, 735–740 (2023). https://doi.org/10.1007/s11920-023-01459-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-023-01459-z

Keywords

Search

Navigation