Behavioral Activation Therapy Cuts Perinatal Suicide Risk

TOPLINE:

In a study of 1117 perinatal adults receiving behavioral activation therapy, the odds of endorsing suicide ideation decreased by 25% with each treatment session and by 80% at 3 months post-randomization, with specialist and nonspecialist providers showing equal effectiveness.

METHODOLOGY:

• A multisite, noninferiority, four-arm randomized clinical trial called the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) compared clinicians (nonspecialist vs specialist) and modalities (telemedicine vs in-person) in delivering behavioral activation therapy.
• Research was conducted at university-affiliated networks in Chicago, Illinois; Chapel Hill, North Carolina; and Toronto, Ontario, Canada.
• Participants included pregnant (≤ 36 weeks) and postpartum (4-30 weeks) adults with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 10).
• A total of 1117 participants who completed at least one treatment session and provided ≥ 1 week of Edinburgh Postnatal Depression Scale data were included in the analysis.
• Treatment consisted of a manualized 6- to 8-session perinatal behavioral activation intervention delivered weekly.

TAKEAWAY:

• Among 1230 enrolled pregnant and postpartum adults, 1117 completed at least one treatment session, with 264 (23.6%) endorsing suicide ideation during treatment.
• The odds of endorsing suicide ideation decreased by 25% with each additional treatment session (odds ratio [OR], 0.75; 95% CI, 0.58-0.96; P = .03).
• At 3 months post-randomization, the odds of endorsing suicide ideation decreased by 80% compared with any time during treatment (OR, 0.20; 95% CI, 0.14-0.27; P < .001).
• No significant differences were found in the odds of endorsing suicide ideation between clinician types (nonspecialist vs specialist) or delivery modalities (telemedicine vs in person).

IN PRACTICE:

“Behavioral activation is a first-line recommended treatment for perinatal depression and may reduce postpartum suicide risk by increasing values-consistent living and awareness of ineffective behaviors,” wrote the authors of the study.

SOURCE:

The study was led by Parisa Kaliush, PhD, Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, and Daisy Singla, PhD, Centre for Addiction and Mental Health in Toronto. It was published online in JAMA Psychiatry.

LIMITATIONS:

High suicide risk prompted exclusion from SUMMIT trial, and the final sample was highly educated, suggesting some limitations in generalizability. However, the prevalence of suicide ideation at baseline (15.0%) was higher than previously cited rates.

DISCLOSURES:

This study was funded by the Patient-Centered Outcomes Research Institute. Bradley Gaynes, PhD, disclosed receiving compensation for authorship/review of UpToDate chapters on depression. Samantha Meltzer-Brody, MD, MPH, reported receiving research funding to the University of North Carolina for clinical trials sponsored by Sage Therapeutics, Electromedical Products International, and Sirtsei Pharmaceuticals, serving as a clinical advisor and professional corporation owner for Modern Health, and serving as a scientific advisor to EmbarkNeuro and Seaport Therapeutics. Simone Vigod, MD, disclosed receiving royalties from UpToDate for authorship of materials on depression and pregnancy.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.