Early mental health support before birth may help prevent postpartum depression

Each morning during rounds as a resident at University of Rochester Medicine, Marika Toscano noticed the same troubling pattern.

Patients admitted for high-risk pregnancies often arrived seeming hopeful and engaged. But after days or weeks of hospitalization, many began withdrawing. Their room lights stayed off. The blinds remained closed. Conversations became shorter.

Toscano, now an assistant professor of maternal-fetal medicine at Johns Hopkins University, drew on her residency experiences to guide new research that found that offering patients evidence-based mental health support during their hospital stay can help prevent postpartum depression. The findings are published in the journal Women’s Health Issues.

People in the study who participated in the ROSE intervention experienced fewer postpartum depression symptoms during the first six weeks after childbirth than those receiving usual care, demonstrating hospitalization as a critical opportunity for early support.

Early intervention is key

Any hospital stay can be stressful and disruptive. Life must be put on hold; support systems can be limited, and there is often a lot of uncertainty. For people hospitalized during a high-risk pregnancy, the risk of developing postpartum depression is roughly twice that of the general pregnant population.

Although postpartum depression is diagnosed after childbirth, symptoms often begin during pregnancy. This study suggests that offering mental health support earlier may improve outcomes for patients at high risk of postpartum depression.

This proactive approach is intentional. Ellen Poleshuck, Ph.D., director of the Program for Mental Health and Gender Wellness in Obstetrics and Gynecology, explains, “We don’t want to wait for people to recognize they have a problem and ask for help.”

Preventive care isn’t always available, especially for women whose prenatal care is interrupted by an unexpected hospitalization. The researchers say offering support proactively is an important step toward making mental health care more equitable.

“This has been a silent population. It’s the scariest, worst experience of their life, to go through a hospitalization during pregnancy. Starting down this path, learning how we can do a better job of supporting these families is really important,” said Poleshuck.

As a fellow, Toscano performed a meta-analysis and systematic review of patients who were admitted to the hospital for high-risk pregnancy. While supportive services such as music therapy and yoga existed, Toscano discovered there were no evidence-based behavioral health programs designed specifically to help prevent postpartum depression in hospitalized patients.

“They’re so resilient and trying to navigate, but I could see their mental health start to slide,” said Toscano. “I wanted to try to identify ways to help them.”

Supporting mothers when and where they need it

Toscano found that one way to help her patients was to implement the ROSE—Reach Out, Stay Strong, Essentials for mothers of newborns—Program. She first learned about the program while studying with Poleshuck, who helped integrate ROSE in outpatient settings at URochester Medicine.

ROSE is an evidence-based behavioral health intervention designed to reduce the risk of postpartum depression through education, communication skills, social support and practical coping strategies. In one-on-one sessions with mental health professionals, patients learn about available resources, develop important communication and coping skills, and have a supportive space to reflect on their feelings.

Toscano and Poleshuck saw the potential in offering ROSE to this specific population.

“Every single one of these women is at risk of developing postpartum depression, but they might not be aware,” said Poleshuck, professor of psychiatry and obstetrics and gynecology at the School of Medicine & Dentistry. “Because they’re admitted, their standard prenatal care is interrupted, and they may not get the opportunity to talk about those topics because the focus shifts so dramatically to the medical complications.”

While hospitalized, patients often spend days or even weeks waiting. Rather than introducing new information during the hectic days after childbirth, researchers saw hospitalization as an opportune time to provide education, emotional support and practical skills before their baby arrives.

Offering hope and validation

Toscano and Poleshuck found that patients not only valued mental health support but also the skills they learned through ROSE.

“There was a lot of skill-building in the sessions,” said Toscano. “The patients especially appreciated learning how to best communicate their needs and ask for help.”

Many participants later described using those same communication skills while advocating for their babies in the neonatal intensive care unit (NICU), talking with medical teams and asking family members for support at home.

The patients also expressed great appreciation for having someone to visit with them, make them feel heard and reassure them that they’re not alone.

“The program helps break down the societal expectations that pregnancy and childbirth are beautiful and easy and joyous, because that’s not the reality for most people,” said Toscano.

While larger studies are needed to confirm these findings, the initial results are promising: Participants experienced measurably fewer postpartum depression symptoms during the critical first six weeks after childbirth.

Toscano and Poleshuck hope these findings will encourage larger studies and, eventually, make preventive mental health support a routine part of care for patients hospitalized during high-risk pregnancies.

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Gaby Clark

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Andrew Zinin

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