Perspectives of perinatal participants who have discontinued brief behavioural activation treatment: Insights from the SUMMIT Trial
Bibliographic record
Abstract
Objective: Up to 20% of women experience symptoms of depression and anxiety during the perinatal period (1). However, as few as 12% receive effective mental health treatment due to various barriers to care (2). In this study, we examined the reasons why perinatal women with symptoms of depression and anxiety who participated in a psychotherapy clinical trial chose to discontinue treatment. The objective was to understand some of the personal and structural barriers this population experiences when accessing mental healthcare. Methods: We conducted a qualitative sub-study within the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial. SUMMIT is a four-arm, randomized, non-inferiority trial to test the effectiveness of behavioural activation aimed at alleviating symptoms of depression and anxiety among perinatal women. Participants were randomized by delivery mode (telemedicine vs. in-person) and provider (specialist vs. non-specialist). Of 1,183 SUMMIT participants, 225 (19%) chose to discontinue treatment, of which N=18 were contacted and agreed to be part of the current study. We conducted a content analysis to identify the most commonly reported reasons for treatment discontinuation. Results: Among 18 participants, the most highly endorsed reasons for treatment discontinuation included: transportation challenges (n=13, 72.2%), difficulty arranging childcare (n=11, 61.1%), dissatisfaction with their assigned delivery mode (n=11, 61.1%), work-family conflict (n=6, 33.3%), feeling overwhelmed (n=6, 33.3%), and health concerns or risks associated with hospital-based counselling (n=6, 33.3%). Participants also expressed dissatisfaction with the content or structure of behavioural activation (n=5, 27.8%) and the timing of treatment (received in pregnancy vs. postpartum) (n=4, 22.2%) which contributed to their discontinuation. Conclusion: Our findings provide insights into the personal and structural barriers perinatal individuals experience when accessing treatment in the context of a research setting. Perinatal participants expressed a preference for virtual mental healthcare for its convenience, demonstrating a feasible way to reduce some of the barriers to care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.047 | 0.092 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".