Improving the perinatal mental health of Veterans with serious mental illness through peer support

About This Grant

SIGNIFICANCE TO VA: In the past decade, the number of women Veterans of childbearing age using VA has nearly doubled, and over forty percent of these women have a diagnosis of serious mental illness (SMI; major depressive disorder, posttraumatic stress disorder, bipolar disorder, schizophrenia, other psychotic disorders). Veterans experience worse pregnancy and birth outcomes than civilians, a disparity largely attributed to their high burden of mental illness and trauma. Pregnant and postpartum Veterans with SMI—who often have numerous mental health, medical, and social challenges—are at high risk for perinatal exacerbation of mental illness, with consequences including maternal morbidity and mortality, poor functioning, and impaired child development. Reach Out, Stay Strong Essentials (ROSE), a brief evidence-based psychoeducational intervention for prevention of postpartum depression in women without mental illness, is being implemented in over two dozen VA facilities; feedback from ROSE implementers supports its use, but with noted limitations for Veterans with SMI. Building on lessons learned from ROSE implementation, I propose to develop and pilot ROSE+, a psychosocial intervention blending ROSE with peer support (i.e., support provided by Veteran peer specialists with personal experience of mental illness). Peer support is a key component of VA mental health care; while evidence exists for peer support in non-SMI perinatal and non-perinatal SMI populations, existing interventions are limited in applicability to the complex social, medical, and mental health needs of perinatal Veterans with SMI. ROSE+ will comprise adapted and combined components of ROSE and evidence-based perinatal and SMI peer support models, tailored to the VA context and the unique needs of perinatal Veterans with SMI. Developed in partnership with VA Office of Women’s Health and Office of Mental Health, this proposal aligns with key VA operations and HSR priorities including women’s health, mental health, maternal health, peer support, and Veteran engagement, and will fill a key gap in care for perinatal Veterans with SMI. INNOVATION & IMPACT: This research will not only set the foundation for the first perinatal mental health intervention for Veterans with SMI, but will also identify additional opportunities to strengthen VA perinatal mental health services and care coordination via an IIR submission in Year 3. SPECIFIC AIMS: 1) Engage Veterans and key VA clinical staff in identifying potential components of ROSE+; 2) Develop and refine the ROSE+ intervention; 3) Assess the feasibility, acceptability, and exploratory outcomes of ROSE+ in a pilot study. METHODOLOGY: Intervention development will be guided by the Transcreation Framework, an implementation science framework for community-partnered development of behavioral interventions for vulnerable populations. Aim 1: To assess the experiences, needs, and care preferences of perinatal Veterans with SMI and inform potential intervention components, I will conduct semi-structured interviews with pregnant and postpartum Veterans with SMI and VA women’s mental health providers, followed by focus groups with VA Maternity Care Coordinators and women VA peer specialists. Aim 2: Using Delphi methodology, I will present potential intervention components—drawn from existing interventions and accompanied by data from the literature and Aim 1 findings—to an expert panel of VA multilevel constituents to identify final components as well as adaptations to optimize fit to the target population and VA women’s health settings. I will then develop and refine the intervention prototype and materials with iterative feedback from partners and mentors. Aim 3: I will conduct a randomized feasibility pilot of ROSE+ compared to usual care including standard ROSE, with approximately 24 perinatal Veteran participants with SMI. The pilot will assess implementation outcomes, including acceptability and feasibility; feasibility of study processes including recruitment and randomization; and exploratory clinical outcomes. PATH TO TRANSLATION/IMPLEMENTATION: Results will inform a subsequent multisite efficacy study, for which I will seek independent VA funding in Year 5.