Maternal mental health is a critical public health component of perinatal care and maternal safety. Postpartum depression can have lasting consequences for the mother, child, and family. After each birth, 1 in 7 women will experience postpartum depression.

A team of researchers from Michigan State University, Care New England Health System and Henry Ford Health is collaborating on a $6.2 million National Institutes of Health mental health research grant, “The ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention.”

The Reach Out, Stand Strong, Essentials for New Mothers program, funded by NIH through the end of 2022, has served low-income women at 98 prenatal clinics. Study findings show that ROSE prevents half of the cases of postpartum depression. Additionally, health care and community agencies find it is more feasible to provide ROSE as universal prevention for all women.

“Postpartum depression causes suffering for mothers and can slow child development,” said Jennifer Johnson, C.S. Mott Endowed Professor of Public Health at MSU's College of Human Medicine and one of two PIs on the grant.

“The newly funded program will be the first study to look at the effectiveness of postpartum depression among a general population of women and women screening negative for postpartum depression risk,” said Caron Zlotnick, one of two PIs on the grant and professor of Psychiatry and Human Behavior, OB/GYN and Internal Medicine at the Warren Alpert Medical School of Brown University and Director of Research for the Department of Medicine at Women and Infants Hospital. “If we find the intervention is effective, we can work to scale up the program, strengthen families while supporting moms, and reduce costs within the health care system.”

Michigan State University is partnering with Henry Ford Health to offer ROSE to all pregnant patients by adding ROSE to Childbirth Education offerings. The grant will support the expansion of the program for several years to come and help researchers determine if all pregnant women or only those at high risk should be given the opportunity to participate in ROSE, an evidence-based postpartum depression prevention intervention.

Amy Loree, Assistant Scientist at Henry Ford Health, will serve as study site co-investigator on the project.

“We’re very excited to be collaborating with the study team and to be able to offer this preventive service to our patients,” said Loree. “Improving perinatal mental health care through effective prevention approaches like ROSE is critical to improving health and well-being for birthing people and their families.”

“The U.S. Preventative Services Task Force recommends that women at risk for postpartum depression receive these preventive interventions. However, our experience implementing ROSE across the country suggests that a universal intervention may be better; easier for agencies, less stigmatizing for mothers, and no one is missed,” Johnson said.

Additionally, “Women who already face societal stigma can fear the consequences of seeking mental health support,” added Johnson. “Utilizing a universal prevention model will help to reduce that stigma, remove barriers to help, and make maternal mental health support available to every mom.”

The ROSE scale-up project will assess the effectiveness, cost-outcome, equity, and scalability of a universal (i.e., available to everyone) vs. selective (i.e., available to only moms determined to be at risk) postpartum depression prevention model using commonly available and existing screening tools.

Postpartum depression is a common and detrimental public health concern. The postpartum period places women at increased risk for a major depressive episode. No method of determining who is at risk is perfect. Offering ROSE to only women determined to be at risk may miss women who could benefit from ROSE.

“In the seven-and-a-half years since the Division of Public Health’s founding in Flint, faculty have been awarded more than $100 million in research funds,” said Aron Sousa, dean of the MSU College of Human Medicine. “This milestone is only made possible through collaboration, community partnership, and this latest grant from NIH. Scaling up this study across the United States will help to strengthen families at a critical time in an infant’s development.”

ROSE has been recommended by the U.S. Preventative Services Task Force for women at risk for postpartum depression. The intervention is freely available to agencies and providers. The curriculum is highly structured, easy to learn, and available in Spanish and English. It does not require a mental health professional. ROSE can be offered in various settings, including prenatal clinics, doula organizations, home visiting programs, and WIC agencies.

"Those who can work to reduce health disparities must accept that challenge as an imperative, especially when it comes to equity in maternal health," said Norman J. Beauchamp Jr., executive vice president for health sciences at MSU. “With these organizations, we have a shared commitment to diversity, equity and inclusion, which means addressing and eliminating historical inequities in health care across our state. This research and outreach program will bring health, hope and healing to more mothers and work to scale an important effort.”