Content warning: This story mentions thoughts of suicide.
Jan. 1, 2026
By Liam Boylan-Pett
When her grandmother died, Gabrielle Ekstrum did not cry. She was days away from giving birth to her second son, and she was focused on his arrival and all that she would need to do for him. But once Lukas was born, Ekstrum says, “I cried nonstop for two weeks.”
During her pregnancy, Ekstrum participated in Michigan State University’s Reach Out, Stay Strong Essentials, or ROSE program. The federally funded research program provided Ekstrum with education and skills needed to prevent or address postpartum depression, which impacts nearly one in eight women who give birth in the United States.
Ekstrum knew that the “baby blues” were common. These are emotional changes like sadness and irritability due to hormonal shifts, fatigue and stress in the aftermath of giving birth that often subside after a week or so. But thanks in part to her participation in the ROSE program, she also knew that two weeks of crying postpartum was much more serious. She was going through something else.
“My emotions were really heightened,” Ekstrum says. “I was struggling with always being sad but also feeling kind of numb. I had thoughts running through my head like, ‘The baby doesn’t even need me. Why am I here?’ And having those thoughts was really, really scary.”
She also knew that she had to do something about it. After participating in the ROSE program, Ekstrum knew there were resources available. So, she reached out to professionals who could help her manage postpartum depression. Her son Lukas is over a year old now and, while Ekstrum says she still doesn’t feel exactly like herself, she is making progress.
“I almost took my own life,” she says of when she was at her lowest. “And imagining my children growing up without me, it just seems like a selfish thing to do. I am happy that I reached out for help. Because if I didn’t, it could have been the worst.”
Ekstrum did not participate in the ROSE program while pregnant with her first son, Mattias, who was born in 2021. While going through the four-session program in 2024, however, she wished she had. Ekstrum realized she had struggled with postpartum anxiety after Mattias’ arrival.
Postpartum anxiety and postpartum depression can be mistaken for the baby blues, but postpartum depression symptoms are more intense and last longer. Parents struggling with the condition are more likely to deal with higher rates of postpartum substance abuse, domestic violence, infant mortality and even psychosis or suicide.
Research from the ROSE program shows that it prevents half of cases of postpartum depression. Not only are those results encouraging individually, but the findings are a cost-effective solution for the nation’s health care system. Setting up the ROSE program at an entire agency costs between $2,000 and $4,000 in staff time, while a single case of untreated postpartum depression costs an average of $34,000. Those costs can grow even higher in rural or underserved areas.
The ROSE program, which can be completed anywhere through online calls and videos, consists of four prenatal sessions and one postnatal session. Topics include education on postpartum depression, managing relationships and the transition to parenthood, self-care, assertiveness and goal setting.
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With such promising data, researcher Jennifer E. Johnson is working to take the ROSE program to a much wider audience. The founding chair of the Charles Stewart Mott Department of Public Health in the MSU College of Human Medicine based in Flint, Johnson and her longtime research partner Caron Zlotnick of Brown University are leading a study to determine whether national guidelines should recommend offering postpartum depression prevention programs like ROSE to everyone who is pregnant or only to moms at risk.
“As a research-intensive and community-engaged institution,” she says, “MSU exists to make life better for people and make the world a better place. So, to be able to prevent postpartum depression and reduce preventable suffering while improving happiness and support for families across the country — and hopefully across the world — is exactly what we’re supposed to be doing.”
Johnson and her team have helped 98 health and community agencies across 32 states and Puerto Rico implement the program, reaching more than 8,000 new parents.
Federal research funding from the National Institutes of Health was used to develop ROSE, to test it in randomized trials, to determine the best ways to implement ROSE nationally and, now, to test whether it should be offered to everyone who is pregnant. “Without federal funding, there is no way that we would be able to do this large national trial,” Johnson says.
“I think it is important for our health care system that we get the best practices out to everyone,” Johnson says. “We do not want people falling through the cracks.”
“I'm still alive,” Ekstrum says, “because of the ROSE program.” Thanks to the program, she knew to reach out for help early and, over time, she has seen improvement. And her family’s support is helping her feel more like herself.
A few months into treatment for her postpartum depression, Ekstrum was chatting with a friend online and she started laughing — really laughing, she says. Her husband, Kyle, whom Ekstrum says was so supportive throughout both pregnancies, told her he hadn’t heard her laugh in months.
“I feel like I’m getting better,” Ekstrum says, “and for other people to be witnessing it is reaffirming.”
Her kids notice, too. When she’s with them in the toy room or at the playground, Ekstrum says she no longer feels lost in her thoughts. She can engage and play with Mattias, 4, and Lukas — and she’s having fun. Mattias even told her he could tell she was happier.
“I’m doing this for the kids,” Ekstrum says. “I’m trying to be the best version of myself for them.”
Thankfully, Ekstrum is still here — for herself and for her family. And thanks to MSU’s ROSE program expansion to health and community agencies across the country, other parents will be too.
Learn more about the ROSE program and how to participate in a study.
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