Study Status
Ongoing
Project Team
Research Faculty: Sona Dimidjian, PhD; Anahi Collado, PhD; Sam Hubley, PhD; Laurel Hicks, PhD; Antonella Onofrietti Magrassi, PhD
Peer Mentors and Trainers: Susannah Welch, MA; Shannon Beckner, BA; Gracia Deras; Isabel Almeida; Pia Long; Tamra Wiser; Lizbeth Clemente; Sondra Teske; Beatriz Ferrufino
Program Managers and Graduate Students: Desiree Bauer, MPH; Joey Levy, MA
Community Partners: Amistad; Everyday Health Group
Alignment with Crown Institute Vision
This project reflects the Crown Institute’s commitment to supporting the wellbeing of children by caring for the adults who care for them. The Institute’s work centers on practical, community-engaged research that strengthens families and supports mental health across the lifespan. Our study advances this mission by expanding Alma to have a train-the-trainer component (offered English and Spanish). This work is aimed to support and guide greater scalability and sustainability of the program.
Background & Context
Depression and anxiety during the perinatal period are significant public health concerns that affect both parents and their children. Rates of depression and anxiety are high, treatment access is low, and the risk of adverse consequences—ranging from obstetric complications to long-term mental health risks for families—are substantial. Many groups, including ethnic minority and low-income women, face additional barriers to receiving care.
Peer support has been widely used around the world to promote maternal health, and strong evidence shows that it can reduce depressive symptoms, increase social support, and improve overall wellbeing. Peer mentors often report personal benefits as well, and peer-led programs tend to align with women’s preferences, especially for those who are hesitant about medication or who rely on informal community networks.
A growing body of research also shows that the skills of behavioral activation (BA)—a practical, skills-based approach to treating depression—can be effectively delivered by trained lay providers and adapted for perinatal populations. BA skills can also be taught through digital self-management tools, offering another accessible path to support.
To build sustainable peer support systems in the U.S., the Train-the-Trainer (TTT) model offers a promising approach. By training peer mentors who can then train others, communities can rapidly increase their capacity to support perinatal women. This model is especially timely given the increased stress, anxiety, and depression experienced by pregnant and postpartum people, and the ongoing need for scalable, community-rooted mental health solutions.
Primary Aims
The aims of this study are to expand the Alma program using a train-the-trainer model. Alma is a peer mentoring program in which parents who have experienced and recovered from depression during the perinatal period, are trained to provide peer mentoring as a resource for depressed perinatal parents and their communities. The Alma program is a research-based peer-to-peer mentoring program that provides support to new and expectant parents. Alma was developed through the collaboration of researchers, mental health and perinatal care clinicians, community stakeholders, policy experts and women with a personal history of perinatal depression.
In the expansion of the Alma program, we aim to conduct an evaluation of the Alma peer mentor program delivered virtually through a the train-the-trainer model to assess the responsiveness of the Alma program to perinatal participants and communities and the impact of the Alma program on participant’s mental health during pregnancy and early parenting.
Research Methods
This study used an open trial methodology in which approximately 200 pregnant and women with children <1 years old were invited to participate in the Alma program. The Alma program was delivered by English and Spanish-speaking peer mentors. Peer mentors were trained by peer mentor trainers with the support of Alma experts. Peer mentor training was guided in part by a digital platform that supports the remote delivery of the Alma program. The Alma program included approximately 6-8 mentoring individual meetings delivered remotely via telephone and/or videoconference.
Key Findings & Publications /
Presentations
Manuscripts from this study are forthcoming.
Contact to Learn More
References
Abrams LS, Dornig K, Curran L (2009). Barriers to Service Use for Postpartum Depression Symptoms Among Low-income Mothers in the United States. Qual Health Res, 1z9(535).
Chowdhary, N., Anand, A., Dimidjian, S., Shinde, S., Weobong, B., Balaji, M., Hollon, S. D., Rahman, A., Wilson, G. T., Verdeli, H., Araya, R., King, M., Jordans, M. J. D., Fairburn, C., Kirkwood, B., & Patel, V. (2016). The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: Systematic development and randomised evaluation. The British Journal of Psychiatry, 208(4), 381–388. https://doi.org/10.1192/bjp.bp.114.161075
Dennis, C. L. (2003a). The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry, 48:61–70.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., Atkins, D. C., Dunner, D. L., & Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658–670. https://doi.org/10.1037/0022-006X.74.4.658
Dimidjian, S., Goodman, S. H., Sherwood, N. E., Simon, G. E., Ludman, E., Gallop, R., Welch, S. S., Boggs, J. M., Metcalf, C. A., Hubley, S., Powers, J. D., & Beck, A. (2017). A Pragmatic Randomized Clinical Trial of Behavioral Activation for Depressed Pregnant Women. Journal of Consulting and Clinical Psychology, 85(1), 26–36. https://doi.org/10.1037/ccp0000151