Sunnyside for Moms, a new initiative at the UI Center on Depression & Resilience (UI CDR) combines cutting edge technology, enhanced mental health outreach efforts, and new opportunities to identify blood biomarkers for depression in an effort to help African American moms from low-income communities identify, manage, and treat perinatal depression. This is the kind of multidisciplinary approach integral to the UI CDR designation as part of the National Network of Depression Centers. It is the future of medicine and it is happening here.
In grad school, Jenna Duffecy was working on a health psychology project with cardiac arrest survivors and their spouses. It was a behavior change intervention that looked at diet, exercise, and medication adherence. Throughout a 12-week intervention for the group around 40 and above people had trouble staying engaged in the program—even when their lives depended on it. It occurred to her then that they needed other ways of providing care for people besides just face-to-face delivery. A few years later, that opportunity would present itself. The result would shape her career and influence the Sunnyside for Moms initiative she is currently developing in conjunction with the Center for Research on Women and Gender at the UI Center on Depression and Resilience.
It was the early aughts; smart phone technology didn’t really exist, online behavior change was limited to some weight loss programs, and no one was really tackling mental health in a digital space. After earning her Ph.D in Clinical Psychology, Dr. Duffecy took a research position. She agreed to work on a little grant project to develop a web intervention focused on depression working alongside a single programmer. As the technology developed, Duffecy found that she had a knack for connecting emerging technology with cognitive behavioral approaches.
“Smart phone apps, websites, text messaging, tablets—you name it and I have probably done something with it.” She explains. “I worked on close to 50 projects with a team of 12 programmers specializing in these kinds of interventions.”
Today, she is the Director of CBT Research and Services at UIC. She is a clinician in the Anxiety and Mood Disorders Clinic and a researcher. Combining the two in creative ways with available technology on behalf of the UI Center on Depression and Resilience has led to some innovative results.
“I have always believed strongly in the clinician/scientist model. That was part of the reason that I always kept a private practice when I was a researcher, because I am not sure how you can develop these kinds of interventions if you are not actively providing them.”
“If I wasn’t in this constant dialogue with people about it, I know I would miss opportunities to intervene as a researcher. I wouldn’t be as good at creating the kinds of interventions that I create if I wasn’t skilled at helping people to modify their thought.”
Most recently, the result is Sunnyside for Moms, an app that she developed in partnership with Dr. Pauline Maki, Director of the Center for Research on Women and Gender, focusing on pregnant low income minority women that show signs of depression. The six week trial included 25 subjects demonstrating symptoms of depression was successful. Participants were better able to manage their mood, manage stress, and approach the world in a way that previously didn’t seem possible.
“I would say that at least a good 30 percent of people enrolled in our trials had zero interest in pursuing traditional mental health, yet these were all folks who met the criteria for depression.“ Duffecy adds. “They needed help, but they weren’t going to get it the way that it is currently available.”
For Dr. Maki, the process starts even further upstream, determining how to identify and screen pregnant moms for depression. The same barriers to care that required the team to get creative with interventions after they showed signs of depression existed before they were even screened. These women were not accessing traditional health care, let alone seeking mental health treatments, but if they were coming in to get routine check-ups during pregnancy it provided a window for Maki to act.
Over the past 20 years, the Center for Research on Women and Gender has focused on how women’s mood and cognition changes across the menstrual cycle as hormones fluctuate. Their largest effort right now is concentrated on pregnant women and began with an intriguing opportunity. The National Network for Depression Centers Women’s Mental Health Taskforce had just created a common instrument to assess mental health history, socio-demographics, and screen for depression and anxiety so that the same scales were being used nationwide. Simultaneously, an initiative through the Vice President for Health Affairs extended the offer to researchers to discount processing fees for blood if used for extra clinical labs.
When she first heard about the opportunities she put them together immediately, here was an opportunity to bank blood on the women that had just completed the scale. If the women were at-risk for perinatal or postpartum depression they could look at the biomarkers as well. Maki’s talent for connecting the dots in unconventional ways is a characteristic that runs throughout this project.
“We focused on perinatal and submitted a grant to do universal screening on pregnant women at UIC. We serve largely poor, urban minority women and we have a philosophy that these are women that there is a probability they have experienced depression before, but they don’t present themselves to be screened or assessed, because they don’t access the health care system frequently.” Maki elaborates. “Pregnancy allows them to do that.”
The research program is two pronged.
First, they trained all the OBGYN providers—physicians, nurses, midwives, attendees, residents—on how to use the PhQ9, a validated tool for screening depression that can help make the distinction between pregnancy related depression and clinical depression.
Second, they created protocols to follow up on screens for depression, so that appropriate interventions can be created that account for the social, cultural, and physical barriers to receiving care. This includes the CBT app, developing a protocol where CBT can be delivered over the phone, and administering a group therapy.
“The work we are doing in this area is pretty novel, but we need a lot of support to do it. We need changes in policies that can pay for these novel treatments and we need people who are willing to donate.” Maki notes. The Sunnyside for Moms project just successfully completed its first 6 week trial and is in the midst of its next phase. Additional funding is needed to provide follow up care.