Emory University School of Medicine researchers, in partnership with the University of Missouri Kansas City (UMKC), have been awarded a five-year, $6 million award from the Patient-Centered Outcomes Research Institute (PCORI) to conduct a study aimed at improving health outcomes for pregnant Black women. The study will assesspost-traumatic stress disorder (PTSD) screening approaches among pregnant Black women, a population at high risk for trauma-related mental health issues.
The multi-site trial will compare the effectiveness of two active screening interventions in improving PTSD symptoms, maternal perinatal care utilization, satisfaction with mental healthcare services and maternal health and birth-related outcomes for Black women. The research team aims to determine the best approach for screening for PTSD during prenatal visits at obstetrics clinics serving Black women with limited socioeconomic resources.
"Black women with limited socioeconomic resources face particularly high levels of trauma and related mental health problems, including PTSD," says co-principal investigator Abigail Powers Lott, PhD, associate professor, Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. "Pregnancy presents a critical opportunity to intervene and address PTSD, as it can have intergenerational impacts and is associated with adverse birth outcomes."
Lott is director of treatment research and education of the Grady Trauma Project (GTP), a large-scale interdisciplinary clinical research program focused on investigating the impact of trauma exposure and related mental health disorders in urban populations, particularly among disadvantaged communities.
Prior work by Lott and co-principal investigator, Briana Woods-Jaeger, PhD, associate professor at Emory Rollins School of Public Health (RSPH), laid the groundwork for this important comparative effectiveness trial. This study will be a collaboration between Lott at GTP and Woods-Jaeger's THRIVE (Together promoting Health and Resilience through Interventions, Voice, & Equity) lab, where she serves as director.
The PCORI-funded study will recruit 804 trauma-exposed pregnant Black women ages 18 or older who are in their first trimester of pregnancy. The research team will collaborate with Grady Health System in Atlanta and Truman Medical Center in Kansas City, MO for participant recruitment and data collection.
Participants will be randomized to receive either a standardized brief screening for PTSD commonly used in medical clinic settings or Screening, Brief Intervention and Referral to Treatment (SBIRT). SBIRT is a 20- to 30-minute intervention led by a trained lay provider that includes standardized screening with validated measures, psychoeducation, motivational interviewing strategy components to promote awareness of psychological symptoms and engagement in relevant resources and coping skills training.
The study's primary outcome will be the change in PTSD symptoms, with secondary outcomes including perinatal care utilization, engagement in mental health care, preterm birth, infant birth weight and maternal morbidity.
"This trial has the potential to provide valuable insights into the implementation of PTSD screening in urban obstetrics clinics, ultimately advancing care for pregnant Black women nationwide," says Woods-Jaeger. "By identifying effective screening and intervention strategies, we hope to improve maternal mental health and reduce adverse birth outcomes in this vulnerable population."
A variety of stakeholders have been involved in the development of the project and will continue to provide input throughout the study. This includes the THRIVE community action board, which is comprised of Black mothers with lived experiences of trauma, healthcare providers, early childhood service providers, community advocates, healthcare administrators, insurance providers and current Black pregnant patients at participating clinics.
"We are committed to ensuring that our research is community-driven and culturally responsive," says Megan Lawley, MD, MPH, assistant professor in the Emory Department of Gynecology and Obstetrics (GYN/OB), a co-investigator on the project. "By actively involving stakeholders in the research process, we aim to address the unique needs of pregnant Black women and improve outcomes for both mothers and babies."
The study, titled "Comparing Two Screening Approaches for PTSD to Enhance Health Outcomes in Pregnant Black Women," will last from July 1, 2024, to June 30, 2029. The findings hold promise in shaping national protocols and advancing care for pregnant Black women nationwide.
Emory collaborators on the study also include Melvin Livingston from RSPH and Sheree Boulet from GYN/OB. The UMKC investigators involved are Tiffany Ruffin and Traci Johnson.
