Does an effective treatment for postpartum depression improve brain development and behaviour in children?

Brain Canada – Bell Let’s Talk clinical trial will determine if an app-based intervention for mothers can change their children’s brains

Canadian researchers are testing an innovative app-based therapy for postpartum depression and anxiety, and measuring whether improvements in a mother’s mental health result in changes to her child’s developing brain.

Funded by Brain Canada and Bell Let’s Talk, the randomized controlled clinical trial (RCT), called BEAM (Building Emotional Awareness and Mental Health), is recruiting 300 people with postpartum depression and/or anxiety symptoms. The first two groups of participants are running through the program now. The next two groups will start in spring 2025.

What’s really unique about this trial is that, in addition to assessing parental mental health before and after the intervention, researchers will also measure the ripple effect on their children. Postpartum depression affects about 12 per cent of new parents.

“Maternal mental health is doubly important,” says Dr. Catherine Lebel, a neuroscientist at the University of Calgary and one of the study leaders. “It’s important for the women, but also for the children and families. This is especially true in the early years — a time when we can set kids up for really strong trajectories of healthy development, or put them at risk of potential problems later on.”

As part of the BEAM trial, half of participants undergo the 10-week app-based intervention, which includes weekly videos, exercises, a social component, an online parent coach, and the support and supervision of a psychologist. The other half receive usual care. Researchers will assess parental mental health and stress before and after treatment, as well as the impact on the child’s behaviour.

Developed by BEAM co-leaders Dr. Lianne Tomfohr-Madsen of the University of British Columbia and Dr. Leslie Roos of the University of Manitoba, the program has been thoroughly pilot tested with strong results, but this is the first RCT and the first time that children’s brains have been studied to determine changes linked to their mothers’ mental health.

Starting in January 2025, researchers will use magnetic resonance imaging (MRI) to examine the brain structure and function in children, ages three and four, whose mothers have participated in BEAM.

The imaging study will investigate:

• the thickness of the cortex (the outer layer of the brain) and structural brain connectivity;
• the wiring of the brain, the white matter that connects different regions and facilitates communication;
• cerebral blood flow, metabolism and how different parts of the brain are working;
• brain function, and how coordinated different parts of the brain are in terms of their fluctuating signals.

Analysis of the data begins in about 18 months, when the study is complete, to determine if the program works for everyone, or only for some.  If successful, findings could be applied to other mental health conditions.

Winnipeg mother-of-two Ashley Pharazyn, who lived through postpartum anxiety five years ago after the birth of her second son, was among the first participants in the pilot testing of BEAM. She says the difference it in made in her life was remarkable.

She now works as a parent coach with BEAM, virtually connecting with 31 parents one-on-one every week. Ms. Pharazyn describes her own experience with postpartum anxiety as “an internal tornado. I didn’t recognize myself,” she says. “All of a sudden, I had become a parent who was really quick to anger. I became reactive. I yelled. That wasn’t who I was.”

At the end of the BEAM intervention, “I was a completely different person – for the better. I was able to understand what some of my signs and cues were when I was feeling really overwhelmed. I learned how to ask for help, which was something I really struggled with.” She now listens and shares her skills and strategies with others across Manitoba, and as far north as Churchill.

A huge potential benefit of BEAM is that it provides access to mental-health care for people who live in rural and remote areas, as well as those who may not have the ability to find psychological services.

If we can provide strong evidence that this is a really good program, then the next step is to talk to provincial governments and health authorities about how to scale it up, where the funding is going to come from, and who is going to be in charge of it.

Dr. Lebel