Perinatal Depression: What Is Technology's Role for Better Care?

Mom goes on computer with baby in arms.

Source: Photo from Sarah Chai from Pexels

More than half a million new moms will suffer from depression within the first year. Even though the numbers are staggering, depression can present itself in so many different ways, making it challenging to accurately diagnosis and provide the most effective treatment recommendations. Technology, from data, AI, even wearables and patient social media and internet activity, may help move the needle on caring for these moms -- and others.

That’s where my colleague and friend, Khatiya C. Moon, comes in. Dr. Moon is a reproductive psychiatrist, collaborative care psychiatrist, and investigator at the Feinstein Institutes for Medical Research and Northwell Health, New York’s largest health system. She is researching how to best implement technology for those new moms and others and better bridge the gap between research and clinical practice.

I had the opportunity to ask Dr. Moon a few questions about her work, what led her down this path and where she sees technology headed in the not-so-distant future.

Michael: Thank you for doing this! Tell us about your research.

Khatiya: I'm a reproductive psychiatrist and collaborative care psychiatrist. That means I work with medically complex patients experiencing depression and anxiety. My research is focused on how digital tools can improve healthcare for medically complex patients, particularly women in the peripartum period.

Michael: Why did you get involved with this area? And why mental health care for you, personally?

Khatiya: I never thought I'd be a researcher, or a psychiatrist, until well into medical school. I thought I would be a global health doctor, traveling the world to fight rare diseases.

While doing a few rotations in sub-Saharan Africa, I saw how simple technologies, even as simple as a caseload registry, could be mined to answer hugely important research questions about clinical care. That’s when I got interested in how tech can expand healthcare capacity in under-resourced settings.

That naturally led me to psychiatry. There’s such a great need for psychiatric care; one doesn’t need to travel far to see that. And I realized that personally, it was more rewarding for me to help people with ordinary, common problems (like depression and anxiety) than esoteric problems (like rashes caused by rare bacteria).

Now, as a reproductive psychiatrist, I’m privileged to work with new moms undergoing postpartum depression—it’s such an honor to help families in that stage of life. And though there are common themes, every patient’s story is unique. That keeps my job endlessly interesting.

Michael: What are your big goals—what are you looking to take away?

Khatiya: A major problem in diagnosing and treating depression is its heterogeneity. If you go by the DSM-5 definition, there are literally hundreds of different ways to have depression. Most experts view what we currently think of as one category—depression—as actually a collection of other things that potentially have different causes and treatments. And we don’t currently understand all the differences between them. The result is that people in treatment go through a process of trial and error. It can take a long time to find the right treatment.

I see digital mental health research as having a role in improving our understanding of depression subtypes so that we can eventually personalize treatment much better than is currently possible. That’s because digital technology (wearables, EMR data, smartphone data) can get us to a level of behavioral granularity that we’ve never had before.

Michael: Any exciting milestones? Papers, trials, breakthroughs you can share?

Khatiya: We worked together on a study of the Google search activity of suicidal young people—harnessing the power of this novel tool as the first step towards improved identification of people with suicidal thoughts. I’m now a co-principal investigator on a study using a mobile app to decrease suicidality.

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Separately, I’ve been building expertise in using digital technology to care for medically complex patients. I published a review paper on the subject, published a pilot test of an app in this patient population, and I am now working on a study with the cardiology department. We’re investigating whether wearables can help predict psychiatric disorders in patients with heart problems.

Michael: And patient stories that stick with you—keep you going?

Khatiya: It always strikes me how many people view themselves as having a moral weakness when struggling with common problems like depression and anxiety. And the shame has yet another layer in the context of motherhood—people feel like they’re not allowed to have any negative feelings towards motherhood, making postpartum depression all the more stressful and isolating. I’m hoping that by improving access to psychiatric care, we can help chip away at those walls.

Michael: Adopting new methods and new practices can be slow—particularly in psychiatry. What can be done now to help advance that progress?

Khatiya: We need better systems for integrating research findings into practice. Even the most impactful, best-funded research study does no good by sitting in a journal where no one will read it. There are models for how to do this. Because of our size and administrative resources, the institutions I work for are potentially in a good position to mobilize and quickly pilot-test novel ideas that research tells us are effective. We’re already doing this with collaborative care—a proven method of providing behavioral health services to primary care patients in a one-stop shop. Since we started the collaborative care program at Northwell it has grown tremendously—where there’s a will, there’s a way.

Michael: Where do you see technology and psychiatry intersecting?

Khatiya: In addition to being a pathway towards novel ways to understand disease, technology will be crucial to implement the ideas we already know work. Scaling therapy treatments, increasing the capacity for measurement-based care, and improving communication between patients and providers; all of these will be made possible through technology.

Michael: Thank you so much for doing this and sharing. Looking forward to seeing where your research takes you.