# “And in some cases, we're the best option:” A qualitative study of community‐based doula support for black perinatal mental health

## TL;DR

This study explores how community-based doulas can help improve mental health screening for Black women during pregnancy and postpartum.

## Contribution

The study provides new insights into the role of community-based doulas in addressing mental health disparities among Black perinatal women.

## Key findings

- Over half of doulas supported using mental health screening tools with their clients.
- Four key themes emerged regarding screening acceptability and cultural considerations.
- Doulas identified ways to bridge mental health care gaps for Black women.

## Abstract

We explored community‐based doulas' perspectives on the acceptability of using formal screening tools to address low rates of mental health screening, diagnosis, and treatment for perinatal anxiety and depression among Black women. Using thematic analysis, we analyzed interview data from 30 community‐based doulas who support Black families during pregnancy, birth, and the postpartum period. Approximately 57% of community‐based doulas supported mental health screening; 23% opposed, and 20% were unsure of whether or not to screen. Four themes emerged from participants' responses, including (1) rethinking screening approaches and procedures; (2) cultural and contextual screening; (3) community‐based doula roles; and (4) client mistrust of mental health questionnaires. Additionally, there were four themes that highlighted community‐based doulas' perspectives of how they might advocate for this population, including (1) bridge to mental health; (2) identification and normalization of symptoms; (3) systemic issues; and (4) mental health specialization. Partnering with trusted community‐based doulas might improve perinatal mental health screening and prevention efforts for Black women experiencing perinatal anxiety and depression.

Black women are less likely to be screened, diagnosed, and treated for perinatal mental health disorders.Community‐based doulas may play a critical role in perinatal mental health care.More than half of community‐based doulas endorsed using validated screening tools with their Black perinatal clients.Acceptability for screening was underscored by rethinking screening approaches, attending to culture and context, considering community‐based doula roles, and understanding client mistrust.Community‐based doula‐identified support included identification and normalization of symptoms, bridging to mental health treatment, and obtaining a mental health specialization.

Black women are less likely to be screened, diagnosed, and treated for perinatal mental health disorders.

Community‐based doulas may play a critical role in perinatal mental health care.

More than half of community‐based doulas endorsed using validated screening tools with their Black perinatal clients.

Acceptability for screening was underscored by rethinking screening approaches, attending to culture and context, considering community‐based doula roles, and understanding client mistrust.

Community‐based doula‐identified support included identification and normalization of symptoms, bridging to mental health treatment, and obtaining a mental health specialization.