At the University of Texas, a specialized research lab focusing onpostpartum depression is working on a tool that uses artificial intelligence (AI) to bridge the gap between mental health care and support for women facing symptoms of the condition. The AI chatbot will be available through a free app being developed by the nonprofit organization Postpartum Support International, UT’s partner in the research. According to Postpartum Support International, the app will be available in 2024.
Dr. Denise De Los Santos is a board certified OBGYN at UT Health Rio Grande Valley and fellow of the American College of Obstetrics and Gynecology. According to De Los Santos, symptoms of postpartum depression are common. She often observes new mothers attempting to ignore their emotions. Many women “shrug off” symptoms of Perinatal Mood and Anxiety Disorder (PMAD), also known as postpartum depression, for fear of being dubbed a bad mom, said De Los Santos.
“Most women don’t want to admit that they’re having trouble because they’re worried about their family members or partners. You know,whoever is going to judge them for having a difficult time,” De LosSantos said.
PMAD is linked to reduced rates of breastfeeding initiation,impaired maternal and infant bonding, and higher chances of developmental delays in infants, according to the CDC. If left untreated, PMAD can have negative effects on the mother's well-being that can lead to sleep, eating, and behavioral issues for the child.Extreme symptoms can also include suicidal thoughts or thoughts of infanticide. According to the Texas Department of State Health Services, mental health conditions areone of the leading pregnancy-related causes of death in Texas.
While social stigma can perpetuate new mothers’ silence and feelings of inadequacy, PMAD treatment can additionally require large out-of-pocket costs, barring low-income or Medicaid recipients from seeking necessary support for postpartum depression, said De Los Santos.
In 2021, nearly half of all Texas births, about 180,000, were paid for through Medicaid, according to the nonpartisan health research organization Kaiser Family Foundation.
Automating a solution
Researchers at UT say their chatbot offers a way to break the stigma mothers experiencing symptoms of PMAD can face, especially those maneuvering a realm of healthcare financial barriers.
“A lot of them (women) just felt so misunderstood and so invalidated,” said Miriam Mikhelson, a former clinical psychology graduate student who participated in lab research for the University of Texas. “It’s not only so hard to find time and money and availability to see somebody that could potentially help… but even when you do, you still might end up with someone who is just not addressing your needs.”
The UT research team used data from a text helpline operated by Postpartum Support International, as well as posts to the social media site Reddit, to train an algorithm that addresses common postpartum concerns.
Currently in testing, the chatbot targets top concerns for postpartum women, including breastfeeding and intrapersonal problems. This technology offers women a judgement free space to discuss or confide problems 24/7, according to chatbot designer and UT electrical and computer engineering doctoral student Xuewen Yao.
De Los Santos said more help is needed for not only new moms but across the entire mental healthcare sector.
"There is a mental health crisis is the United States and perinatal mood disorder is not an exception to that,” said De Los Santos. “I think that goes to just using what is available, you know. I think not everybody has access to conventional mental health resources.”
The increasing use of AI prompts some mental healthcare providers,like Rebeka Villarreal, a licensed therapist at Just Mind in Austin, to raise ethical considerations, including questions about data storage and access. Moreover, Villarreal worries women might use AI as a treatment stand-in rather than a preliminary resource.
“I think AI is kind of like in this really kind of sexy, elusive state where people are feeling I think romanticized by it,” said Villarreal. “What concerns me about AI is that it’s only as smart as it’s programmed, right? There aren’t guardrails on it. It’s not a treatment substitute.”
AI technology lacks the ability to measure and monitor progress,develop rapport and offer genuine empathy, she said.
Mikhelson, who helped with the UT research, emphasized that the teamdid consider the ethics involved with serving the particularlyvulnerable population of moms suffering from postpartum depression.
“Part of that is making it really clear that this is not human,”said Mikhelson. “We also want to make sure that we’re clear that we don’t provide any kind of crisis support.”
As part of its design, the chatbot will explicitly state these limitations and refer anyone indicative of crisis to an emergency hotline.
Texas’ plan
The Department of State Health Services is also seeking solutions for new mothers.
Texas Health Steps, an online informational guide produced by Texas Medicaid, urges doctors to screen for postpartum depression during a new mom’s first checkup following the birth. While nearly 40% of new mothers fail to attend postpartum visits, they’re more likely to attend infant checkups.
As a result, the state now offers incentives to healthcare providers for screening women for postpartum depression during 3-, 6-, and9-month infant wellness checks.
Additionally, this year the Texas Legislature passed a bill extending Medicaid coverage for new mothers for up to one year.Previously, coverage was only available for two months after birth.
In 2021 the state released a five-year strategic plan to address postpartum depression, including raising awareness among healthcare providers, establishing a referral network of community-based mental health providers and support services, and increasing women’s access to formal and informal peer support services.
According to Mikhelson, chatbots like the one she developed at UT aren’t intended to replace these traditional healthcare services.
“There’s just already such a gap in the help that’s needed by postpartum populations,” Mikhelson said. “Postpartum mood and anxiety disorders are just so common and so important to address.”
Haley McLeod received a degree in journalism from Texas State University and is an intern for Texas Community Health News, a collaboration between the School of Journalism and Mass Communication and the university's Translational Health Research Center. TCHN stories, reports and data visualizations are provided free to Texas newsrooms.
