Bridges to treatment satisfaction: the roles of trauma, social support, race and ethnicity among perinatal women receiving behavioural activation therapy.

Background: High treatment satisfaction is related to improved treatment adherence and outcomes in psychotherapy research. Satisfaction with psychotherapy treatment among racially and ethnically diverse perinatal populations with post-traumatic stress (PTS) remains understudied. The aims of this study are to examine the relations between PTS symptoms, perceived social support, and race and ethnicity, and treatment satisfaction among perinatal women receiving behavioural activation (BA) psychotherapy.

Methods: This is a mixed-methods study of the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial-a large, multi-site, non-inferiority trial for perinatal women with depressive and anxiety symptoms (NCT04153864). A two-sample t-test compared baseline PTS symptoms, social support, and treatment satisfaction between participants from white and racial and ethnic minority groups. Hierarchical multiple linear regression examined whether PTS symptoms, perceived social support, race and ethnicity predicted treatment satisfaction. Content analysis of open-ended responses explored facilitators and modifications for improving treatment satisfaction across PTS symptom severity and race and ethnicity.

Results: Of 1230 women, 1119 (90.98%) had ≥ 1 BA session. Compared to their white counterparts, baseline PTS symptom severity was higher (t(1087) = - 4.98; p < 0.001; 95% CI = - 2.23, - 0.97), and social support lower (t(1087) = 8.05; p < 0.001; 95% CI = 0.43, 0.71) among racial and ethnic minority women. Lower baseline PTS symptom severity (β = - 0.009; 95% CI = - 0.016, - 0.002) and higher perceived social support (β = 0.042; 95% CI = 0.013, 0.072) were associated with higher post-treatment satisfaction across the sample. Descriptive analysis revealed no differences in treatment satisfaction across race and ethnicity; treatment satisfaction was higher for racial and ethnic minority women when social support was added to the regression model (β = 0.077; 95% CI = 0.005, 0.149). Content analysis (n = 807) revealed no differences by PTS symptoms severity or race and ethnicity across reported facilitators and modifications. BA as a treatment modality (n = 446, 55.27%) was a key facilitator; modifications included more sessions (n = 202, 25.03%).

Conclusions: PTS symptom severity and social support predict treatment satisfaction among racially and ethnically diverse perinatal populations and should be considered when delivering psychotherapy.

Trial registration: ClinicalTrials.gov NCT04153864. Registered on November 6, 2019.