Beyond Screening Tools: How Training and Scope Guidance Shape Doulas’ Pmad-Related Practice

Background and Purpose: Perinatal mood and anxiety disorders (PMADs) affect 1 in 5 pregnant and postpartum individuals in the U.S. Untreated PMADs are a leading cause of suicide and accidental overdose in birthing parents. Doulas are positioned to facilitate detection of and treatment for PMADs. However, PMAD-related doula training varies widely, with few quantitative studies on this topic. Our study addresses this gap by examining how doulas’ PMAD-related preparation and professional context relate to two practice-relevant outcomes: (1) doulas’ perceived competence in recognizing PMAD symptoms; and (2) how often doulas engage in discussions with clients about perinatal mental health.

Methods: We administered a cross-sectional online survey to certified doulas across the

United States (N = 178) to assess PMAD training quality, perceived responsibility

to assess PMADs, psychosocial inquiry frequency, perceived competence in recognizing PMAD symptoms, comfort level in using screening tools and making referrals, continuing education, and practice characteristics. Participants comprised 178 doulas, 148 of whom completed the survey (Progress =100%); 30 provided partial responses. Most participants who responded to the gender identity item (n = 171) were women. Participants were 18 to 74 in age; 71.9% were White and 25.8% were Black, Indigenous, or a person of color. 57.9% held a bachelor’s degree or higher. Most were certified through a professional organization (68.0%) and self-employed (79.8%). The modal years of practice was 2 to 5 years (32.0%). Most participants who responded to the continuing education item (n = 152) had completed PMAD-focused professional development (76.3%).

Results: Participants reported moderately high training quality (M = 3.72, SD = 1.04 on a 1-5 scale). Perceived responsibility to assess was high (M = 4.71, SD = 0.45). Psychosocial inquiry frequency was also high (M = 4.49, SD =0.65). Perceived competence was moderately high (M = 4.32, SD = 0.83). On average, participants reported approximately two assessment barriers (M = 1.84, SD = 1.07) and offered nearly six referral resources to clients (M = 5.81, SD = 2.89). Most participants (79.2%) reported discussing emotional well-being routinely, and 53.9% shared resources to initiate conversations about mental health. While 28.7% endorsed screening tools as one approach to introducing mental health topics, only 9.4% (14 of 149 respondents to this item) used them.

Conclusions and Implications: Doulas build sustained relationships with birthing people and are positioned to recognize early signs of PMADs. This study demonstrates that the pathway from training to practice runs through perceived competence, and that scope clarity is the strongest predictor of that competence. By integrating these quantitative findings with qualitative insights, we can craft evidence-based recommendations for doula training. The goal is not to transform doulas into mental health screeners, but to equip them with the confidence, clarity, and relational skills needed to support perinatal mental health within a broader system of care.