Opportunities and Challenges in Using Smartphone Sensor Data to Capture Surgeon Behavior and Well-Being: A Qualitative Analysis of Surgical Residents' Perspectives.

PURPOSE Colorectal cancer (CRC) screening is not routinely performed in Egypt, and more than one third of CRC cases occur in individuals age 40 and younger, with overall survival estimated at only 2 years, presumably because of late diagnoses. To lay the foundation for the development of a CRC multilevel screening program in Egypt to promote CRC prevention and early detection, this qualitative study aimed to explore the potential barriers to and facilitators of screening from the perspectives of physicians and residents in Alexandria. METHODS We conducted one-on-one, 1-hour, semistructured interviews with primary health care physicians and specialists—oncologists and gastroenterologists—practicing in Alexandria, Egypt. Focus groups of residents, stratified by social class and gender, were also held. Interviews and focus groups were conducted in Arabic by trained interviewers/moderator, and were audio recorded, transcribed, translated into English, and analyzed using thematic analysis. RESULTS Seventeen physicians participated—8 specialists and 9 primary care physicians—and 7 focus groups—7 to 8 participants each—were held. According to both interview and focus group participants, individual-level barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention in the culture, fear, and cost. Provider-level barriers as mentioned by physicians included a belief that only high-risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately. Structural-level barriers, discussed by physicians and focus group participants, included cost and a lack of testing availability. Potential facilitators of screening mentioned by physicians included implementing a media campaign emphasizing early detection and curability. Focus group participants focused on making screening tests free or low cost, obligatory, and convenient. CONCLUSION On the basis of the perceptions of physicians and residents of Alexandria, Egypt, multiple barriers to and facilitators of CRC screening exist. Addressing these would be important in designing a successful screening program.

BackgroundWe present a digital phenotyping protocol designed to continuously and objectively measure behavioral, physiological, and contextual data during pregnancy and the postpartum period using passive sensing from Garmin smartwatches and smartphones, along with active ecological momentary assessments (EMAs). This novel protocol uniquely adapts to the unpredictable timing of childbirth, spanning from the third trimester through 6 weeks post partum, to accurately capture critical temporal changes and maternal-infant outcomes. By providing high-frequency real-time data, this methodology offers comprehensive insights into pregnancy-related behaviors and physiological processes, overcoming the limitations of traditional retrospective self-report methods.ObjectiveWe aim to develop a protocol for longitudinal data collection supporting digital phenotyping that is optimized for pregnancy and the postpartum period. This protocol leverages the pregnant population’s heightened interest in health and tracking. It aims to minimize the burden on the participants, increase retention, and assess the value of wearables compared to smartphones to determine the appropriate data collection methods.MethodsData will be collected from 30 nulliparous participants from the start of the third trimester through 6 weeks post partum. This protocol uses 3 distinct 1-time surveys, alongside daily and weekly EMAs, to capture real-time maternal experience data. Passive maternal data—such as activity, vitals, sleep, and location—are collected via smartphones and Garmin smartwatches. Participants are expected to log data about the newborn after delivery through the mobile app Huckleberry. This protocol was developed in collaboration with the Northeastern University Sath Laboratory, which focuses on digital phenotyping and longitudinal data collection, and the Tufts Medical Center’s obstetrics and gynecology department, which has expertise in working with the pregnant population.ResultsThis study was funded in August 2024. Data collection is projected to run from October 2025 to July 2026. As of September 2025, the study has been approved, and recruitment and data collection are to begin. The results are expected to be published by August 2026. We plan to assess the retention rates, survey and EMA completion rates, wear time of the smartwatch without intervention, and data volume logged in the Huckleberry app. In addition, we will perform digital phenotyping to determine whether the data collected during pregnancy can be used to predict breastfeeding outcomes, delivery outcomes, and maternal-infant well-being.ConclusionsThis protocol integrates the use of digital phenotyping in pregnancy and postpartum research, providing a novel method for capturing real-time indicators of maternal well-being. It will determine the expected rates of data completion and appropriate sample size using a power analysis for a more extensive future study. By integrating smartphone and wearable sensor data, this protocol has the potential to transform the way maternal health clinical interventions are designed and implemented in the future.International Registered Report Identifier (IRRID)PRR1-10.2196/77175

IMPACT: Better understanding how clinicians make decisions about pain management, particularly since our prior research has demonstrated that opioids prescribed at discharge is the strongest predictor of opioids taken, is critical to decrease high-risk medication prescribing while preserving high-quality care. OBJECTIVES/GOALS: (1) Identify major biological, psychological, and social determinants of medical and surgical residents’ pain management decisions; (2) Determine salient themes regarding the experience of residents in the management of acute and chronic pain METHODS/STUDY POPULATION: Focus groups of internal medicine and general surgery residents at an academic, tertiary care training hospital located in an urban setting were conducted. Due to the COVID-19 pandemic, all focus groups were conducted virtually and occurred during required didactic sessions to facilitate participation. All interviews were recorded and transcribed. Two reviewers independently reviewed and coded the data following the principles of constructivist grounded theory. RESULTS/ANTICIPATED RESULTS: 42 residents participated in ten focus groups ranging in size from two to five individuals. Six themes emerged demonstrating salient BPS factors in pain management decisions: (1) patient and clinician expectations determine what is considered normal/acceptable; (2) inability of pain scales to reliably capture patient pain; (3) desire for more objective methods of pain assessment, while simultaneously recognizing that pain is an inherently subjective experience; (4) difficulty in determine when pain is 'real’ or 'legitimate'; (5) lack of education and protocols regarding pain management; (6) the importance of engaging other services such as acute pain service or nurse educators in complicated situations. Junior residents often expressed doubt in the appropriateness of their approaches and decisions. DISCUSSION/SIGNIFICANCE OF FINDINGS: Surgical and medical trainees routinely treat pain and may struggle, particularly in the early phases of training, to determine if pain levels are appropriate. There is also a lack of education and/or best practices for assessing and managing pain. These areas represent high-value, clinician-focused targets for future interventions to improve care.

Surgical Trainee Perspectives on the Opioid Crisis: The Influence of Explicit and Hidden Curricula

BACKGROUND We present a digital phenotyping protocol designed to continuously and objectively measure behavioral, physiological, and contextual data during pregnancy and postpartum periods using passive sensing from Garmin smartwatches and smartphones, along with active ecological momentary assessments (EMAs). This novel protocol uniquely adapts to the unpredictable timing of childbirth, spanning from the third trimester through six weeks postpartum, to accurately capture critical temporal changes and maternal-infant outcomes. By providing high-frequency real-time data, this methodology offers comprehensive insights into pregnancy-related behaviors and physiological processes, overcoming limitations of traditional retrospective self-report methods. OBJECTIVE The objective is to develop a protocol for longitudinal data collection supporting digital phenotyping that is optimized for pregnancy and postpartum. This protocol leverages the pregnant population’s heightened interest in health and tracking with over 50% using mobile health apps [1]. This protocol aims to minimize burden on the participants, increase retention, and assess the value of wearables compared to smartphones to determine appropriate data collection methods. METHODS Data will be collected on 30 nulliparous participants from the start of the third trimester through 6 weeks postpartum. This protocol utilizes three distinct one-time surveys, alongside daily and weekly Ecological Momentary Assessments (EMA), to capture real-time maternal experience data. Passive maternal data - such as activity, vitals, sleep, location - are collected via smartphone and Garmin smartwatch. Participants are expected to log data about the newborn after delivery through the mobile application Huckleberry. This protocol was developed in collaboration between the Northeastern University SATH Lab who focus on digital phenotyping and longitudinal data collection and Tufts Medical Center Obstetrics and Gynecology who have expertise working with the pregnant population. RESULTS The planned completion date is December 2026, with a manuscript published afterward. We plan to assess retention rates, survey and EMA completion rates, track wear time of smartwatch without intervention, and data volume logged in Huckleberry. CONCLUSIONS This protocol integrates the use of digital phenotyping in pregnancy and postpartum research, providing a novel method for capturing real-time maternal well-being indicators. It will determine expected rates of data completion and appropriate sample size using a power analysis for a more extensive future study. By integrating smartphone and wearable sensor data, this protocol has the potential to transform the way maternal health clinical interventions are designed and implemented in the future.

BackgroundSocial anxiety disorder is a highly prevalent and burdensome condition. Persons with social anxiety frequently avoid seeking physician support and rarely receive treatment. Social anxiety symptoms are frequently underreported and underrecognized, creating a barrier to the accurate assessment of these symptoms. Consequently, more research is needed to identify passive biomarkers of social anxiety symptom severity. Digital phenotyping, the use of passive sensor data to inform health care decisions, offers a possible method of addressing this assessment barrier.ObjectiveThis study aims to determine whether passive sensor data acquired from smartphone data can accurately predict social anxiety symptom severity using a publicly available dataset.MethodsIn this study, participants (n=59) completed self-report assessments of their social anxiety symptom severity, depressive symptom severity, positive affect, and negative affect. Next, participants installed an app, which passively collected data about their movement (accelerometers) and social contact (incoming and outgoing calls and texts) over 2 weeks. Afterward, these passive sensor data were used to form digital biomarkers, which were paired with machine learning models to predict participants’ social anxiety symptom severity.ResultsThe results suggested that these passive sensor data could be utilized to accurately predict participants’ social anxiety symptom severity (r=0.702 between predicted and observed symptom severity) and demonstrated discriminant validity between depression, negative affect, and positive affect.ConclusionsThese results suggest that smartphone sensor data may be utilized to accurately detect social anxiety symptom severity and discriminate social anxiety symptom severity from depressive symptoms, negative affect, and positive affect.

Purpose Focus groups are a qualitative method of collecting data by engaging a small group of participants in a structured discussion about a specific topic. When research centers on a social issue or a minoritized population, focus groups can serve as a particularly powerful method for data collection by empowering participants and making them a partner in the research process. Focus groups conducted with transgender and gender diverse participants, specifically, have been found to have positive outcomes, such as promoting a sense of belonging and the opportunity to connect with other TGD individuals. Although previous studies have established the potential for focus groups to promote positive outcomes among TGD participants, there is a need for quantitatively testing specific positive outcomes of TGD individuals participating in focus groups. The current study aims to evaluate the effects of focus group participation on a sense of pride and community connectedness among TGD individuals. Method Focus groups were conducted to explore the construct of gender euphoria and the role of art in eliciting it. The present study is centered around both the qualitative feedback from participants as well as the quantitative results of the pre- and post-focus group surveys. Each participant completed a survey before and after participating in the focus group. Results Participation in focus groups was found to increase a sense of pride among TGD individuals. In contrast to what was expected, however, focus group participation did not lead to an increase in a sense of community connectedness. Despite this, the qualitative data show that participants did engage in acts of community connectedness, such as resource sharing. Conclusion These findings highlight the beneficial attributes of focus group methodology.

Background Anti-racism curricula are increasingly being recognized as an integral component of medical education. To our knowledge, there has not yet been a publication exploring resident perspectives from multiple institutions and explicitly representing both underrepresented in medicine (UIM) and non-UIM perspectives. Objective To explore and compare UIM and non-UIM pediatric residents’ perspectives on the content and qualities of meaningful anti-racism curricula. Methods We performed an IRB-approved multi-institutional, qualitative study that incorporated Sotto-Santiago et al’s conceptual framework for anti-racism education. Between February and May 2021, we conducted focus groups of UIM and non-UIM pediatric residents at three large residency programs in the United States. We developed focus group guides using literature review, expert consensus, feedback from study team racial equity experts, and piloting. Focus groups were conducted virtually, audio-recorded, and transcribed verbatim. We employed thematic analysis to code transcripts, create categories, and develop themes until we reached thematic sufficiency. We completed member checking to ensure trustworthiness of themes. Results Forty residents participated (19 UIM and 21 non-UIM) in a total of six focus groups. We identified 7 themes, summarized as: 1) racism in medicine is pervasive, therefore (2) anti-racism education is critical to the development of competent physicians, and 3) education should extend to all healthcare providers. 4) Residents desired education focused on action-oriented strategies to advance anti-racism, 5) taught by those with both learned and lived experiences with racism, 6) in a psychologically safe space for UIM residents, and 7) with adequate time and financial resources for successful implementation and engagement. Conclusion Our multi-institutional study affirms the need for pediatric resident anti-racism education, promotes co-creation as a method to affect culture change, and provides practical strategies for curricular design and implementation.

Digital phenotyping is a process that allows researchers to leverage smartphone and wearable data to explore how technology use relates to behavioral health outcomes. In this Research Concepts article, we provide background on prior research that has employed digital phenotyping; the fundamentals of how digital phenotyping works, using examples from participant data; the application of digital phenotyping in the context of substance use and its syndemics; and the ethical, legal and social implications of digital phenotyping. We discuss applications for digital phenotyping in medical toxicology, as well as potential uses for digital phenotyping in future research. We also highlight the importance of obtaining ground truth annotation in order to identify and establish digital phenotypes of key behaviors of interest. Finally, there are many potential roles for medical toxicologists to leverage digital phenotyping both in research and in the future as a clinical tool to better understand the contextual features associated with drug poisoning and overdose. This article demonstrates how medical toxicologists and researchers can progress through phases of a research trajectory using digital phenotyping to better understand behavior and its association with smartphone usage.

Labor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized. To understand experiences with unionization among general surgery residents and residency program faculty and staff. This exploratory qualitative study included data from the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) trial. In the exploratory phase of the SECOND trial (from March 6, 2019, to March 12, 2020), semistructured interviews about wellness were conducted with residents, faculty (attending physicians), and staff (program administrators) at 15 general surgery residency programs. Unionization was identified as an emergent theme in the interviews. Data analysis was performed from March 2019 to May 2023. The main outcome was resident and faculty experience with resident labor unions. In the qualitative analysis, lexical searches of interview transcripts identified content regarding resident labor unions. A codebook was developed inductively. Transcripts were coded by dyads, using a constant comparative approach, with differences reconciled by consensus. A total of 22 interview transcripts were identified with relevant content. Of these, 19 were individual interviews conducted with residents (n = 10), faculty (n = 4), administrative staff (n = 1), a program director (n = 1), a department chair (n = 1), and designated institutional officials (n = 2), and 3 were from resident focus groups. Residents from all postgraduate year levels, including professional development (ie, research) years, were represented. Interviewees discussed resident unions at 2 programs (1 recently unionized and 1 with a decades-long history). Interviewees described the lack of voice and the lack of agency as drivers of unionization ("Residents…are trying to take control of their well-being"). Increased salary stipends and/or housing stipends were the most concretely identified union benefits. Unanticipated consequences of unionization were described by both residents and faculty, including (1) irrelevance of union-negotiated benefits to surgical residents, (2) paradoxical losses of surgery department-provided benefits, and (3) framing of resident-faculty relationships as adversarial. Union executives were noted to be nonphysician administrators whose participation in discussions about clinical education progression may increase the time and effort to remediate a resident and/or reduce educators' will to meaningfully intervene. Active surgical resident participation within the union allows for an understanding of surgical trainees' unique needs and reduced conflict. In this qualitative study, unionization was a mechanism for resident voice and agency; the desire to unionize likely highlighted the lack of other such mechanisms in the training environment. However, these findings suggest that unionization may have had unintended consequences on benefits, flexibility, and teaching. Effective advocacy, whether within or outside the context of a union, was facilitated by participation from surgical residents. Future research should expand on this exploratory study by including a greater number of institutions and investigating the evolution of themes over time.

BackgroundUnhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and tuberculosis (TB). Computer-based interventions (CBIs) can reduce unhealthy alcohol use, are scalable, and may improve outcomes among patients with HIV or TB.ObjectiveWe assessed the acceptability, adaptability, and feasibility of a novel CBI for alcohol reduction in HIV and TB clinical settings in Pune, India.MethodsWe conducted 10 in-depth interviews with persons with alcohol use disorder (AUD): TB (6/10), HIV (2/10), or HIV-TB co-infected (1/10) selected using convenience sampling method, no HIV or TB disease (1/10), 1 focus group with members of Alcoholics Anonymous (AA; n=12), and 2 focus groups with health care providers (HCPs) from a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3D virtual counselor. Qualitative data were analyzed using structured framework analysis.ResultsThe majority (9/10) of in-depth interview respondents were male, with median age 42 (IQR 38-45) years. AA focus group participants were all male (12/12), and HCP focus group participants were predominantly female (n=15). Feedback was organized into 3 domains: (1) virtual counselor acceptability, (2) intervention adaptability, and (3) feasibility of the CBI intervention in clinic settings. Overall, in-depth interview participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All focus group participants preferred a human virtual counselor to an animal virtual counselor so as to potentially increase CBI engagement. Additionally, interaction with a live human counselor would further enhance the program’s effectiveness by providing more flexible interaction. HCP focus group participants noted the importance of adding information on the effects of alcohol on HIV and TB outcomes because patients were not viewed as appreciating these linkages. For local adaptation, more information on types of alcoholic drinks, additional drinking triggers, motivators, and activities to substitute for drinking alcohol were suggested by all focus group participants. Intervention duration (about 20 minutes) and pace were deemed appropriate. HCPs reported that the CBI provides systematic, standardized counseling. All focus group and in-depth interview participants reported that the CBI could be implemented in Indian clinical settings with assistance from HIV or TB program staff.ConclusionsWith cultural tailoring to patients with HIV and TB in Indian clinical care settings, a virtual counselor–delivered alcohol intervention is acceptable and appears feasible to implement, particularly if coupled with person-delivered counseling.

BackgroundManaging advanced cancer can be psychologically distressing and burdensome for family caregivers and their care recipients. Innovations in the collection and modelling of passive data from personally-owned smartphones (e.g., GPS), called digital phenotyping, may afford the possibility of remotely monitoring and detecting distress and burden. We explored the potential of using passively-collected GPS data from smartphones to assess and predict caregiver and patient distress and burden.MethodsThis exploratory longitudinal cohort study enrolled smartphone-owning family caregiver and patient participants with advanced cancer (August 2021-July 2023) recruited via an oncology clinic or self-referral through Facebook. Participants downloaded a digital phenotyping research app, called Beiwe, that passively collected GPS data for 24 weeks. Participants completed self-report measures (PROs) of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), mental health (PROMIS Mental Health), and caregiver burden (Montgomery-Borgatta Caregiver Burden scale) at baseline and every 6 weeks for 24 weeks. After pre-processing raw GPS data into daily GPS features (e.g., time spent at home, distance traveled/day), computing biweekly moving averages and standard deviations, and conducting a principal components analysis (PCA) of the resulting variables, within-person regression models were used to assess associations between changes in PRO measures and changes in PCA scores, with adjusted-R2 as the measure of effect size (small = 0.02, medium = 0.13, large = 0.26).ResultsEvaluable data were collected from 48 participants (family caregivers = 32; patients = 16). Caregiver smartphone data explained small-to-medium variance in caregiver anxiety (0.06), depression (0.15), and mental health (0.07). Patient smartphone data predicted small to medium variance in caregiver depressive symptoms (0.12) and burden (0.05). Combined caregiver and patient smartphone data explained small variance in caregiver depressive (0.02) and anxiety symptoms (0.10) and large variance for PROMIS-mental health (0.36) and burden (0.50). For patient outcomes, caregiver smartphone data accounted for small variance in anxiety symptoms (0.07); patient smartphone data predicted large variance in anxiety symptoms (0.24). Combined data explained medium variance in patient depressive symptoms (0.18).ConclusionsThe exploratory study demonstrates the potential predictive utility of using passive smartphone data to detect changes in caregiver and patient psychological distress and burden. A larger study is needed to validate these findings and further explore the clinical application of digital phenotyping in cancer.

A Review of:
 Tewell, E. C. (2014). Tying television comedies to information literacy: A mixed-methods investigation. The Journal of Academic Librarianship, 40(2), 134-141. doi:10.1016/j.acalib.2014.02.004
 
 Abstract
 
 Objective – This study assessed the effects of showing television comedy clips to demonstrate information literacy concepts when teaching one-shot instruction sessions. More specifically, it examined whether the students’ retention and understanding increased when television comedy clips were used and whether students preferred instruction that included popular culture examples.
 
 Design – A mixed-methods investigation that employed multiple-choice questionnaires and focus group interviews.
 
 Setting – A small liberal arts college in the United States of America.
 
 Subjects – A total of 211 freshmen students enrolled in a First-Year Studies course. The students were divided into 16 class sections. The author collected a total of 193 valid responses to the pretests and posttests in his study.
 
 Methods – Half of the class sections (103 respondents) were taught selected information literacy concepts using television comedy clips and a group discussion led by the instructor. The other half (90 respondents) were taught using only an instructor-led discussion. The classes were randomly selected to belong to the experimental group (with TV comedy clips) or the control group (without TV comedy clips). An online pretest questionnaire, consisting of 10 multiple-choice questions, was administered at the beginning of the 90-minute library instruction session for both groups. An online posttest questionnaire, consisting of the same questions as the pretest but in a randomized order, was completed by the students at the end of the session. About a month later, one-hour focus group interviews were conducted with a small subset of the study’s subjects who volunteered to participate in the focus groups. The experimental focus group consisted of five study participants who had attended a library instruction session that involved showing the television comedy clips and the control focus group consisted of six study participants who had attended a library instruction session that did not include showing the television comedy clips.
 
 Main Results – The experimental group scored higher than the control group on the posttest with an average “increase of 1.07 points from pre- to posttest compared to a 0.13 mean increase in the control group” (p. 139), which means that the experimental group answered one more question correctly. Four out of the five participants in the experimental focus group also discussed the television comedy clips even though they were not asked about them. Conversely, when asked about what they enjoyed in the class, the majority of participants from both focus groups discussed the content covered in the session rather than any teaching methods employed. “The quantitative results suggest that student test results either increased, as in the experimental group, or remained relatively level, as in the control group, due to the type of instruction received” (p. 137). 
 
 Conclusion – The author states that the results from the test questionnaires and answers from focus group sessions indicate that using television comedy clips may be a successful way of improving students’ retention of course content. However, the study’s results could not demonstrate that students liked classes with popular culture examples more than classes without them, since the majority of focus group participants found the course content more interesting than the manner in which the content was taught. The relevancy of the content presented in an information literacy session appears to make more of an impact on the students than the format in which it is presented.

Digital phenotyping is the real-time collection of individual-level active and passive data from users in naturalistic and free-living settings via personal digital devices, such as mobile phones and wearable devices. Given the novelty of research in this field, there is heterogeneity in the clinical use cases, types of data collected, modes of data collection, data analysis methods, and outcomes measured. The primary aim of this scoping review was to map the published research on digital phenotyping and to outline study characteristics, data collection and analysis methods, machine learning approaches, and future implications. We utilized an a priori approach for the literature search and data extraction and charting process, guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews). We identified relevant studies published in 2020, 2021, and 2022 on PubMed and Google Scholar using search terms related to digital phenotyping. The titles, abstracts, and keywords were screened during the first stage of the screening process, and the second stage involved screening the full texts of the shortlisted articles. We extracted and charted the descriptive characteristics of the final studies, which were countries of origin, study design, clinical areas, active and/or passive data collected, modes of data collection, data analysis approaches, and limitations. A total of 454 articles on PubMed and Google Scholar were identified through search terms associated with digital phenotyping, and 46 articles were deemed eligible for inclusion in this scoping review. Most studies evaluated wearable data and originated from North America. The most dominant study design was observational, followed by randomized trials, and most studies focused on psychiatric disorders, mental health disorders, and neurological diseases. A total of 7 studies used machine learning approaches for data analysis, with random forest, logistic regression, and support vector machines being the most common. Our review provides foundational as well as application-oriented approaches toward digital phenotyping in health. Future work should focus on more prospective, longitudinal studies that include larger data sets from diverse populations, address privacy and ethical concerns around data collection from consumer technologies, and build "digital phenotypes" to personalize digital health interventions and treatment plans.

Objective-This study examined the individual-level factors impacting pregnant women's access to mental health treatment for depression.Methods-A total of 1,416 pregnant women receiving prenatal care completed measures of depressive symptomatology, willingness to seek treatment for depression or anxiety, and perceived barriers to seeking such care.Results-Women with Beck Depression Inventory scores {greater than or equal to; ≥}16 (indicating possible depression) (N=183) were more likely than women with lower scores (N=1,233) to identify the following barriers: cost, lack of insurance, lack of transportation, long waits for treatment, previous bad experience with mental health care, and not knowing where to go for treatment.Lower income was correlated with increased endorsement of cost and transportation as barriers. Conclusions-Resultssuggest that addressing financial and logistical barriers through changes in mental health services and policy will improve access to care for antenatal depression.However, attending to these issues alone will not address additional important barriers to care such as lack of trust.Antenatal depression affects approximately 10% of women during pregnancy (1), and rates among low-income pregnant women may be as high as 27.6% (2).It is associated with psychological and physical morbidity, including poor birth outcomes (3), and increased rates of suicide (4).Study of perinatal mental health services is critical both because of these negative sequelae and because the perinatal period presents a unique window of opportunity for more frequent contact with the health system.Preventive and care coordination resources are often available during pregnancy, although they may not be available at other times.This is especially true for low-income women, the majority of whom receive their health care exclusively in the obstetric setting (5).Despite the increased contact of pregnant women with the health system, low rates of antenatal depression detection have been well documented (6).Moreover, although there is evidence that treatment is effective (7,8), many pregnant women with depression go untreated (9), and poor women are particularly unlikely to access mental health treatment