“We were really looking forward to it, discussing what kind of parents we’d be,” Sarkis said. “But we hardly ever talked about how hard it was going to be.”

Then the emotional challenges began.  

The couple’s first attempt to start a family ended in an ectopic pregnancy that required Seakly to have emergency surgery. The results of the procedure left the couple wondering if they would even be able to have a child.

But within the year, the Manukyans were elated to discover Seakly was pregnant again. During labor, however, the couple faced another frightening ordeal when complications led to an emergency cesarean section. After his birth in December of 2024, Masis, their son, had to spend 11 days in the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s (NICU).

After they brought their baby home, the couple worked on adjusting to the major changes in their lives. Sarkis said the emotional weight of the experience began affecting him.

“Two months later, these fears started surfacing: Am I doing enough to protect my family?” he said. “Are we doing everything we can to keep something bad from happening?”

Sarkis said the fearful thoughts increasingly consumed him, fueled by stress, sleep deprivation and the pressure he felt to protect his wife and child.

Experts say growing awareness around maternal mental health is widening the conversation to include the emotional wellbeing of the entire family—especially fathers—during pregnancy and the postpartum period.

“You can’t predict the impact of having a new baby, especially after a difficult childbirth and time in the NICU,” Sarkis said. “Sleep deprivation and everything else just begins piling up.”

Seakly said she began noticing signs that her husband was struggling emotionally after the traumatic birth, as both parents devoted nearly all their energy to caring for their newborn son.

“I saw it pretty quickly, but I think I was in denial because all of our attention was on the baby,” she said. “Sarkis lost a lot of weight after Masis was born, and a few months later, when he finally verbalized how he was feeling, it clicked for me that partners can be just as affected by birth trauma as mothers.”

Drawing from her own positive experience of getting therapy during the ups and downs of their journey to become parents, Seakly, who is a registered nurse at Cedars-Sinai, encouraged Sarkis to seek professional support as well.

“I learned that taking care of ourselves and each other is vital to the physical, emotional and mental health of our child,” she said. “Without Sarkis’ support mentally and emotionally, the domino effect of all the negative things we experienced could have been detrimental to our family.”

With his wife’s encouragement, Sarkis sought support through the Reproductive Psychology Program at Cedars-Sinai.

Sarkis worked with therapist Ruth Maouda, PsyD, a postdoctoral fellow in the program. Maouda says new parents often experience self-doubt, anxiety and emotional overwhelm during the transition from pregnancy to postpartum—particularly after traumatic birth experiences or severe sleep deprivation.

“One of the most important things I tell first-time postpartum parents is that they are entering an experience of ‘firsts,’” Maouda said. “Nothing can fully prepare you for becoming a parent and acknowledging that learning curve can help relieve some of the anxiety and pressure parents place on themselves.”

Sarkis said that during his sessions with Dr. Maouda he also learned practical coping strategies such as breathwork and mindful meditation, techniques that have helped him manage anxiety and obsessive thinking during high-stress moments.

“Therapy helped me to show up better for my son because now I feel equipped,” Sarkis said. “I have tools I can use every day.”

Maouda said supporting a parent’s mental health can have a positive ripple effect throughout the household.

“Raising a child takes a village,” Maouda said. “Supporting a parent’s mental health allows them to better support their partner and child. Protecting your own mental health helps prevent stress from rippling across the entire family system.”

Sarkis believes that talk therapy and developing coping strategies helped him become more emotionally present and patient, allowing him to enjoy everyday moments with Masis and feel more connected to his family.

Eynav Accortt, PhD, director of the Cedars-Sinai Reproductive Psychology Program, said studies estimate paternal postpartum depression affects about 10% of fathers, and the risk doubles when mothers are also experiencing perinatal mood or anxiety disorders.

“If one or both parents are struggling with their mental health, it affects the entire family,” said Accortt, a clinical psychologist who supervised Maouda’s care of Sarkis. “Supporting the emotional wellbeing of both parents is essential to building strong family bonds during the transition to parenthood.”

Sarkis believes seeing a therapist ultimately strengthened not only his mental health, but also the couple’s communication and partnership.

“My husband’s decision to get professional help was one of the most impactful acts of love—for himself and for our family,” Seakly said. “It helped him become the father he wanted to be for Masis and the partner he wanted to be for me.”

Sarkis hopes other fathers will recognize that they, too, may need support during the transition to parenthood.

“I think that having children is romanticized a lot. It’s beautiful but it’s also life-altering, It’s OK to ask for help if you are struggling,” he said. “That made all the difference for me and my family.”

Read more from Cedars-Sinai Stories and Insights: Research Aims to Improve Maternal Health Equity

More than a quarter of U.S. adults say they are estranged from at least one close relative, and “going no-contact” with family members is a phrase heard more often these days. Whether more people are distancing themselves from family—or simply more comfortable talking about it—is unclear.

What is clear, said Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, is that loneliness is a growing health problem, and the holidays can intensify feelings of depression and isolation.

“There are many causes of loneliness, but certainly one of the most significant emerging causes is our physical disconnection and increasing reliance on technology to communicate with each other,” Danovitch said. “We evolved to be a highly social species with the capacity to form personal relationships, families, tribes and communities. Some of the most remarkable distinctions of the human brain are those that help us understand one another, imagine another person’s perspective, and empathically share their feelings.

“But we’ve seen an unraveling of the social structures that have always anchored us, and particularly during times of need, that has left many of us feeling alone and disconnected.”

These dynamics create a host of challenges and difficult emotions that commonly surface during the holidays, when relationships, family and community are front and center.

The Cedars-Sinai Newsroom spoke with Danovitch about ways to cope with loneliness and estrangement during the holiday season, as well as how to build meaningful and healthy connections.

Why do people feel lonelier or depressed during the holidays? 

There are several reasons. Loneliness and isolation are amplified during the holidays if people are already experiencing a sense of separation from their families of origin or the social pain of loneliness. Even people who are not estranged from their families—but who may not live close by or aren’t accustomed to spending time together—can suddenly feel overwhelmed by dynamics that resurface as if no time has passed, although one person is now an adult and another a grandparent. Another contributor to holiday depression or loneliness is expectations. People bring personal ideas about what the holidays should look like, and those expectations often carry emotional weight—and often don’t align with reality.

How can people cope when there is family estrangement or spending time together is difficult?

When it comes to family dynamics, relationships are messy. Families are messy. It’s valuable to be aware of challenging dynamics and to bring patience and grace to any interactions. Take a deep breath and feel compassion and forgiveness if you feel like you're not being your best self. If you suddenly slip back into the 13-year-old version of yourself, give yourself a break. Give your family a break. Also, know that you can't solve everything over one holiday. Developing better or more fulfilling relationships with family takes effort and time. Lean into relationships and approach engagement and connecting in a way that feels appropriate for the situation and the individuals.

For mental wellbeing, is it OK to maintain boundaries with family during the holidays?

There's no right or wrong answer. Boundaries are individualized, and I wouldn’t judge the reason somebody does or doesn't want to spend time with their family—or whether they remain estranged. That's for them to decide. But I think it's helpful to be honest and accepting of our decisions on how to handle the tradeoffs we make. Self-acceptance and self-compassion are an important foundation for everything else.

How can people cope if they don’t have family to spend the holidays with?

Foster connections within the community and the people around you—friends, neighbors, or groups who share an interest that’s important to you. Think about participating in a food kitchen or a beach cleanup, or volunteer with an animal shelter or in supportive services for kids. Spend time outdoors or reach out to your neighbors. Consider what interests you, what moves you, and how you can find others who share those interests. These connections are crucial for mental health. 

What are healthy ways to manage holiday stress—say, social anxiety or discomfort during holiday gatherings?

Social anxiety is one of the most common types of anxiety, and meeting new people is one of the most stressful things people do. Part of what makes us anxious is the feeling that we're being judged, so we're prone to worrying about coming across the right way. When you're in a group and somebody is new, be gracious and include them. It goes a long way. For people worried about falling into old habits with their family, consider intentional activities. Some families come together and talk, and then conversation drifts toward points of conflict—like politics or religion. Redirect with a board game, a movie or a group hike. It’s time together that matters.

Read more on the Cedars-Sinai Blog: Social Anxiety—How to Navigate the Holiday Season

The tone was urgent: “Please pick up your child now.” Moments later, Kim, director of the Division of Pediatric Surgery, learned his Pacific Palisades community was on the brink of a wildfire evacuation order. He raced home to help his family pack, but he felt certain, based on past experience, they’d be back soon.

The Kim family is now marking four months in a Santa Monica apartment: The L.A. wildfires, which began Jan. 7, 2025, and also devastated the Altadena community, destroyed their home.

Kim’s daughters, 13 and 16, were uprooted from their home, school and community. In a flash, they were separated from friends and unable to participate in local activities. And now, with summer break approaching, they and many other affected students could experience more disruption in their daily routines.

Connections and Consistency

Suzanne Silverstein, MA, ATR, founding director of Cedars-Sinai’s Share & Care, a program at 30 L.A.-area schools helping at-risk children through trauma, said parents should be prepared to guide children—many of whom are still grieving—through that disruption.

“The Pacific Palisades and Altadena communities were very tight-knit, and they are still suffering,” Silverstein said. “Children and parents have had to deal with losing homes as well as their community connections. It’s a double whammy, and it’s normal to still be grieving.”

Silverstein said children in the Share & Care program have received donated items, and she often hears them say, “I had this in my house that burned down.”

She added, “They’re also struggling because they’ve changed schools—their family moved, or their original school is no longer there—and their friends are at different schools. They’ve had to start over.”

Silverstein emphasized the importance of maintaining connections, especially during the summer break. She encourages parents to set up playdates with friends who have moved to different areas, saying, “Whole families can reconnect, which can be a gift to have everyone together for some positive experiences, and to see that everyone is OK.”

Consistency also is key, Silverstein said. If children have always attended summer camp and their camp is taking place this summer, it could be healing for them to go again, “if it’s something that’s familiar to them and something they can connect to, from before the fire.”

An art therapist, Silverstein also encourages children to express themselves in the ways they are most comfortable.

“Is it writing, is it drawing, is it through poetry or acting? Give them more of those experiences this summer,” she tells parents.

Art is a healing tool in Share & Care—younger children are encouraged to draw what they’re experiencing, while older ones are encouraged to write or draw in a journal, and then share if they’d like.

Also taught are mindfulness, calming breathing techniques, and how to sit quietly together and listen to what others in the group are sharing.

These are activities parents can continue with their children during summer recess, Silverstein said.

“We’ve been teaching parents the breathing techniques we’ve used with their children,” she said. “Parents also can benefit, as this continues to be a stressful and overwhelming time for them, too.”

Silverstein noted that the healing process is different for every child, and a strong parent-child connection can lead the way in best addressing the needs of each individual.

Leaning on Each Other

In the weeks following the fire, Kim’s family stayed in Orange County with relatives. He remembers kindness on full display when his daughters—competitive swimmers—were invited to swim with the local team. His older daughter took them up on the team’s offer.

“That was a huge part of maintaining some semblance of connection, and it helped her recovery,” he said, because she could participate in a routine activity she enjoys while also making new friends.

Kim said both daughters, as well as he and his wife, have benefited from social time with former neighbors and friends who are recovering from the fires.

“Talking about the complete loss we’ve experienced with people who’ve also been through it is a huge help,” he said.

Kim said he hopes to create a “normal” summer experience for his daughters, even though the family is living in a different place—filling it with swim meets and a vacation to the East Coast, a family tradition. His older daughter also will volunteer at Cedars-Sinai, an activity she finds fulfilling.

For the Kim family, time together may prove to have been the most healing.

“My wife and I were quite concerned about the stress of this trauma on the girls,” he said. “Earlier on, there were teary days and sleepless nights, but it’s been a while since we’ve seen emotions bubble up. We continue to watch them closely and make sure they know we’re here for them. I’m in awe of their resilience—it gives me strength to see them get up every morning, go to school and carry on to the next day.”

As the school year ends, these moments are more important than ever.

“We can’t get back the things we lost,” Kim said, “but we can help each other write the next chapter.”

Read more on the Cedars-Sinai Blog: Five Deep Breathing Exercises for Kids and Teens

Cedars-Sinai investigators have created machine learning (ML) models, a type of artificial intelligence, that can use patients’ electronic health records to predict—independent of racial minority biases—the risk of postpartum depression.

The ML models, described in the peer-reviewed journal JAMA Network Open, were more likely to correctly identify postpartum depression in racial minorities compared to non-Hispanic white patients. Because many postpartum women who are Black or Hispanic are not properly diagnosed with postpartum depression, the use of these models could help improve early detection across all racial groups, potentially leading to more equitable healthcare outcomes.

“Prior models assumed that all women evaluated for postpartum depression received the same treatment and often did not account for racial disparities,” said Tiffani J. Bright, PhD, senior author of the study and the co-director of the Center for Artificial Intelligence Research and Education and research assistant professor in the Department of Computational Biomedicine at Cedars-Sinai. “We were able to create models that did not perpetuate the same biases often seen in prior prediction models, suggesting the critical role of equity-centered modeling decisions in ensuring equitable patient care.”

Additional Cedars-Sinai authors include Emily F. Wong, PhD; Anil K. Saini, PhD; Eynav E. Accortt, PhD; Melissa S. Wong, MD; and Jason H. Moore, PhD.

Funding: This research was supported by NIH National Center for Advancing Translational Science (UCLA CTSI Grant Number UL1TR001881), which supports Cedars-Sinai’s Honest Enterprise Research Broker (HERB) Committee that is responsible for extracting data from electronic health records for research purposes. We would also like to thank the departments of Obstetrics & Gynecology, Psychiatry, Nursing, and Case Management, and the Nursing Healthcare Teams for implementing the Quality Improvement project. The first and corresponding author, Emily F. Wong, had full access to all the data extracted for this study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Addressing the complexity of causes behind poor health outcomes for Black mothers requires commitment, investment and innovation to produce meaningful, measurable change.

“Ensuring equitable outcomes for our patients is a priority at the highest level of Cedars-Sinai. Black Maternal Health Week raises awareness about birthing inequities that exist, and the multidisciplinary work required to close the gap,” said Christina Harris, MD, Cedars-Sinai vice president and chief health equity officer.

“But the work of preventing harm and saving Black lives is a continuous process that is not confined to one week. It is 24 hours a day, seven days a week, every week and every year. That is the level of commitment that is required,” Harris said.

Cedars-Sinai initiatives to improve Black maternal health include lowering the rates of a common cause of death during childbirth, funding community partners, providing mandatory anti-discrimination education and bridging the gap in maternal mental health care.

Community Conversations

Throughout the year, Cedars-Sinai partners with BlackDoctor.org for a series of Community Conversations that address a wide range of health and public health concerns. This month’s conversation will focus on Black maternal mental health.

According to the American Counseling Association, Black women face an increased risk of perinatal mood and anxiety disorders, including depression and post-traumatic stress disorder. On April 10, “Shining a Light on Black Maternal Mental Health” will feature a panel of healthcare experts discussing the importance of early diagnosis and access to support and effective treatment. The conversation will include an inspirational Black mom who shares her journey of recovery from serious postpartum depression. 

AI Plus Aspirin Eliminates Racial Disparities in Preeclampsia Treatment

"Whenever we focus on eliminating racial or ethnic disparities in care, we ultimately end up increasing the quality of care for everybody,” said maternal-fetal medicine specialist Melissa Wong, MD.

Aspirin can reduce the risk of developing preeclampsia, a dangerous hypertensive complication of pregnancy that can lead to serious complications and even death. But Black pregnant women are particularly vulnerable to being overlooked for aspirin treatment.  

A study led by Wong found that using artificial intelligence to automate decision-making about prescribing low-aspirin—and to identify patients at risk for preeclampsia—resulted in an increase in appropriate aspirin treatment and eliminated the racial disparity in care.

Perinatal Antidiscrimination Initiative

“Not being heard, or having assumptions made about you or your condition, can be a critical barrier to getting good medical care. I've found there are differences in how people perceive respect, or disrespect, based on race and ethnicity," explains Kimberly Gregory, MD, MPH, director of Maternal-Fetal Medicine and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology.

“Always Listening and Learning with You”—ALLY—is a phrase developed by the Cedars-Sinai perinatal unit to characterize an effective approach to patient advocacy and health equity.

The principal of “allyship” is the foundation of annual department compliance training on unconscious bias. The course demonstrates the value of inclusive terminology, offers opportunities to explore how to advocate for  patients and colleagues and emphasizes the critical role staff members play in improving the experiences of patients.

Black Maternal Mental Health

“Black women are twice as likely to experience perinatal mood and anxiety disorders, including postpartum depression, than their white counterparts. They are also less likely to receive treatment,” said clinical psychologist Eynav Accortt, PhD, director of the Reproductive Psychology Program.

Cedars-Sinai investigators are recruiting participants for an NIH funded study aimed at addressing those disparities. The Resources, Inspiration, Support, Empowerment (R.I.S.E.) for Black Maternal Mental Health study tests a mobile health web application designed to help manage stress in pregnancy.

Black women living anywhere in the U.S. who are 12-32 weeks pregnant and at least 18 years old can participate in the study. Click here for more information.

Community Partners

Cedars-Sinai also partners with trusted community organizations committed to improving Black maternal and infant health.

Since 2022, Cedars-Sinai has committed over $3.5 million to 14 organizations which focus on reaching perinatal and postnatal Black women in Los Angeles County, across the continuum of care. Grantees include highly respected partners such as the California Black Women’s Health Project, which provides health education and other resources meant to build empowering relationships within the community of Black pregnant and parenting women they serve.

“Striving for health equity among all populations has long been a goal of Cedars-Sinai. These organizations are key partners in that mission. The grants—and opportunities to combine resources for the good of public health—are an important way we can contribute to improving Black maternal health and well-being,” Harris said.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color                           

The application—called Xaia, for eXtended-Reality Artificially Intelligent Ally—expands access to mental health support for patients, furthering Cedars-Sinai’s mission to elevate the health of communities it serves in Los Angeles and beyond.

Cedars-Sinai investigators created Xaia as a way to offer patients self-administered, AI-enabled, conversational therapy in relaxing spatial environments such as a creek-side meadow or a sunny beach retreat where patients also can do deep breathing exercises and meditation.

The Xaia application offers users an immersive therapy session led by a trained digital avatar, programmed to simulate a human therapist.

“Apple Vision Pro offers a gateway into Xaia’s world of immersive, interactive behavioral health support—making strides that I can only describe as a quantum leap beyond previous technologies,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and co-founder of the Xaia technology. “With Xaia and the stunning display in Apple Vision Pro, we are able to leverage every pixel of that remarkable resolution and the full spectrum of vivid colors to craft a form of immersive therapy that’s engaging and deeply personal.”

While developing the app for Apple Vision Pro, Spiegel said, his Cedars-Sinai team reimagined how spatial computing can support behavioral health and overall wellbeing in ways never before possible.

Omer Liran, MD, a psychiatrist at Cedars-Sinai and co-founder of Xaia, says the app represents a transformative step in making quality therapy accessible to all.

“Apple Vision Pro has allowed us to create a platform where technology fades into the background and the user's healing journey comes to the forefront,” Liran said. “This application is a culmination of years of rigorous research, clinical expertise and a vision to democratize mental wellness in a way that respects the uniqueness of every individual's experience. Using the powerful capabilities of Vision Pro, we’re now able to bring this experience to life with its full potential.”

Before the launch of Apple Vision Pro, the Xaia technology was featured in a first-of-its-kind study published in the peer-reviewed journal Nature Digital Medicine. Findings from the study showed Xaia as both beneficial and safe for patient use.

To develop Xaia, Spiegel and Liran enlisted the support of Cedars-Sinai’s Technology Ventures—the enterprise that protects and supports the commercialization of discoveries and technologies. Technology Ventures also facilitates access to promising inventions—like Xaia—that improve the quality of life for patients around the world.

The managing director of Cedars-Sinai’s Technology Ventures, Nirdesh Gupta, PhD, said that ideas developed in an academic medical center environment like Cedars-Sinai offer a one-of-a-kind perspective—focused both on advancing research and expediting clinical care needs.

James Laur, JD, vice president of Intellectual Property at Cedars-Sinai, echoed that sentiment.

“The hospital ecosystem is at the heart of care delivery, and Cedars-Sinai has the unique advantage of being closest to the patients and their varying needs,” said Laur. “Xaia is the result of several years of support and funding, and we are elated to see the technology come to life in this meaningful and clinically relevant way.”

Conflicts of Interest: Spiegel and Liran are co-founders of VRx Health. The Xaia technology is exclusively licensed from Cedars-Sinai to VRx Health for commercialization.

Read more from the Cedars-Sinai Blog: Virtual Reality and the Brain-Body Connection

Known as the eXtended-Reality Artificially Intelligent Ally, or XAIA, the program offers users an immersive therapy session led by a trained digital avatar. Findings from a first-of-its-kind study were published today and showed that participants benefited from the sessions.

“To our knowledge, this is the first time mental health therapy has been studied using generative artificial intelligence within immersive virtual reality,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and first and corresponding author of the study published in the peer-reviewed journal Nature Digital Medicine.

Cedars-Sinai investigators created XAIA as a way to offer patients self-administered, AI-enabled, conversational therapy in relaxing virtual reality environments—such as a creek-side meadow or a sunny beach retreat where patients can also do deep breathing exercises and meditation.

As highlighted in the study, participants interacted with XAIA, which employs a large language model programmed to resemble a human therapist. The avatar was developed by Cedars-Sinai psychiatrist Omer Liran, MD, with input from Cedars-Sinai clinical psychologist Robert Chernoff, PhD, who co-authored the paper and helped assess the program for safety.

Expert mock therapy sessions were performed and transcribed to hear firsthand how a trained psychologist can—and should—interact with patients. From these sessions, recurring exchanges and patterns were identified and encoded into the large language model as rules and preferred responses for XAIA to emulate. These findings were then used to train the generative AI technology behind XAIA while incorporating over 70 best practices for mental health therapy.

“After teaching XAIA these skills, she offered therapy in a more empathetic, compassionate and meaningful way,” Chernoff said. “She handled a range of situations very well and did not show evidence of safety concerns during our testing.”

Fourteen participants with mild to moderate anxiety or depression interacted with XAIA for 30 minutes, then participated in debriefing interviews. Researchers then provided an analysis of the interview transcripts. Therapy topics ranged from loneliness and family problems to financial distress.

Participants frequently responded to the avatar as if it were a person and shared raw emotions. For example, one study participant told XAIA, “I feel like I’m a failure. The only thing I have to look forward to—I know you're going to laugh—is to go see Taylor Swift … and she's like the only thing that's keeping me alive. I'm sorry I'm crying.”

XAIA responded with comments like, “Firstly, there’s no need to apologize for crying. These feelings are valid.”

In another exchange, a participant told XAIA, “I think I look to other people to validate my self-worth and so rejection is especially painful. So, I am reluctant to put myself in situations where I could be rejected.”

XAIA responded, saying, “That's quite an insightful observation about yourself. It can be challenging when our self-worth is tied to the approval or validation of others. Fear of rejection can indeed make social interactions daunting. Could you share a little more about where you think this need for validation comes from?”

Participants described the program as easy to maneuver, and indicated that XAIA was “friendly,” “approachable,” “calming,” “empathic,” “empowering,” “unbiased” and “intelligent.” Participants also reported perceived advantages over traditional talk therapy, and all participants said they would recommend the program to others, although some indicated they would still prefer a human therapist if given the choice.

“These results provide initial evidence that VR and AI therapy has the potential to provide automated mental health support within immersive environments,” said Spiegel, director of the Cedars-Sinai master's degree program in health delivery science (MHDS) and the George and Dorothy Gourrich Chair in Digital Health Ethics. “By harnessing the potential of technology in an evidence-based and safe manner, we can build a more accessible mental healthcare system.”

When creating XAIA, investigators sought to help address a national shortage of psychotherapists, especially in rural areas where access to mental health services is often delayed or nonexistent.

“The prevalence of mental health disorders is rising, yet there is a shortage of psychotherapists and a shortage of access for lower income, rural communities,” Spiegel said. “While this technology is not intended to replace psychologists—but rather augment them—we created XAIA with access in mind, ensuring the technology can provide meaningful mental health support across communities.”  

Conflicts of Interest: Spiegel and Liran are co-founders of VRx Health. The XAIA technology is exclusively licensed from Cedars-Sinai to VRx Health for commercialization.

Funding: The study was conducted using internal resources from Cedars-Sinai with additional support from the Marc and Sheri Rapaport Fund for Digital Health Science and Precision Health at Cedars-Sinai.

Other Cedars-Sinai authors involved in the study include Omer Liran, MD, Allistair Clark, MA; Jamil S. Samaan, MD; Carine Khalil, PhD; Kavya Reddy, MD; and Muskaan Mehra, BS.

Follow Cedars-Sinai Academic Medicine on X for more on the latest basic science and clinical research from Cedars-Sinai.

Read more from the Cedars-Sinai Blog: Virtual Reality and the Brain-Body Connection

Heart failure affects nearly 6 million adults in the United States, and approximately 50% of heart failure patients experience symptoms of depression along with their condition. Past studies show patients with heart failure and depression have lower cardiac function, more emergency department visits and hospital admissions, higher caregiver burden, and poorer quality of life compared with patients with heart failure who are not depressed.

“The most important finding here is that patients experiencing depression have a choice in terms of their treatment between therapy or medications,” said Waguih W. IsHak, MD, vice chair of Education and Research in the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai and first author of the study. “Patients who prefer not to be on medication can do behavioral activation therapy with similar results.”

The study, which was published in the peer-reviewed journal JAMA Network Open, followed more than 400 patients over the course of a year. Half of the study participants received antidepressant medication management to treat depression symptoms while the other half participated in behavioral activation psychotherapy, an evidence-based treatment for depression that promotes engagement in activities a patient finds enjoyable. 

The research was done in close collaboration with the Smidt Heart Institute at Cedars-Sinai, and its heart failure program led by Michele Hamilton, MD, vice chair of the Department of Cardiology in the Smidt Heart Institute and co-author of the study.

Investigators say there was no statistically significant difference between the effectiveness of the two methods, with each patient group experiencing a more than 50% reduction in the severity of depressive symptoms.

Study participants randomized to receive behavioral activation therapy worked with a therapist to develop a personalized list of activities that bring them joy and fulfillment, including having lunch with a friend, taking a walk, volunteering, listening to their favorite music—among other options—on a regularly scheduled basis. The treatment focused on increasing the level of enjoyable and rewarding activities the patient was doing every week for 12 weeks, and then incorporating them into their regular activity schedule.

Patients who received psychotherapy intervention showed a slight improvement in their physical and mental health-related quality of life, a secondary outcome monitored by the study. They also had fewer emergency department visits and spent fewer days hospitalized during the course of the study compared with the patients who were randomized to receive antidepressant medications.

“This study, which was conducted in a real-world setting, demonstrates that it is entirely feasible to incorporate psychiatric treatment into specialty medical care. Integrating psychiatric treatment into medical care is an effective way to reduce stigma, increase access and improve outcomes for people who struggle with mental health problems alongside their chronic medical conditions,” said Itai Danovitch, MD, MBA, chair of the Department of Psychiatry and Behavioral Neurosciences and a study co-author. “Most people who suffer from depression do not receive effective treatment. It is critical that we increase screening for psychiatric conditions and ensure that patients have access to high-quality and effective mental health care.”

Other Cedars-Sinai authors involved in the study are Michele A. Hamilton, MD; Samuel Korouri, BA; Marcio A. Diniz, PhD; James Mirocha, MS; Rebecca Hedrick, MD; Robert Chernoff, PhD; Jeanne T. Black, PhD; Harriet Aronow, PhD; Brigitte Vanle, MD, PhD; Jonathan Dang, MD; Gabriel Edwards, MD; Tarneem Darwish, MD; Gabrielle Messineo, LCSW; Stacy Collier, RN; Mia Pasini, RN; John G. Harold, MD; and Brennan Spiegel, MD, MSHS. Additional authors include Kaleab K. Tessema, MD, PhD; Michael K. Ong, MD; and Kenneth Wells, MD.

Funding: The study by was funded by the Patient-Centered Outcome Research Institute (PCORI) (award No.: 2017C2-7716; paid to Cedars-Sinai Medical Center).

Read more from the Cedars-Sinai Blog: Living With Heart Failure

Ahead of World Suicide Prevention Day on Sept. 10, Vicain spoke with the Cedars-Sinai Newsroom about some common suicide myths and the importance of suicide prevention.

How prevalent is suicide in the U.S.?

Suicide is a serious public health issue in the U.S. According to the Centers for Disease Control and Prevention (CDC), between 2000-2021, suicide rates increased by nearly 40% and suicide was responsible for close to 50,000 deaths, which is about one death every 11 minutes.

In 2021, suicide was among the top nine leading causes of death for people ages 10-64 and the second-leading cause of death for people ages 10-14 and 20-34. By raising awareness, reducing stigmas about suicide and encouraging hope through action, we can help reduce suicide rates and suicidal attempts.

What are some common myths about suicide?

There are several common myths associated with suicide:

• A person must have a mental illness to commit suicide.
• Only trained professionals can help individuals experiencing suicidal thoughts.
• Talking about suicide increases the chances that a person may act on it.
• People who talk about suicide are just seeking attention.
• Suicide occurs without warning.
• People who take their own lives are selfish.
• Suicide can’t be prevented.

These myths are simply not true. It’s important that people remember that each of us has a responsibility to take care of the people around us.

What do you think is one surprising factor about suicide that most individuals don’t know?

Most individuals with suicidal thoughts don’t want to die by suicide. According to the CDC, in 2021, of the estimated 12.3 million American adults who thought about suicide, 3.5 million planned a suicide attempt, and 1.7 million attempted suicides.

What are some ways people can build awareness and promote actions to lower suicide rates?

To create hope, we need to gain awareness and have a greater understanding of suicide. There are a lot of myths and stigmas related to suicide. And so, it is important for us to not only work to dispel these myths and stigmas but also provide resources to those around us. When a person is suffering in silence, they need to know that there are alternative solutions. Resources can help individuals understand that they are not alone and there is hope—a way out. We must also ensure we are present for those in need of support. Each of us can create a holistic approach to help prevent suicide by:

• Fostering a sense of connection.
• Checking in with friends and family.
• Creating a space of laughter.
• Honoring each other on a day-to-day basis. This doesn’t need to be a grandiose deal. Little things can have a meaningful impact.
• Creating protective environments and promoting healthy connections.

If you see a loved one suffering or notice a change in a person’s demeanor or appearance, reach out and ask if they need help.

What resources are available to help people deal with stress, depression and anxiety?

There are a number of resources that are available to help people in need of emotional support:

• Cedars-Sinai Community Resource
• CDC Suicide Prevention Resources
• LifeLine
• Trevor Project

Read more on the Cedars-Sinai Blog: What to Do When a Loved One Is Suicidal

Anna Solt, MD, a Cedars-Sinai psychiatrist, said that reduced access to mental healthcare, cultural stigmas and even stereotypical beliefs within a culture can cause barriers to mental health treatment.

“There are stereotypes within Hispanic communities, for example—women are seen as being dramatic and often anxious or nervous, and for men, it’s normal to have a temper or be irritable—that doctors sometimes buy into. But these can be symptoms of mental illness that tend to be overlooked,” said Solt.

Mental illness affects more than 1 in 5 adults in the U.S., according to the Centers for Disease Control and Prevention, and the prevalence of mental illness varies from one demographic to another, Solt said.

During Minority Mental Health Awareness Month in July, the Cedars-Sinai Newsroom spoke with Solt about mental health services and barriers for minorities, and strategies for getting help.

How many people from minority communities receive mental health services?

People belonging to minority groups are less likely to receive mental healthcare. For example, of the people with mental illness, 48% of white people receive mental health services whereas only 30% of Black and Hispanic populations and 22% of Asian American populations receive treatment. There are also differences between the type of services that minorities seek. White people, Native American people and Native Alaskan people are more likely to receive outpatient services and be accepting of psychiatric medication. Inpatient services are more utilized by Black people, and as mentioned, Asian Americans are the least likely to seek mental health services.

What barriers keep minorities from accessing treatment?

In general, it is mental illness stigma, a lack of understanding between the patients and their families that a certain symptom is a sign of mental illness, and the lack of diversity and cultural competence among the healthcare professionals who treat patients. There are also financial barriers, such as accessing medical insurance, and language barriers.

How can we change the conversation about mental health?

When people are reluctant to seek mental healthcare, I think the most helpful thing to do is to educate them. Many people believe that some symptoms of mental illness—being dramatic or upset and trying to calm your feeling with alcohol or other substances—are normal. But it’s very important to educate people about mental illness and let them know that this is not something that you could just get over on your own. You need an evaluation, you need a diagnosis, and you may need medication or therapy.

How can people access mental health services?

If someone is in crisis, they should be calling 911 or the suicide prevention and crisis lifeline, which is now 988. That is what people are supposed to do. If it’s not a crisis, I suggest that people ask their primary care physician for a referral to a mental health specialist. There are also online resources like the National Alliance of Mental Illness, the National Institute of Mental Health, or the California government webpages that provide mental health programs and services.

Read more on the Cedars-Sinai Blog: Expanding Mental Health Resources Among Latinx Youth

Having a child is a major life event accompanied by physiological changes and the stress of caring for a completely dependent little human. That experience is commonly referred to as “the baby blues.”  

But 15% to 20% of women who give birth will experience major changes in their mood and overall wellbeing that can linger for months. These new mothers can suffer from perinatal mood disorders that can include depression, anxiety, obsessive-compulsive disorder and even post-traumatic stress.

Cedars-Sinai clinical psychologist Eynav Accortt, PhD, director of the Reproductive Psychology Program, shares information on what is known about these changes in mental health faced by millions of women and the types of treatment and support that are available to help mothers recover.

Newsroom: What do we know about the scope of maternal mental health disorders?

It's a much wider range of symptoms and diagnoses than described by the term postpartum depression or “the baby blues.”  Perinatal mood and anxiety disorders can be experienced during pregnancy and up to a year after birth, when symptoms often develop. When diagnosed, this can include major depressive disorder, bipolar depression, generalized anxiety, panic disorder, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder.

Newsroom: What are the risk factors for developing perinatal mood disorders?

Things that may increase the risk for developing a perinatal mood and anxiety disorder include genetic factors such as a family or personal history of mental illness. Even medical complications during pregnancy, such as preeclampsia or gestational diabetes, can elevate a woman’s risk. At Cedars-Sinai, we are investigating a possible connection between these pregnancy illnesses and inflammation. We want to know if inflammation may increase the risk of developing depression during and after pregnancy.  

Parents with a newborn in a neonatal intensive care unit have twice the risk of developing postpartum depression, anxiety and PTSD. Research also points to race and ethnicity as risk factors for mental health problems associated with maternity. Black mothers are twice as likely to develop a perinatal mood or anxiety disorder than white women, primarily due to the impact of  racial discrimination.

Newsroom:  When should a new mother be concerned about her mental health?

If two weeks post-delivery a woman continues to experience symptoms of depression and anxiety that interfere with her ability to function or to care for herself and her baby, it’s important to get some professional help. A good first step is to speak with your obstetrician and let them know what you are going through. In addition to feeling sad or crying all the time, persistent feelings of anger, worthlessness and inadequacy, or feeling disconnected from the baby, are associated with perinatal mood and anxiety disorders. In extreme cases, intrusive, negative thoughts about self-harm, or hurting the child, can be part of mental illness associated with pregnancy, childbirth and motherhood.  

Newsroom: What kind of help is available to women experiencing anxiety and depression during pregnancy and postpartum?

Therapy, including cognitive behavioral therapy. interpersonal psychotherapy or other modalities, can provide meaningful help. Antidepressants can be part of a treatment plan by providing relief and helping improve mood and regulation of emotions. In particular, Zoloft proved to be a safe and effective antidepressant to use during pregnancy and breastfeeding.

The Reproductive Psychology Program at Cedars-Sinai is dedicated to helping women experiencing mental health conditions before, during and after pregnancy. We make sure women can receive the resources, support, care and treatment they need to improve their emotional and mental wellbeing.

Mothers should not suffer in silence. The important first step is to talk to someone—a partner or other family member, a friend, a co-worker, or your physician—and let them know you are struggling. The well-baby checkups that happen frequently in the first six months of life offer a perfect opportunity for a new mother to talk to a healthcare provider about her problems.

Newsroom: As a therapist who counsels women struggling with their mental health during pregnancy or postpartum, what encouragement do you offer?

Every reproductive journey is different. Getting pregnant, having a baby, and going through the postpartum period can be stressful, life-changing experiences. It's important to give yourself grace, and to reach out to your loved ones. If you don't feel well, and you're not able to take care of yourself or your baby, there are services and providers available to help you. There is no reason to lose hope.

Read more on the Cedars-Sinai Blog: The Difference Between Postpartum Anxiety, OCD and Psychosis