A large, multisite randomized trial found that both telemedicine-delivered psychotherapy and therapy provided by non-specialists were noninferior to in-person, specialist-led psychotherapy in treating perinatal depression and anxiety.

Between January 2020 and October 2023, researchers enrolled 1,230 pregnant and postpartum participants across the U.S. and Canada into four treatment arms: nonspecialist telemedicine (n=472), specialist telemedicine (n=469), nonspecialist in-person (n=145), and specialist in-person (n=144). Patients received weekly behavioral activation (BA) therapy, an evidence-based intervention for depression and anxiety. The primary endpoint was depressive symptoms measured by the Edinburgh Postnatal Depression Scale (EPDS) at 3 months post-randomization.

EPDS scores for nonspecialists averaged 9.27 (95% CI 8.85-9.70), while specialists recorded 8.91 (95% CI 8.49-9.33). Similarly, telemedicine patients had an EPDS score of 9.15 (95% CI 8.79-9.50) compared to 8.92 (95% CI 8.38-9.45) for in-person sessions. For anxiety symptoms measured by the Generalized Anxiety Disorder (GAD-7) scale, nonspecialists and specialists had scores of 6.44 (95% CI 6.01-6.86) and 6.36 (95% CI 5.95-6.78), respectively. Telemedicine and in-person treatments resulted in scores of 6.43 (95% CI 6.09-6.78) and 6.29 (95% CI 5.71-6.88), respectively.

A majority of participants (80%) completed at least 4 sessions of the 8-session protocol, with an average attendance of 6.20 sessions. Telemedicine participants attended significantly more sessions than those receiving in-person therapy, averaging 6.55 compared to 5.07 (P < .001). Patient satisfaction remained comparable across all treatment arms.

No serious adverse events were linked to the trial interventions. Among participants, 62.1% preferred telemedicine, while 60.7% initially favored specialist-led psychotherapy. Despite this preference, the results demonstrate that non-specialists can effectively deliver structured psychotherapy.

"This trial suggests compelling evidence for task-sharing and telemedicine to improve access to psychotherapies for perinatal depressive and anxiety symptoms," the authors concluded in Nature Medicine.

Full disclosures can be found in the study.