Abstract
During the COVID-19 pandemic, outpatient psychotherapy transitioned to telemedicine. This study aimed to examine barriers and facilitators to resuming in-person psychotherapy with perinatal patients as the pandemic abates. We conducted focus group and individual interviews with a sample of perinatal participants (n = 23), psychotherapy providers (n = 28), and stakeholders (n = 18) from Canada and the U.S. involved in the SUMMIT trial, which is aimed at improving access to mental healthcare for perinatal patients with depression and anxiety. Content analysis was used to examine perceived barriers and facilitators. Reported barriers included concerns about virus exposure in a hospital setting (77.8% stakeholders, 73.9% perinatal participants, 71.4% providers) or on public transportation (50.0% stakeholders, 26.1% perinatal participants, 25.0% providers), wearing a mask during sessions (50.0% stakeholders, 25.0% providers, 13.0% participants), lack of childcare (66.7% stakeholders, 46.4% providers, 43.5% perinatal participants), general transportation barriers (50.0% stakeholders, 47.8% perinatal participants, 25.0% providers), and the burden of planning and making time for in-person sessions (35.7% providers, 34.8% perinatal participants, 27.8% stakeholders). Reported facilitators included implementing and communicating safety protocols (72.2% stakeholders, 47.8% perinatal participants, 39.3% providers), conducting sessions at alternative or larger locations (44.4% stakeholders, 32.1% providers, 17.4% perinatal participants), providing incentives (34.8% perinatal participants, 21.4% providers, 11.1% stakeholders), and childcare and flexible scheduling options (31.1% perinatal participants, 16.7% stakeholders). This study identified a number of potential barriers and illustrated that COVID-19 has fostered and amplified barriers. Future interventions to facilitate resuming in-person sessions should focus on patient-centered strategies based on empathy regarding ongoing risk-aversion among perinatal patients despite existing safety protocols, and holistic thinking to make access to in-person psychotherapy easier and more accessible for perinatal patients.
Highlights
Recent studies suggest that approximately 8 to 13% of women experience perinatal depression in Canada and the United States [1,2], and 15–20% of women experience perinatal anxiety [3]
A key finding that emerged was that the majority of perinatal, provider, and stakeholder participants in the current study expressed a number of barriers to resuming in-person psychotherapy sessions that were specific to the COVID-19 pandemic, which included perinatal participants’ concerns about virus exposure in a hospital setting, virus exposure while taking public transportation, and having to wear a mask during psychotherapy sessions
This paper drew on multistakeholder, qualitative data to examine the relevant factors to resuming in-person psychotherapy sessions with perinatal patients
Summary
Recent studies suggest that approximately 8 to 13% of women experience perinatal depression in Canada and the United States [1,2], and 15–20% of women experience perinatal anxiety [3]. The COVID-19 pandemic has further exacerbated depression and anxiety symptoms among perinatal populations [6,7]. There is a growing body of evidence that suggests that telemedicine is a convenient [11], efficacious [12,13], cost-effective [14], and an acceptable [12,15] mode of receiving psychotherapy, there remains a need for further evidence to decipher whether psychotherapy delivered via telemedicine is as effective as receiving it in-person [16,17], and for whom telemedicine may be most suitable [18]
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