Virtual psychiatric care for perinatal depression (Virtual-PND): A pilot randomized controlled trial

Abstract

• Novel protocol for home-based psychiatrist video-visits for perinatal depression. • Positive experiences among users, including comfort with communication and convenience. • Depressive symptom reduction in video-visit protocol similar to in-person only condition. Barriers to in-person mental health care are common in pregnant and postpartum women with depression. We assessed the feasibility of a trial protocol for evaluating the use of secure, in-home synchronous virtual psychiatric care. In this pilot randomized controlled trial in Toronto, Canada, women aged ≥18 years, pregnant or 0-12 months postpartum, with Edinburgh Postnatal Depression Scale (EPDS) scores >12, were randomized 1:1 to in-person visits only, or to an intervention condition where they were offered the option of video-visits for some or all of their follow-up care. We assessed trial protocol feasibility, and secondarily EPDS score at 12 weeks post-randomization. 63 women were randomized (33 intervention, 30 control) of which 87.9% ( n = 29) in the intervention group and 66.7% ( n = 20) in control group completed the 12-week follow-up questionnaire. About 48.5% ( n = 16) of intervention group participants used video-visits at least once, with high acceptability for participants and providers across a number of domains, and no adverse events. EPDS mean scores decreased from 16.6(SD 5.06) to 11.6(SD 4.77) and 16.9(SD 3.15) to 12.4(SD 3.96) for intervention and control groups, respectively (adjusted mean difference -0.64, 95%CI -2.95 to 1.67). It was feasible to recruit for a protocol evaluating psychiatrist video-visits for perinatal depression. Video-visits were acceptable to users and the psychiatrists providing their healthcare. A future non-inferiority efficacy trial can assess treatment outcome moderators to explore variability in effectiveness by illness severity and other factors, and cost-effectiveness of various types of video-visit strategies for psychiatric care in this population.