Telehealth Ensured Access to Perinatal Mental Healthcare, But Care Gaps Remain

The transition to using telehealth for perinatal mental health services for mothers and infants helped improve access to care during the pandemic and led to similar outcomes as in-person services, a study published in the Infant Mental Health Journal found. But inequities persisted among racial minority groups.  

Perinatal mood and anxiety disorders, which can occur during or after pregnancy, have been linked to poorer birth outcomes and problems with infants’ social and emotional development.

Psychosocial stress and low social support are two risk factors for these disorders. The COVID-19 pandemic led to increased social isolation and disrupted social interaction, which raised particular concerns for pregnant patients and their mental health.

When the pandemic called for limited in-person interaction, the Healthy Expectations Perinatal Mental Health Program at a tertiary care children’s hospital in the Rocky Mountain Region transitioned its services to a fully virtual model to ensure continuation of care.

The program offered parent-child early relational assessments, a maternal postpartum peer support group, a mother-infant dyadic group, infant developmental therapy, and mothers group therapy.

The health system was able to successfully transition each therapy service to a telehealth setting, except for the infant developmental therapy.

Researchers looked at the health outcomes of patients who received therapy via telehealth between March 15 and December 15, 2020, and compared them to the outcomes of patients who participated in the in-person model between March 15 and December 15, 2019.

During the pre-pandemic period, the program received initial outreach calls from 147 patients. This number increased to 157 during the pandemic. In 2019, 25 mother-infant pairs enrolled in the program and 16 completed the program. The following year, the program saw a higher completion rate with 18 pairs enrolling and 15 completing the program.

Virtual visits could also increase access to convenient care for some patients, particularly those in their third trimester when physical discomfort may make traveling difficult, the study noted.

The program used the Edinburgh Postnatal Depression Scale (EPDS) to track patient outcomes before, during, and after the program. EPDS scores for incoming patients in the in-person group and telehealth group were similar, with scores ranging from 14 to 16.

After completing the program, the average EPDS score for participants in both groups was zero, indicating that telehealth was just as effective as in-person therapy.

The shift to telehealth was also associated with an increase in patients who had public insurance, perhaps due to the Centers of Medicare and Medicaid Services (CMS) newly offering coverage for virtual services during the pandemic.

Using telehealth for perinatal mental healthcare helped maintain care continuation during the pandemic, but it did not help reduce racial disparities in accessing care, the study found.

“In spite of theoretical potential for increased access for underserved populations by offering services via telehealth and the increased intervention completion, we found surprisingly similar demographic pictures overall and decreased racial/ethnic diversity when considering [Mother-Infant Therapy Group] participants across the 9-month pre-pandemic and pandemic periods across several demographic markers,” researchers wrote.

The majority of participants in the pre-pandemic period were white and not Hispanic or Latina. During the pandemic, this majority increased while the number of Hispanic or Latina patients dropped further.

This suggests that targeted outreach to minority and underserved communities is needed to address racial care disparities and inequities when it comes to accessing telehealth services.

What’s more, some patients found it difficult to participate in virtual therapy sessions if they did not have anyone else to watch their infant during the visits. Other distractions such as older children, texts, calls, and email notifications impeded their ability to participate.

“Despite the challenges and drawbacks to the telehealth adaptation of this program over the past year, we witnessed deep and lasting connections between participants in the group programs and increased mutual enjoyment between mothers and babies,” the researchers concluded.