New Study Eyes Telemedicine for Treating Perinatal Stress, Depression

Researchers in North Carolina, Chicago and Toronto are collaborating on a large-scale study aimed at determining whether behavioral healthcare services delivered by telemedicine can help new mothers dealing with anxiety and depression.

The five-year study, funded by a $13.2 million grant from the Patient-Centered Outcomes Research Institute (PCORI), will also test whether a nurse can deliver these services with the same quality of care as a specialist.

“We’re asking whether it matters if the therapy is done by a specialist or a non-specialist, and does it matter if it is done in person or by telemedicine?” Brad Gaynes, MD, MPH, a professor of psychiatry at the University of North Carolina School of medicine and co-investigator for the study, said in a press release. “We’re really testing whether you can get the same outcome from each method of treatment.”

“The evidence supporting non-specialist delivered interventions is impressive,” added global health researcher Daisy Singla, PhD, of the University of Toronto, a co-principal investigator in the study. “In some of the most low-resource contexts in the world, non-specialists such as peers, nurses, teachers and lay counsellors have been trained to effectively deliver psychological treatments. In North America, nurses are at the frontlines of managing women during the perinatal period. They are eager to learn the relevant skills to tackle perinatal depression and anxiety.”

UNC is partnering with researchers at the University of Toronto and Chicago’s North Shore University Health System on the project, which focuses on talk therapy or behavioral activation, a form of psychotherapy that focuses on providing patients with the skills needed to make small behavioral changes that can improve their mood and overall mental health.

If it’s proven that this form of treatment can be delivered by telehealth and by a nurse instead of a specialist, the connected health platform could significantly expand access to care for millions of expectant and new mothers cross the globe. An estimated one in five women deal with depression and anxiety during and after pregnancy, yet less than 20 percent of that group can easily access talk therapy, either because they can’t get to a care facility or specialists aren’t available.

It would also add to a growing body of mHealth and telehealth programs aimed at improving care management and coordination for new mothers and their children, from mobile health apps that give moms on-demand access to resources and care providers to virtual care services that connect them to specialists.

“This study attempts to meet the public health need of providing psychotherapy like behavioral activation to perinatal women on a population level,” Samantha Meltzer-Brody, MD, MPH, director of the UNC Perinatal Psychiatry Program, the UNC School of Medicine Ray M. Hayworth Distinguished professor of psychiatry and co-principal investigator for the study, said in the press release. “Many people don’t get the services they need, especially in rural areas. We want to reach people where they are and increase access for these patients.”

“It is difficult to access quality talk therapy,” added Crystal Schiller, PhD, an assistant professor of psychiatry at UNC and clinical lead of the study. “There’s a real limit on the number of specialists in North America and it is also expensive - many of the specialists are out of network so patients have to pay out of pocket. As a result, many women actually get medication as a first step instead of starting with talk therapy.”

The study will take place at all three locations and involve roughly 1,360 women, divided into four groups: those receiving treatment in person by a specialist; those using telemedicine to access a specialist; those being treated in person by a nurse; and those using telemedicine to see a nurse. 

“I see many patients who would benefit from this treatment who are not able to get it in the current health care system,” said Alison Stuebe, MD, MSc, an associate professor of maternal-fetal medicine at UNC, associate director of research and program development for the UNC Center for Maternal and Infant Health and co-investigator for the study. “I’m really hopeful that with these study results we can improve their health and well-being by immediately implementing some of these care-delivery methods and making treatment easier to access.”