Yang Rebecca, Vigod Simone N, Hensel Jennifer M
Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.
J Med Internet Res. 2019 May 20;21(6):e13172. doi: 10.2196/13172.
Depression and anxiety during the postpartum period are common, with psychotherapy often being the preferred method of treatment. However, psychological, physical, and social barriers prevent women from receiving appropriate and timely psychotherapy. The option of receiving psychotherapy through videoconferencing (VC) during the postpartum period presents an opportunity for more accessible and flexible care.
The aim of this study was to assess the feasibility, acceptability, and preliminary effectiveness of optional VC added to usual office-based psychotherapy, with a psychotherapist during the postpartum period.
We conducted a pilot randomized controlled trial with 1:1 randomization to office-based care (treatment as usual; TAU) or office-based care with the option of VC (treatment as usual plus videoconferencing; TAU-VC) for psychotherapy during the postpartum period. We assessed the ability to recruit and retain postpartum women into the study from an urban perinatal mental health program offering postpartum psychotherapy, and we evaluated the uptake, acceptability, and satisfaction with VC as an addition to in-person psychotherapy. We also compared therapy attendance using therapist logs and symptoms between treatment groups. Symptoms were assessed at baseline and 3 months postrandomization with the Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7-item, and Parental Stress Scale. Furthermore, 3-month scores were compared between groups with intention-to-treat linear mixed-effects models controlling for baseline score.
We enrolled 38 participants into the study, with 19 participants in each treatment group. Attendance data were available for all participants, with follow-up symptom measures available for 25 out of 38 participants (66%). Among the 19 TAU-VC participants, 14 participants (74%) utilized VC at least once. Most participants were highly satisfied with the VC option, and they reported average savings of Can $26 and 2.5 hours in travel and childcare expenses and time per appointment. There were no significant differences between the 2 groups for psychotherapy attendance or symptoms.
The option of VC appears to be an acceptable method of receiving psychotherapy for postpartum women, with benefits described in costs and time savings. On the basis of this small pilot sample, there were no significant differences in outcomes between office-based care with or without the option of VC. This study has demonstrated the feasibility of such a program in an urban center, which suggests that a larger study would be beneficial to provide evidence that is more conclusive.
产后抑郁和焦虑很常见，心理治疗通常是首选的治疗方法。然而，心理、身体和社会障碍使女性无法获得适当和及时的心理治疗。产后通过视频会议（VC）接受心理治疗为更便捷和灵活的护理提供了机会。
本研究的目的是评估在产后期间，在常规门诊心理治疗基础上增加可选视频会议治疗方式，由心理治疗师进行治疗的可行性、可接受性和初步疗效。
我们进行了一项试点随机对照试验，将患者以1:1的比例随机分配至常规门诊治疗组（照常治疗；TAU）或可选择视频会议的常规门诊治疗组（照常治疗加视频会议；TAU-VC），以接受产后心理治疗。我们评估了从一个提供产后心理治疗的城市围产期心理健康项目中招募和留住产后女性参与研究的能力，并评估了视频会议作为面对面心理治疗补充方式的使用率、可接受性和满意度。我们还使用治疗师记录比较了治疗组之间的治疗出勤率和症状。在基线和随机分组后3个月，使用爱丁堡产后抑郁量表、广泛性焦虑障碍7项量表和父母压力量表评估症状。此外，使用控制基线分数的意向性治疗线性混合效应模型比较两组之间的3个月得分。
我们招募了38名参与者进入研究，每个治疗组有19名参与者。所有参与者都有出勤数据，38名参与者中有25名（66%）有随访症状测量数据。在19名TAU-VC参与者中，14名参与者（74%）至少使用过一次视频会议。大多数参与者对视频会议选项非常满意，他们报告每次预约平均节省26加元和2.5小时的交通和托儿费用及时间。两组在心理治疗出勤率或症状方面没有显著差异。
视频会议选项似乎是产后女性接受心理治疗的一种可接受的方式，在成本和时间节省方面有好处。基于这个小的试点样本，有无视频会议选项的门诊治疗在结果上没有显著差异。这项研究证明了这样一个项目在城市中心的可行性，这表明进行更大规模的研究将有助于提供更具决定性的证据。
