About 20% of women experience depression or anxiety during the perinatal period (pregnancy to one year following childbirth). Brief psychotherapies are considered first-line interventions by treatment guidelines. However, only about 10% of affected perinatal patients receive psychotherapy. Scaling up psychological interventions to the population has remained a problem for the treatment of perinatal depression, as well as other conditions. A potential solution to this gap is providing telemedicine, which is as effective as in-person care and is preferred by perinatal patients. Another solution is task-sharing, which involves nonspecialists (nurses and midwives) providing brief, structured treatment. In this very large trial, Singla and colleagues randomized 1,230 pregnant and post-partum women to receive 8 weekly behavioural activation interventions by (1) non-specialists with telemedicine, (2) non-specialists in person, (3) specialists with telemedicine, and (4) specialists in person. Behavioural activation therapy is a brief treatment for depression with evidence for its efficacy. One of the unique aspects of this trial is that it is large enough with sufficient statistical power to test a “non-inferiority” hypothesis – that is, a hypothesis that outcomes in any of the study conditions would not be different based on a pre-established margin. The results indicated no difference in depression and anxiety outcomes when comparing providers (specialist vs non-specialist) and modality (telemedicine vs in-person) at 3 months post-treatment. In addition, there were no differences among conditions for client satisfaction, therapeutic alliance, and perceived social support.
Practice Implications
Access to specialist providers tends to be scarce, and treatments are inequitably accessible to most of the world's population. Scaling up psychological interventions to the population has been a goal for a very long time. Patients prefer psychological treatments to medications, but often, patients are only offered medications because of the ease of distribution and access. This large and unique trial suggests that providing psychological interventions by non-specialists using telemedicine could be an effective means to solve the issue of treatment accessibility in the world’s perinatal population. The findings suggest that brief psychological interventions by non-specialists using telemedicine are not inferior and may be a solution to increasing access to mental health care.
Singla, D., Silver, R.K., Vigod, S.N., Schoueri-Mychasiw, N., Jo Kim, J., La Porte, L.M., Ravitz, P.,… Meltzer-Brody, S. (2025). Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: A pragmatic, noninferiority randomized trial. Nature Medicine, 31, 1214-1224. https://doi.org/10.1038/s41591-024-03482-w
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