# Engagement, efficacy, and experiences of psychotherapy for perinatal populations with depression and anxiety during the COVID-19 pandemic

## TL;DR

The study found that telemedicine psychotherapy for perinatal depression and anxiety during the pandemic was as effective and satisfying as in-person therapy.

## Contribution

Demonstrated that telemedicine is a viable alternative to in-person psychotherapy during public health crises like the COVID-19 pandemic.

## Key findings

- Enrollment, retention, and satisfaction rates were comparable between peak and non-peak pandemic periods.
- Depressive and anxiety symptoms improved similarly regardless of pandemic phase or treatment modality.
- Telemedicine-based psychotherapy maintained efficacy and participant satisfaction during significant disruptions.

## Abstract

Engagement in psychotherapy is essential for achieving effective mental health outcomes, yet maintaining participation can be challenging—especially during significant disruptions such as the COVID-19 pandemic. The SUMMIT Trial evaluated a brief behavioral activation treatment for perinatal depression and anxiety, comparing telemedicine with in-person psychotherapy. Due to pandemic-related disruptions, in-person randomization was suspended twice, dividing participants into peak and non-peak COVID-19 timeframes.

This secondary mixed-methods analysis examined enrollment, retention, satisfaction, and depressive and anxiety symptoms between peak (March 2020-July 2021 & Jan-April 2022) and non-peak COVID-19 periods (Jan-March 2020, Jul 2021-Jan 2022, April 2022-Sep 2023). During peak-COVID-19, participants received telemedicine-only; otherwise, they were randomized to telemedicine or in-person treatment. T-tests compared symptom scores and enrollment rates; chi-square and logistic regression analyzed retention and satisfaction. Qualitative data underwent thematic analysis.

Of 1230 participants, 597 (48.5%) enrolled during peak-COVID and were randomized to telemedicine, while 693 (56.3%) were randomized to telemedicine or in-person treatment. Enrollment (25.4 vs. 21.8 participants/month, p = 0.250), retention (98.12% vs. 98.42%, p = 0.689) and satisfaction (CSQ-8: 3.45 vs. 3.39, p = 0.174) did not differ significantly. No differences were observed in depressive or anxiety symptoms at baseline (EPDS: 15.85 vs. 15.72, p = 0.546; GAD-7: 11.70 vs. 11.96, p = 0.3670) or at 3 months (EPDS: 9.09 vs. 9.09, p = 0.980; GAD-7: 6.42 vs. 6.38, p = 0.907).

Engagement, efficacy, and experience were comparable across pandemic phases, highlighting the feasibility of telemedicine-based adaptations in the midst of public health crises.