A Randomized Controlled Trial of a Telehealth Group Intervention to Reduce Perinatal Depressive Symptoms: A Mixed Methods Analysis

Introduction: Perinatal depression affects approximately 20% of childbearing individuals and is associated with adverse perinatal outcomes. Nonpharmacological therapies are effective for mild to moderate depression, but multiple access barriers exist, including financial constraints and the inconvenience of in-person appointments. Remote access (ie, telehealth) to services is a promising option, but few studies have evaluated the effectiveness of this approach. The objective of this study was to use a mixed methods approach in a randomized controlled trial to evaluate the effectiveness of a group videoconference intervention to reduce symptoms of perinatal depression. Methods: Participants were assigned to a videoconference intervention group (VCI; mindfulness-based cognitive behavioral therapy) or an attention control group (AC; childbirth preparation or early parenting education) via a videoconference system. Groups of 4 to 6 pregnant and postpartum individuals with mild to moderate symptoms of depression attended a one-hour session for 9 weeks using an electronic device from their own home. The Edinburgh Postnatal Depression Scale (EPDS) measured depression symptoms before and after intervention with follow-up to 8 months. Focus groups assessed participants’ telehealth experiences and were analyzed for common themes. Results: From May 2020 through May 2022, 81 participants were randomized, and 69 (85.2%) ultimately initiated study participation (36 in VCI, 33 in AC group). Participants in both groups had a significant decrease in EPDS score of 3.36 (95% CI, 4.55-2.17) that was maintained 8 months postintervention. There were no significant interactions between time and intervention group (all P >.249). In the focus group analysis, themes of connection, shared experience, empowerment, and community building were consistent between the 2 intervention groups. Discussion: Both intervention groups had clinically meaningful improvement in EPDS scores up to 8 months postintervention. Anchored in the common themes in the qualitative analysis, our results suggest that participation in telehealth group sessions, regardless of session content, may be beneficial in reducing depression symptom burden.