Virtual Psychiatric Care for Perinatal Depression
Virtual Psychiatric Care for Perinatal Depression
Perinatal depression occurs in 15% of pregnant women and new mothers, yet as few as 1 in 5
 receive adequate treatment. It has a negative impact on the woman herself, as well as a
 potential for serious consequences for her child. Virtual psychiatric care is a potential
 model that may provide accessible mental health care during this time, as barriers to
 in-person care often include unpredictable infant schedules, competing childcare demands, or
 travel/cost challenges. The Virtual-PND intervention consists of 12-weeks of the option of
 supplementing in-person psychiatric care with secure, in-home real-time video-visits through
 the Ontario Telemedicine Network. This pilot RCT will demonstrate the feasibility of
 proceeding to a future large-scale RCT evaluation of virtual psychiatric care for this
 population.
This is a two-site pilot randomized controlled trial (RCT) to evaluate the feasibility of a
 Virtual Psychiatric Care for Perinatal Depression (Virtual-PND) intervention protocol,
 comparing virtual care to in-person care only. Participants will be pregnant or postpartum
 women with a major depressive disorder who are referred for care at one of the participating
 study sites. Each study site is a specialist reproductive psychiatric program where women
 from the greater Toronto area are referred, and generally treated with in-person care. Those
 randomized to the virtual care group will be able to receive psychiatric visits with
 video-based visits. Those randomized to the in-person care group will receive in-person care
 only, as per usual clinical practice at the study sites. The length of the active treatment
 phase will be 12 weeks from enrolment. The overall objective of this pilot RCT is to
 determine the feasibility of conducting a larger RCT to evaluate the efficacy of the
 treatment model, comparing outcomes among those with and without access to virtual care, and
 cost-effectiveness.
Inclusion Criteria:

 -  ≥18 years old

 -  Pregnant or 0-12 months postpartum

 -  Experiencing clinically significant depressive symptoms (defined as a score of ≥12 on
 the Edinburgh Postnatal Depressive Scale, EPDS, during eligibility screening)

 -  Able to access the internet on a device (i.e. mobile phone, tablet, personal computer)
 with video-visit capacity (including web camera and speakers)

 -  Comfortable with email communication

 Exclusion Criteria:

 -  Active alcohol/substance use disorder in the past 12 months

 -  Active suicidal ideation

 -  Current mania or psychosis

 -  Unsuitable for virtual care, as per assessment of the treating psychiatrist