(753) Conversion to Telehealth During COVID-19 and Depression Symptom Response in a Perinatal Collaborative Care Model

Objective: We aimed to assess the association between conversion to telehealth and depression symptom response in a perinatal collaborative care model-based treatment (PCCM).

Study Design: This was a retrospective study of pregnant and postpartum people from 2017-2022 who engaged in a PCCM for perinatal mental health care. Outcomes were analyzed by epoch, defined as pre-telehealth (preT) (2017-2020) and post-telehealth (postT) (2020-2022) cohorts, based on when PCCM converted to telehealth as a result of the COVID-19 pandemic. Sociodemographic (age, race/ethnicity, parity, substance use) and perinatal data (gestational age at delivery, delivery route) and all PHQ-9 scores were abstracted from the EHR. Bivariate and multivariate analyses were performed to compare depressive symptom response over time between preT and postT cohorts in three ways: change in PHQ-9 score from initial to final, dichotomized PHQ-9 score improvement from initial to final, and as a linear mixed effects model to analyze trajectories of PHQ-9 scores adjusting for random effects within each person.

Results: Of 1422 people who met eligibility criteria, 679 (48%) engaged in PCCM postT. There were no differences in age, race/ethnicity, parity, tobacco use, gestational age at delivery, and delivery route between cohorts. People in preT were less likely to have prior substance use, but more likely to have medical comorbidities and prior mental health diagnoses compared to postT. Both groups had decreases in PHQ-9 scores, consistent with improvement in depressive symptoms, but preT had greater mean decreases and were more likely to have an improvement in scores than postT, after adjusting for potential confounders (Table). There was no difference in PHQ-9 trajectories between the cohorts (Figure).

Conclusion: Overall, we observed improvements in depression symptoms in PCCM with greater improvements in mean PHQ-9 scores in preT compared to postT, but no differences in scores when accounting for random effects in each person, suggesting that mental health services via telehealth offers similar outcomes compared to in-person visits.