How telemedicine could benefit perinatal psychiatry

To the Editor

We would like to emphasize how telemedicine could benefit perinatal psychiatry.

In the context of the COVID-19 pandemic (Shore et al., 2020), we implemented telemedicine for parents with mood disorders and their infants (Gressier et al., 2020).

First, telemedicine offers a naturalistic assessment of caregiver–infant pairs, in which previously underestimated interactions can be observed. Most parents share a view of their homes, allowing for a better assessment of their daily environment and lifestyle, including childcare, cooking and smoking habits. The presence of the child in his or her own environment also provides relevant information for understanding interactions and psychopathology. Children’s investment of space and their use of objects/toys are informative to evaluate their development. Primary caregiver’s responses to various infant requests and unexpected situations allow for the assessment of parental abilities, shortcomings and neglect. Caregivers with the greatest parental concern may respond to each of their child’s needs, leaving the therapist alone for a time. Others may demonstrate their child’s abilities, sometimes through hyperstimulation, especially in the context of anxious depression. Others may ignore their child, placing him or her aside. This more naturalistic assessment is also less intrusive, especially for children.

Second, telemedicine enables evaluation of the whole family. In particular, it can lead to unplanned interactions with the secondary caregiver. His or her place and ability to take care of the baby when the primary caregiver is not available, as well as his or her own mental health can be better assessed. Siblings can also be examined. Notably, whereas face-to-face consultation may be better for psychotherapeutic work, the emotional cost seems lower for family members via video, allowing for improved expression of feelings and difficulties. Telemedicine thus increases the whole family’s access to health care.

Third, telemedicine improves collaboration by simplifying and expanding access to multidisciplinary meetings (including psychiatrists, pediatricians, psychologists and nurses) with high cost-effectiveness and better quality of care. Psychoeducation and psychotherapeutic interventions can also be implemented.

Thus, the use of telemedicine can improve mental health services for perinatal psychiatry and extend the perinatal psychiatrist’s reach to a larger geographical area. Despite concerns for therapeutic relationship establishment, privacy, safety, technological drawbacks and care restrictions (unwilling patients, delusion, suicidal thought or child maltreatment), telemedicine can ensure continued perinatal psychiatric care and also appears to be an innovative and valuable means to assess the caregivers’ bond, infant’s development and family interactions in a broader, ecological and multidisciplinary view.