Effectiveness of Telepsychotherapy Versus Face-to-Face Psychological Intervention for Perinatal Anxiety and Depressive Symptomatology During COVID-19: The Case of an Italian Perinatal Psychological Care Service

Background: COVID-19 has limited pregnant and postpartum women’s access to mental health services, leading to the introduction of online interventions. Objectives: This study aims to compare the effectiveness of telepsychotherapy (i.e., psychotherapy provided through digital technology supporting real-time interactivity in the audio or audiovisual modality) with the one yielded by face-to-face interventions in treating perinatal depression and anxiety and to assess the therapist’s perceived alliance in both interventions. Methods: We collected anamnestic information and obstetrical risk factors for 61 women. We evaluated the effectiveness of face-to-face (N = 31) vs. telepsychotherapy (N = 30) interventions on depressive and anxiety symptoms at baseline (T0) and the end of treatment (T1) using the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI-Y 1 and 2). We assessed the degree of alliance perceived by therapists with the Working Alliance Inventory (WAI-T). Results: Both groups showed significant decreases in depressive (EPDS face-to-face: T0 12.65 ± 5.81, T1 5.77 ± 4.63, p < 0.001; EPDS remote: T0 11.93 ± 5.24, T1 5.70 ± 4.46, p < 0.001; effect size: 0.002) and state anxiety (STAI-Y 1 face-to-face: T0 51.19 ± 13.73, T1 40.23 ± 12.86, p < 0.001; STAI-Y 1 remote: T0 51.10 ± 11.29, T1 38.00 ± 10.90, p < 0.001; effect size: 0.007//STAI-Y 2 face-to-face: T0 43.13 ± 12.11, T1 41.03 ± 13.06, p = 0.302; STAI-Y 2 remote: T0 44.20 ± 8.70, T1 39.30 ± 9.58, p = 0.003; effect size: <0.001) symptoms by the end of treatment. Women treated remotely also experienced a significant reduction in trait anxiety at T1 (p = 0.003). We found no significant differences in either symptomatology (EPDS; STAI-Y) between the two interventions at baseline or in the therapist-perceived alliance. Conclusions: Synchronous telepsychotherapy for perinatal depression and anxiety showed comparable treatment response to face-to-face interventions, with both modalities associated with significant symptom reduction and the establishment of a working alliance. These findings support the potential of telepsychotherapy as a valuable alternative when in-person services are not accessible, especially during emergency contexts.