Table 3.
Implementation outcomes.
Outcome | Study | Assessment or treatment | Main diagnosis | Intervention (number of studies) | Comparator (number of studies) | Results |
|
Assessment comparability | |||||||
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Drago et al (2016) [27] | Assessment and treatment | Multiple | Videoconferencing (n=24) | Face-to-face (n=23); no comparator (n=1) | Assessment was found to be highly consistent between remote and face-to-face settings; correlation coefficient=0.73 (95% CI 0.63-0.83). |
|
|
Muskens et al (2014) [32] | Assessment | Multiple | Telephone diagnostic interviewing (n=16) | Face-to-face diagnostic interviewing (n=16) | There were a few studies that were properly performed to draw conclusions regarding the comparability of telephone and face-to-face interviews for psychiatric morbidity. Telephone interviewing for research purposes in depression and anxiety may however be a valid method. |
|
Fidelity and competence of therapists | Turgoose et al (2018, veterans) [38] | Treatment | PTSDa | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | High levels of fidelity and therapist competence (n=3), with no significant differences compared with face-to-face settings. |
|
Patient adherence to intervention | |||||||
|
Bolton and Dorstyn (2015) [24] | Treatment | PTSD | Internet-based CBTb with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) | Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) | Qualitative feedback revealed that the comprehension of the therapy materials was high, with participants completing a set of homework tasks (n=5). |
|
|
Dorstyn et al (2013, ethnic minorities) [21] | Treatment | Depression | Telephone CBT (n=2); telephone supportive counseling (n=1); telephone structural ecosystems therapy (n=1); internet-based CBT with weekly individual sessions (n=2); internet telepsychiatry (n=1); internet supportive counseling and personalized email correspondence (n=1) | Face-to-face (n=1); treatment as usual (n=3); minimal support control or waitlist (n=2); no control (n=2) | Most studies reported good treatment adherence with rates of completion of 75-97%. |
|
|
Garcia-Lizana and Munoiz-Mayorga (2010) [28] | Assessment and treatment | Multiple | Videoconferencing for diagnosis and follow-up (n=3); video-based evaluation of competency to stand trial (n=1); nonspecific video-based CBT (n=5); video-based psychoeducation and counseling (n=1) | Face-to-face (n=10) | Across two studies, mixed results were found for treatment adherence, with one study finding no difference and another reporting better adherence in the face-to-face group. |
|
Patient attendance | |||||||
|
Dorstyn et al (2013, ethnic minorities) [21] | Treatment | Depression | Telephone CBT (n=2); telephone supportive counseling (n=1); telephone structural ecosystems therapy (n=1); internet-based CBT with weekly individual sessions (n=2); internet telepsychiatry (n=1); internet supportive counseling and personalized email correspondence (n=1) | Face-to-face (n=1); treatment as usual (n=3); minimal support control or waitlist (n=2); no control (n=2) | One study reported difficulty reaching participants by telephone resulting in fewer sessions completed. |
|
|
Christensen et al (2019, older adults) [25] | Treatment | Depression or a range of diagnoses including depression | Video consultations for telepsychiatry (n=21) | Face-to-face (11), no control (10) | Video consultations increased access to care and removed barriers such as having to travel (n=4). |
|
|
Lin et al (2019) [30] | Treatment | Substance use disorders | Video- or telephone-based psychotherapy (n=10); remote medication management (n=3; patient presents at local clinic with nurse and are connected to a physician at a distant site via videoconference) | Face-to-face psychotherapy (n=7); telephone (n=2); treatment as usual (n=1); no control (n=3) | Most studies reported increased retention in telemental health groups (n=4); however, no difference in in number of sessions attended was sometimes reported (n=2). One alcohol addiction study reported lower dropout in the telemental health group, and more patients in this group were still in treatment at 6 months and one year. Two opioid addiction studies found that videoconference interventions resulted in a better retention of participants up to one year as compared with those receiving in-person care. Another opioid study found >50% retention at 12 weeks but did not have a comparison group. However, another two studies found no difference between videoconference-delivered psychotherapy and in-person psychotherapy in the number of sessions attended. |
|
|
Turgoose et al (2018 veterans) [38] | Treatment | PTSD | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | In the majority of cases, there were no differences between teletherapy and in-person treatments on dropout or attendance. There was some indication that teletherapy may help to increase uptake. |
|
Safety | |||||||
|
Bolton and Dorstyn (2015) [24] | Treatment | PTSD | Internet-based CBT with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) | Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) | Client safety was deemed satisfactory. |
|
|
Turgoose et al (2018, veterans) [38] | Treatment | PTSD | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | There might be some occasions where veterans have concerns about exposure tasks due to the lack of physical presence of the therapist; however, overall, it was established that these can be used just as effectively remotely. If appropriate steps are taken to manage safety, then episodes of acute suicidality can also be managed. |
|
Technical difficulties | |||||||
|
Bolton and Dorstyn (2015) [24] | Treatment | PTSD | Internet-based CBT with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) | Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) | Minimal technical difficulties were encountered (n=1); participants reported that they would have preferred different forms of media, for example, a mobile app, to supplement support (n=1). |
|
|
Christensen et al (2019, older adults) [25] | Treatment | Depression or a range of diagnoses including depression | Video consultations for telepsychiatry (n=21) | Face-to-face (11), no control (10) | Challenges such as mistrust in technology were reported frequently (n=4). |
|
|
Turgoose et al (2018, veterans) [38] | Treatment | PTSD | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | Commonly reported technical difficulties were low-image resolution on videoconferencing technology, not being able to connect, and audio delays. |
|
aPTSD: posttraumatic stress disorder.
bCBT: cognitive behavioral therapy.