Table 3.
Summary characteristics of included studies of teleconsultations in patients with mental health conditions
| Main Diagnosis | Study ID | Design | Risk of Bias | Country | Population | Therapy type | Sessions, Follow up |
Attrition | Key outcomes | Results |
|---|---|---|---|---|---|---|---|---|---|---|
| Video consultation | ||||||||||
| Depression (HAMD≥15 |
Choi 2014 (41) | RCT | High | USA | Low income older adults (50–64 years) bN = 121 TM = 43 F2F = 42 Telephone support = 36 22.3% male |
Problem-solving therapy | 6 sessions 24 weeks follow-up |
a
TM = 5 (11.6%) F2F = 7 (16.6%)) |
Depression (HAMD) Treatment acceptance |
• Improvement in depression in both groups, no significant difference • Positive attitudes towards TM |
| Choi 2014b (42) | RCT | High | USA | Low income older adults (>50 years) bN = 158 TM = 56 F2F = 63 Telephone support = 39 21.5% male |
Problem-solving therapy | 6 sessions 36 weeks follow up |
a
TM = 7 (12.5%) F2F = 9 (14.3%) |
Depression (HAMD) and disability (WHODAS) | • Improvement in depression and disability in both groups • Significantly lower depression symptoms by Week 36 in TM vs. F2F • No significant difference in disability scores |
|
| Depression (DSM- IV criteria for major depressive disorder) (linked studies) |
Egede 2015 (28) | RCT (non-inferiority) | Low | USA | Military veterans (>58 years) N = 241 TM = 120 F2F = 121 97.5% male |
Behavioural activation | 8 sessions 12 month follow up |
TM = 20 (16.6%) F2F = 16 (13.2%) |
Depression (GDS, BDI) | • TM is non-inferior to F2F for the treatment of depression |
| Egede 2016 (29) | Low | Quality of life Satisfaction with treatment |
• No significant differences in SF-36 or satisfaction with treatment between TM and F2F at 12months | |||||||
| Egede 2018 (45) (subgroup analysis of Egede 2015/16) | RCT | Low | USA | Military veterans (>58 years) with type 2 diabetes N = 90 TM = 43 F2F = 47 97.8% male |
Behavioural activation | 8 sessions 12 month follow up |
NR | Type 2 diabetes control | • TM was superior to F2F treatment to lower HbA1C | |
| Depressive disorder (minor or major) | Luxton 2016 (30) | RCT (non-inferiority) | High | USA | Military members and veterans (18–65 years) N = 121 TM = 62 F2F = 59 81.8% male |
Behavioural activation | 8 sessions 3 month follow up |
TM = 22 (35.5%) F2F = 17 (28.9%) |
Depression | • Significant reductions in depression in both group • By the end of treatment (8w), the F2F group experienced a significantly greater reduction in depression symptoms vs. the TM group. However, this difference became non-significant in the 3m follow-up |
| PTSD | Acierno 2016 (31) | RCT (non-inferiority) | Some concerns | USA | Military veterans (mean age 45 years) N = 232 TM = 131 F2F = 134 94.4% male |
Behavioural Activation and Therapeutic Exposure | 8 sessions 12 month follow up |
48 did not complete at least 5 sessions TM = 18.0% F2F = 23.1% |
PTSD Depression |
• TM was non-inferior to F2F treatment to reduce PTSD and depression symptoms at all time points |
| PTSD | Acierno 2017 (32) | RCT (non-inferiority) | Some concerns | USA | Military veterans (mean age 42 years) N = 132 TM = 64 F2F = 68 96.2% male |
Prolonged exposure | 10 to 12 sessions 6 month follow up |
TM = 32.8% F2F = 19% (did not complete ≥6 sessions) |
PTSD Depression |
• TM was non-inferior to F2F treatment to reduce PTSD at all time points. • TM was non-inferior to F2F for depression at 6-month follow-up, but not earlier |
| PTSD | Maieritsch 2016 (33) | RCT | High | USA | Military veterans (mean age 31 years) N = 90 TM = 45 F2F = 45 93.3% male |
Cognitive processing therapy | 10 sessions 12 week follow up |
TM = 20 (44.4%) F2F = 19 (42.2%) |
PTSD Depression Therapeutic alliance |
• Significant decreases in depression and PTSD symptoms in both arms, but the difference between groups was not calculated due to high attrition |
| Medically unexplained pain | Chavooshi 2017 (34) | RCT | Some concerns | Iran | Adults aged 18–45 years with medically unexplained pain for ≥6 months N = 81 TM = 39 F2F = 42 64.2% male |
Intensive short- term dynamic psychotherapy | 16 sessions | TM = 9 (23%) F2F = 14 (33%) |
Pain intensity Depression Anxiety |
• F2F treatment led to significantly greater improvements in pain intensity, depression and anxiety compared to TM • Treatment satisfaction was similar in both groups |
| Opioid abuse | King 2014 (35) | RCT | High | USA | Outpatients attending addiction treatment services N = 59 TM = 24 F2F = 35 44.3% male |
Motivated Stepped Care Counseling | 12 weeks with number of sessions: TM = 5.4 (SD = 2.54) F2F = 6.1 (SD = 3.30” |
TM = 2 (8.3%) F2F = 1 (2.8%) (did not complete 3 follow-ups) |
Client satisfaction Therapeutic alliance |
• Treatment satisfaction and therapeutic alliance was high and similar in both groups |
| Telephone consultation | ||||||||||
| Depression | Alcantara 2016 (37) | RCT | High | USA & Puerto Rico | Low-income Latinos (≥18 years) in primary care N = 257 TM = 87 F2F = 84 Usual care = 86 18% male |
Engagement and Counselling for Latinos (ECLA); including psychoeducation, behavioural activation, cognitive reframing, and motivational interviewing | 6 to 8 sessions First 4 sessions were weekly; the 5th and 6th were biweekly unless more immediate care was needed. Continued up to 8 sessions. 2–4 months follow up |
TM = 17 (31.0%) F2F = 31 (46.9%) |
Worry reductions (PSWQ) | • Significantly larger worry reductions in TM vs. F2F |
| Depression (Major depression) | Fann 2015 (43) | RCT | High | USA | Patients with traumatic brain injury (mean age 45.8 years) bN = 100 TM = 40 F2F = 18 63% male |
Cognitive behavioural therapy | 12 sessions over 12 weeks 24 weeks follow up |
TM = 5 (12.5%) F2F = 2 (11.1%) |
Depression Therapeutic alliance |
• No significant differences between TM and F2F for depression severity or therapeutic alliance |
| Depression (linked studies) |
Kalapatapu 2014 (39) (subgroup analysis of Mohr 2012) |
RCT | Low | USA | Patients with problematic alcohol use in primary care (mean age 42–45 years) N = 103 TM = 50 F2F = 53 12.6% male |
Cognitive behavioural therapy | 18 sessions over 18 weeks 6 months follow-up |
TM = 26.0% F2F = 24.5% | Depression Alcohol use Treatment adherence |
• No significant difference between TM and F2F at any time point for depression outcomes |
| Mohr 2012 (38) | RCT (non-inferiority) | Low | USA | Patients in primary care (mean age 47 years) N = 325 TF = 163 F2F = 162 22.5% male |
Cognitive behavioural therapy | 18 sessions over 18 weeks 6 months follow-up |
TM = 34 (20.9%) F2F = 53 (32.7%) |
Depression Treatment adherence |
• TM improves adherence • Depression severity improved in both groups, but was significantly better in the F2F group by the 6-month follow-up |
|
| Stiles-Shields 2014 (40) | Low | Therapeutic alliance | • No significant differences in therapeutic alliance | |||||||
| Cancer | Watson 2017 (36) | RCT | High | UK | Cancer patients referred to psychological care (mean age 48–52 years) N = 118 TM = 60 F2F = 58 27.9% male |
Cognitive behavioural therapy | Up to 8 sessions over 12 weeks | TM = 17 (28.3%) F2F = 23 (39.6%) |
Depression Anxiety |
• No significant differences from baseline to Week 8 in depression and anxiety |
F2F, face-to-face, PTSD, post-traumatic stress disorder, RCT, randomised control trial, TM, telemedicine
aAttrition was due mostly to deteriorating health problems that resulted in hospitalization, nursing home placement, and death
bThird patient group was telephone support, but not included as the intervention given to this group differed from the others.
cThird patient group was usual care, including rehabilitation and primary care services (without cognitive behavioural therapy)