Introduction: The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has transformed health care significantly. COVID-19 is highly contagious and physical distancing is recommended to prevent its infection. Telemedicine is a viable option for both health care providers and patients to reduce COVID-19 infection while allowing access to medical care. In response to the COVID-19 pandemic, several countries have relaxed their regulations to increase access to health care via telemedicine. As a result, the use of telemedicine is expanding worldwide.
Aims: Psychiatry, in particular, is probably the most suitable for the use of videoconferencing because it is characterized by the unique features in that diagnosing, and symptom assessment are based primarily on patient interviews and observations, and laboratory tests are limited therefore the physical presence of the patient is less important. However, it is unknown for which mental illness telepsychiatry is as effective as face-to-face treatment.
Methods: We conducted a comprehensive meta-analysis comparing telepsychiatry vs. face-to-face care for mental illness. We conducted a literature search without language restrictions, using MEDLINE/PubMed, Cochrane library, Scopus, Embase, CINAHL and PsychInfo from database inception (last search: March 1st, 2021). Hand searches of reference lists of relevant publications were also conducted. We included randomized controlled trials comparing telepsychiatry vs. face-to-face treatment, and reported any meta-analyzable data, including effectiveness, efficacy or safety/tolerability-related outcomes. The primary outcome was set as the mean change from baseline to endpoint in the standard symptom scale scores used for each disease. Secondary outcomes included all meta-analyzable outcomes.
Results: We identified 32 studies (n=3,592) across 11 mental illness that met the inclusion criteria and analyzed. Disease-specific analyses showed that telepsychiatry treatment significantly outperformed face-to-face treatment for patients with depressive disorders [N=6, n=561, standardized mean difference (SMD)=-0.325, 95% confidence interval (CI)=-0.640 to -0.011, p=0.043]. On the other hand, face-to-face treatment was superior to telepsychiatry in improving symptom scale score for patients with bulimia nervosa (N=1, n=128, SMD=0.368, 95% CI=0.018 to 0.717, p=0.039). There was no significant difference between telepsychiatry and face-to-face treatment in the primary outcome integrating the study of all diagnoses (N=26, n=2,290, p=0.248). In all cause discontinuation, telepsychiatry treatment for patients with mild cognitive impairment was associated with significantly lower discontinuation compared with face-to-face treatment [N=1, n=61, risk ratio (RR)=0.552, 95% CI=0.312 to 0.975, p=0.040]. However, for the patients with substance abuse, the result was reversed (N=1, n=85, RR=37.41, 95% CI=2.356 to 594.1, p=0.010). For all other diagnosis, telepsychiatry was not significantly different from face-to-face treatment in all cause discontinuation, and the result did not alter integrating the study of all diagnoses (N=28, n=3,403, p=0.646).
Conclusions: It was confirmed that telepsychiatry produced comparable symptom improvement effect for patients with various psychiatric disorders compared to face-to-face treatment. However, for a few specific psychiatric disorders, telepsychiatry treatment was significantly superior or inferior to face-to-face treatment, suggesting that the effectiveness of telepsychiatry may vary by disease type. Further larger scale and longitudinal trials will help to ascertain the disease area in which telepsychiatry is more useful.
No conflict of interest
P.0233