JMIR Publications

ABSTRACT

Background:

Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions.

Objective:

Conduct robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy.

Methods:

In this systematic review, we included randomised controlled trials comparing telehealth (telephone, video or both) versus face-to-face delivery of psychotherapy for less common mental health conditions, and physical health conditions requiring psychotherapy. Psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and delivered by general practitioners, primary care nurses or allied health staff (such as psychologists, counsellors, etc). Patient (symptom severity, overall improvement in psychological symptoms, function), process (working alliance, client satisfaction) and financial (cost) outcomes were included.

Results:

A total of 12 randomised controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioural and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, telephone in 3 trials, both in 1 trial, and delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for lack of blinding of participants, due to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately post-treatment, standardised mean difference was 0.05 (95% CI -0.17 to 0.27), P =.65, or at any other follow up timepoint. Similarly, there were no significant differences immediately post treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analysed, including overall improvement (SMD 0.00, 95%CI -0.40 to 0.39), function (SMD 0.13, 95%CI -0.16 to 0.42), working alliance client (SMD 0.11, 95%CI -0.34 to 0.57), working alliance therapist (SMD -0.16, 95%CI -0.91 to 0.59), and client satisfaction (SMD 0.12, 95%CI -0.30 to 0.53), or at any other timepoint (3 months, 6 months and 12 months).

Conclusions:

To effectively treat less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no evidence includable in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions.