Psychiatric Treatment Conducted via Telemedicine versus In-person Modality in PTSD, Mood and Anxiety Disorders: a Systematic Review and Meta-analysis

Ali Abbas Shaker*, Stephen F. Austin, Ole Jakob Storebø, Julie Perrine Schaug, Alaa Ayad, John Aasted Sørensen, Kristine Tarp, Henrik Bechmann, Erik Simonsen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Background: Telemedicine (TM) has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, TM usage is expected to expand within the psychiatric field. The efficacy of TM is well described in the scientific literature. However, there is a need for a comprehensive quantitative review, analyzing and considering different clinical outcomes and psychiatric diagnoses.
Objective: To assess if individual psychiatric outpatient treatment for post-traumatic stress disorder (PTSD), mood, and anxiety disorders in adults using TM is equivalent to in-person (IP) treatment.
Methods: A systematic search of RCTs was conducted in recognized databases for this review. Four outcomes were assessed: (1) treatment efficacy, (2) levels of patient satisfaction, (3) working alliance, and (4) attrition rates. The inverse-variance method was used to summarize the effect size for each outcome.
Results: A total of 7414 records were identified and 20 trials were included in the systematic review and meta-analysis. The trials included PTSD (nine trials), depressive disorder (six trials), a mix of different disorders (four trials), and general anxiety disorder (GAD) (one trial). Overall, the analyses yielded evidence supporting that TM is comparable to IP treatment regarding treatment efficacy (SMD = -0.01, 95% CI = [-0.12, 0.09], P = .84; I2 = 19 %, seventeen trials, n = 1814), patient satisfaction MD = -0.66, 95% CI = [-1.60, 0.28], P = .17; I2 = 44 %, six trials, n = 591), and attrition rates (RR= 1.07, 95% CI =[0.94, 1.21], P = .32; I2 = 0%, twenty trials, n = 2804). Results also indicated that the working alliance between TM and IP modalities was comparable, but heterogeneity was substantial to considerable (MD = 0.95, 95% CI = [-0.47, 2.38], P = .19; I2 = 75%, six trials, n = 539).
Conclusion: This meta-analysis provided new knowledge of individual TM interventions which were considered equivalent to IP treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of evidence regarding efficacy was rated as "moderate." Further, high-quality RCTs are needed to strengthen the evidence base for treatment provided via TM within psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data (IPD) meta-analysis is suggested for future studies to personalize TM.
Original languageEnglish
Article numbere44790
JournalJMIR Mental Health
Volume10
Number of pages17
ISSN2368-7959
DOIs
Publication statusPublished - 2023

Keywords

  • Telemedicine
  • Telepsychiatry
  • Video consultation
  • mHealth
  • eHealth
  • Covid-19
  • Synchronous technology

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