Internalizing symptoms impede adolescents’ ability to transition from in-person to online mental health services during the 2019 coronavirus disease pandemic

Abstract

Introduction Online mental health services were previously found to be effective in many studies. However, this method was not generally used in Israel. By the end of 2019, the coronavirus disease 2019 pandemic erupted, forcing mental health services to transition to online meetings to maintain the standard of care. In this cross-sectional study, we investigated the attitudes of adolescent patients toward this involuntary new mode of care. Methods Forty-four adolescents (mean age 14.62 ± 2.12 years, 54.5% females) and 40 of their primary caregivers completed a battery of questionnaires that included the telemedicine satisfaction questionnaire, session evaluation questionnaire, working alliance inventory, and pediatric symptom checklist. Results Both adolescents and their caregivers reported a reasonable experience with the online medium and a feeling that the meetings were overall powerful, helpful, and comfortable as demonstrated by medium to high scores on the telemedicine satisfaction questionnaire and session evaluation questionnaire questionnaires. A therapeutic alliance was generally maintained according to working alliance inventory scores. However, working alliance inventory scores were negatively correlated with higher levels of internalizing symptoms and parental stress. Discussion Our findings point to the possibility that anxious/depressed adolescents will have greater difficulties re-establishing therapeutic alliance when transitioned from in-person to online meetings. This may be due to the introduction of an “invisible” third party to the therapeutic setting—the computer. Psychologists and psychiatrists should be aware of these difficulties and respond adequately to maintain the standard of care.

Satisfaction with pediatric telehealth according to the opinions of children and adolescents during the COVID-19 pandemic: A literature review

“…( 18 , 25 , 27 ), Australia ( 21 , 26 ), and Canada ( 23 , 31 ) ( Table 1 ). In addition, one study was conducted in each of these nations: South Korea ( 22 ), Israel ( 24 ), the United Kingdom ( 28 ), and Poland ( 30 ). Studies focused on a variety of health conditions such as general medicine, eating disorder, type 1 diabetes, mental health, and speech impairment ( Table 1 ).…”

“…Among the 14 studies, there were 2 interventions ( 20 , 22 ) ( Table 2 ). Five were prospective cohort investigations where investigators classified individuals as participating in telehealth services and then followed them over time to assess their satisfaction ( 19 , 24 , 27 , 29 , 30 ). Two studies used retrospective analyses where answers to satisfaction surveys among individuals participating in telehealth at certain time periods in the past were assessed ( 21 , 26 ).…”

“…The authors used reliable and valid surveys ( Table 2 ), such as the Jefferson scale of patient perceptions of physician empathy (Cronbach’s alpha = 0.896) ( 29 ). The Telemedicine Satisfaction Questionnaire (TSQ) (Cronbach’s alpha = 0.88) and the Working Alliance Inventory (WAI) (Cronbach’s alpha = 0.92 for the long version; Cronbach’s alpha = 0.89 for the WAI short version) were utilized ( 18 , 24 ). Other authors developed the surveys themselves with or without the collaboration of consultants specializing in telehealth ( 19 , 20 , 22 , 23 , 27 , 28 ).…”