Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis

Abstract

Ensuring continuity of care for patients with major depressive disorders poses multiple challenges. We conducted a systematic review and meta-analysis of randomised controlled trials comparing real-time telehealth to face-to-face therapy for individuals with depression. We searched Medline, Embase, and Cochrane Central (to November 2020), conducted a citation analysis (January 2021), and searched clinical trial registries (March 2021). We included randomised controlled trials comparing similar or identical care, delivered via real-time telehealth (phone, video) to face-to-face. Outcomes included: depression severity, quality of life, therapeutic alliance, and care satisfaction. Where data were sufficient, mean differences were calculated. Nine trials (1268 patients) were included. There were no differences between telehealth and face-to-face care for depression severity at post-treatment (SMD −0.04, 95% CI −0.21 to 0.13, p = 0.67) or at other time points, except at 9 months post-treatment (SMD −0.39, 95% CI −0.75 to −0.02, p = 0.04). One trial reported no differences in quality-of-life scores at 3- or 12-months post-treatment. One trial found no differences in therapeutic alliance at weeks 4 and 14 of treatment. There were no differences in treatment satisfaction between telehealth and face-to-face immediately post-treatment (SMD −0.14, 95% CI −0.56 to 0.28, p = 0.51) or at 3 or 12-months. Evidence suggests that for patients with depression or depression symptoms, the provision of care via telehealth may be a viable alternative to the provision of care face-to-face. However, additional trials are needed with longer follow-up, conducted in a wider range of settings, and with younger patients.

Symptoms of depression and anxiety, and unmet healthcare needs in adults during the COVID-19 pandemic: a cross-sectional study from the Canadian Longitudinal Study on Aging

“…Primary care outreach-related interventions, in which providers initiate contact, have been highlighted as beneficial for vulnerable groups that may find it difficult to seek healthcare services [82]. Mental health programs that use telemedicine may also help improve continuity of care for individuals with the conditions [83,84]. Group exercise programs have also been recommended for improving mental health, while also helping form social bonds [85].…”

Telehealth: a new opportunity for out-patient psychiatric services

“…Current estimates suggest that around one-third of university students worldwide have mental health problems, the most common of which are depression and anxiety. 1 These problems have been linked to various negative consequences, such as impaired academic performance and learning, 2 increasing risky behaviours, including problematic alcohol and drug use, 3 suicidal ideation and related behaviours. 4 Research has shown that mental health problems frequently occur among university students in Chile as well, 5 and the COVID-19 pandemic led to additional difficulties and negative experiences that had an adverse effect on their mental health.…”

“…We acknowledge the generosity of George and his family in supporting the publication of this article. The material used in this article is based on part of a chapter entitled 'The complementary role of herbalists and traditional healers in promoting mental healthperspectives from traditional healing and psychiatry', from Mental Health in Africa: Towards Inclusivity, Innovations and Opportunities, 3 with kind permission from Cambridge Scholars Publishing. This research received no specific grant from any funding agency, commercial or not-for-profit sectors.…”

“…Not only do we have the capability to utilise technology to do this, but it has become highly acceptable to both patients and clinicians as a means of accessing care. 3 Of course, telehealth cannot completely replace face-to-face care, but it is a perfectly adequate substitute in many instances and at the very least can serve as a key facilitator. For example, in outpatient psychiatric care, it can work synergistically alongside face-to-face interactions with a clinician (general practitioner, psychiatrist or psychologist).…”

‘I almost felt like I can be a little bit more honest’: experiences of a telehealth group for bipolar disorder

“…Telehealth programs and telehealth-delivered therapy became a standard way to deliver mental health services during the COVID-19 pandemic (Shakeri et al, 2022) and these platforms continue to be used post-pandemic by many pracitioners. Telehealth/video conferencing group therapy and individual therapy programs have been shown to be as effective as face-to-face therapy in several studies (Gentry et al, 2019;Poletti et al, 2020;Scott et al, 2022) showing support for the use of these platforms for mental health service delivery beyond COVID-19. As such, growing interest in researching telehealth-delivered interventions has been seen as a result of the pandemic in a wide range of mental health areas such as caregiver psychoeducation in schizophrenia (Mueser et al, 2022), anxiety in multiple sclerosis (Kever et al, 2022), clergydelivered group therapy CBT treatments for depression (Weaver et al, 2022) and OCD treatment for rural veterans (Fletcher et al, 2022).…”