Telemental Health For Youth With Chronic Illnesses: Systematic Review

Abstract

Background Children, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap. Objective In this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ≤25 years with chronic illnesses. Methods PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ≤25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals. Results We screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis. Conclusions The state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic.

Family Structure Diversity and Youth Health Care Access and Interactions With Health Care Providers

“…Another approach to increasing youth health care access could be for family nurses to adopt more mobile and telehealth tools in general, and for youth living in structurally diverse families more specifically. With the increased prevalence of mobile health and telehealth services in response to the COVID-19 pandemic, such tools may be one valuable strategy to utilize in ensuring continuity of care and patient-provider trust and rapport among youth broadly (N. Lau et al, 2021; Vajravelu & Arslanian, 2021).…”

Assessment and Treatment of Adolescents With Chronic Medical Conditions

“…Cognitive behavioral therapy (CBT) and problem-solving interventions have been demonstrated as efficacious and effective for the treatment of youth with chronic medical conditions (Bennett et al, 2015 ; Lau et al, 2021 ). One recently published intervention, the Children’s Health and Illness Recovery Program (CHIRP; Carter et al, 2020 ), is a 12-session manualized intervention for teens with chronic medical conditions and their families.…”

“…The global COVID-19 pandemic has furthered challenges for all youth, including disruption in routines, missed academic and learning opportunities, social isolation, changes in peer and family relationships, fear and uncertainty regarding the future, and increased psychiatric symptoms (Lau et al, 2021 ). Adolescents with chronic medical conditions are particularly vulnerable to psychiatric comorbidity and this risk may be heightened during the COVID-19 pandemic.…”

“…There has been a rapid shift in providing telehealth psychotherapy and health and behavioral intervention services despite limited research supporting the efficacy or effectiveness of interventions delivered using a virtual modality in adolescent populations. However, results presented in a recent review paper examining the initial feasibility and efficacy of telemental health for youth with chronic medical conditions provide preliminary support for the use of virtual cognitive behavioral and problem-solving interventions for this population (Lau et al, 2021 ). Clinicians should consider use of telehealth treatment modalities to increase access to care and reduce risk of transmission of COVID-19 to vulnerable children and families, which may occur during in-person appointments.…”

A New Web Score to Predict Health Status in Paediatric Patients with Chronic Diseases: Design and Development of the PENSAMI Study

“…According to this perspective, the aspects comprising HRQoL in chronically ill paediatric patients can be shared into two factors: disease-related factors (age of onset, disease severity, complications, treatment, sense of normality and positive attitude towards the disease), and non-disease-related factors (age, gender, socioeconomic status, support of parents, social wellbeing, and support) [ 11 ]. Recent literature has highlighted that psychosocial variables can assume a crucial role, more than the presence, per se, of the physical and clinical dimensions of a chronic condition [ 12 , 13 , 14 ]. Supporting this idea, clinical settings have progressively recognised the need to complement traditional health indicators with psychosocial factors [ 15 , 16 , 17 ].…”