Teletherapy Versus In-Person Psychotherapy for Depression: A Meta-Analysis of Randomized Controlled Trials

Giovanetti, Annaleis K.; Punt, Stephanie; Nelson, Eve‐Lynn; Ilardi, Stephen S.

doi:10.1089/tmj.2021.0294

Cited by 49 publications

(43 citation statements)

References 44 publications

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“…Sensitivity analyses examined the change scores using categorical values. For the categorical sensitivity analyses, the PHQ-9 categories included no depression (0), minimal depression [ 1 – 4 ], mild depression [ 5 – 9 ], moderate depression [ 10 – 14 ], moderately severe depression [ 15 – 19 ], and severe depression [ 20 – 27 ]. The GAD-7 categories included minimal anxiety (0–4), mild anxiety [ 5 – 9 ], moderate anxiety [ 10 – 14 ], and severe anxiety [ 15 – 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Behavioral health care has been a leader in the utilization of telehealth applications given that evaluation and treatment typically translate easily between visit encounter modalities (telephone, videoconference, in-person) [ 8 ]. Randomized control trials (RCTs) and subsequent reviews demonstrate the efficacy of telebehavioral health and have failed to detect significant differences between in-person and telehealth interventions [ 9 , 10 ]. However, many previous studies have limited generalizability and frequently lack diversity in patient populations with rural and minority patients often being underrepresented [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of in-person vs. telebehavioral health outcomes from rural populations across America

et al. 2022

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Background This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs’ 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group. Methods The research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates. Results Across a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms. Conclusion In our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of in-person vs. telebehavioral health outcomes from rural populations across America

et al. 2022

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“…Three meta-analyses conducted by Drago et al, Batastini et al and Giovanetti et al have examined outcomes comparing TM to IP treatment. [22][23][24] Drago et al examined a wide range of interventions within psychiatry but excluded psychotherapeutic interventions. They found that TM was not inferior to IP across a range of mental health outcomes.…”

Section: Open Accessmentioning

confidence: 99%

Psychiatric treatment conducted via telemedicine versus in-person consultations in mood, anxiety and personality disorders: a protocol for a systematic review and meta-analysis

et al. 2022

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IntroductionMajor advancements in technology have led to considerations how telemedicine (TM) and other technology platforms can be meaningfully integrated in treatment for psychiatric disorders. The COVID-19 pandemic has placed a further focus on use of TM in psychiatry. Despite the widespread use of TM, little is known about its effect compared with traditional in-person (IP) consultation. The objective of this systematic review is to examine if individual psychiatric outpatient interventions for adults using TM are comparable to IP in terms of (1) psychopathology outcomes, (2) levels of patient satisfaction, (3) working alliance and (4) dropout from treatment.Methods and analysisThis review will only include randomised controlled trials for adult participants with mood disorders, anxiety or personality disorders. The primary outcome is psychopathology, and secondary outcomes include patient satisfaction, treatment alliance and dropout rate. Systematic searches were conducted in MEDLINE, APA PsycINFO, Embase, Web of Science and CINAHL. The inverse-variance method will be used to conduct the meta-analysis. Effect sizes will be calculated as standardised mean difference (Hedges’ g) for the primary outcome, mean difference for patient satisfaction and working alliance, and risk ratio for the dropout rate. Effect sizes will be supplemented with 95% CI. We will calculate the I² statistic to quantify heterogeneity and Chi-square statistic (χ²) to test for heterogeneity for the primary outcome. Potential clinical and methodological heterogeneity moderators will be assessed in subgroup and sensitivity analysis. The risk of bias will be assessed by Cochrane Risk of Bias Tool V.2, and confidence in cumulative evidence will be assessed by Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationNo ethical approval is required for this systematic review protocol. Data sets will be deposited in the Zenodo repository. The findings of this study will be published in a peer-review scientific journal.PROSPERO registration numberCRD42021256357.

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“…Over the last 20 years, an increased emphasis on evidence-supported treatments has become a prominent topic in psychotherapy (American Psychological Association [APA], Presidential Task Force on Evidence-Based Practice, 2006). This has led to an increase in randomized controlled trials (RCTs) of telemental health applications; meta-analyses are emerging summarizing this mounting literature base and finding no statistically significant differences between in-person care and care delivered via telehealth (Giovanetti et al, 2022). RCTs are referred to as the “gold standard” of evidence but, like any methodology, are not without limitations.…”

Section: Research Questionsmentioning

confidence: 99%

Assessing depression outcomes in teletherapy for underserved residents in Central Texas: Telehealth’s move to treatment-as-usual.

Armstrong¹,

McCord²,

Stickley³

et al. 2022

Journal of Rural Mental Health

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Telehealth is a flexible and cost-effective solution for providing psychotherapy services. The present study examines teletherapy outcomes data using two methodological frameworks: a categorical outcome approach, clinically significant change (CSC), and a continuous outcome approach, latent growth mixture modeling (LGMM). Archival data from 424 rural-residing clients were analyzed. Kaplan-Meier survival curves were fitted in two ways of comparison. The level of change was also explored and was modeled at five points as well as six points. A latent growth mixture model was fitted to assess depression severity over time. Clients achieved either CSC or overall improvement on the Patient Health Questionnaire-9 after three-seven sessions. Session-to-session results indicated that change took longer (10-11 sessions). Reliable deterioration was infrequently experienced and, thus, difficult to model. The LGMM fit best with three classes, of which two started clinically and varied in their improvement rates. The third class started nonclinically and showed little improvement over time. This study advances the literature regarding outcomes for rural clients by utilizing the frame of treatment-as-usual psychotherapy effectiveness and providing more generalizability to this specific population.

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Teletherapy Versus In-Person Psychotherapy for Depression: A Meta-Analysis of Randomized Controlled Trials

Cited by 49 publications

References 44 publications

Comparison of in-person vs. telebehavioral health outcomes from rural populations across America

Comparison of in-person vs. telebehavioral health outcomes from rural populations across America

Psychiatric treatment conducted via telemedicine versus in-person consultations in mood, anxiety and personality disorders: a protocol for a systematic review and meta-analysis

Assessing depression outcomes in teletherapy for underserved residents in Central Texas: Telehealth’s move to treatment-as-usual.

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