The effect of telephone-administered psychotherapy on symptoms of depression and attrition: A meta-analysis.

Abstract

Increasingly, the telephone is being used to deliver psychotherapy for depression, in part as a means to reduce barriers to treatment. Twelve trials of telephone-administered psychotherapies, in which depressive symptoms were assessed, were included. There was a significant reduction in depressive symptoms for patients enrolled in telephone-administered psychotherapy as compared to control conditions (d = 0.26, 95% confidence interval [CI] = 0.14-0.39, p < .0001). There was also a significant reduction in depressive symptoms in analyses of pretreatment to posttreatment change (d = 0.81, 95% CI = 0.50-1.13, p < .0001). The mean attrition rate was 7.56% (95% CI = 4.23-10.90). These findings suggest that telephone-administered psychotherapy can produce significant reductions in depressive symptoms. Attrition rates were considerably lower than rates reported in face-to-face psychotherapy. Keywords depression; meta-analysis; psychotherapy; telemental healthThe telephone was invented by Alexander Graham Bell in 1876. The first report of telemedicine in a major medical journal, which described the use of the telephone to diagnose a child's cough, occurred three years later in 1879 ("The Telephone as a Medium of Consultation and Medical Diagnosis," 1879). The telephone quickly became a widely used tool in the practice of primary-care medicine. In contrast, providers of psychotherapy were slow to adopt the telephone to deliver mental health-related services. To the best of our knowledge, the first report of the use of the telephone in the administration of psychotherapy was published in 1949, 70 years after the first telemedicine report (Berger & Glueck, 1949). In 1996, a report developed by an American Psychological Association task force found that empirical evidence concerning telephone-administered psychotherapy was (Haas, Benedict, & Kobos, 1996). In the last decade, this has changed considerably.Most of the work in telephone-administered psychotherapy has focused on treating depressive symptoms. Depression is common and is a significant cause of disability (Murray & Lopez, 1997). Psychotherapy is an attractive treatment option for many patients, as evidenced by the finding that approximately two-thirds of depressed patients prefer psychotherapy over antidepressant medication (Bedi et al., 2000;Brody Khaliq, & Thompson, 1997;Dwight-Johnson, Sherbourne, Liao, & Wells, 2000;Priest, Vize, Roberts, Roberts, & Tylee, 1996). However, only 20% of all patients referred for psychotherapy ever enter treatment (Brody et al., 1997;Weddington, 1983) and, of those who enter, nearly onehalf will drop out (Wierzbicki & Pekarik, 1993). One reason for this discrepancy between interest and failure to initiate or follow through with psychotherapy is that there are considerable barriers for many patients, including time constraints, transportation problems, caregiving responsibilities, stigma concerns, disability, or living in a rural area that lacks adequate mental health services (Alvidrez & Azocar, 1999;Hollon et al., 2002;Y...

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