Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 22, 2016; 6(2): 269-282
Published online Jun 22, 2016. doi: 10.5498/wjp.v6.i2.269
Review of key telepsychiatry outcomes
Sam Hubley, Sarah B Lynch, Christopher Schneck, Marshall Thomas, Jay Shore
Sam Hubley, Christopher Schneck, Marshall Thomas, Jay Shore, Helen and Arthur E Johnson Depression Center, Department of Family Medicine, Aurora, CO 80045, United States
Sarah B Lynch, Department of Clinical Health Psychology, University of Colorado Denver, Denver, CO 80217-3364, United States
Author contributions: All authors conceived the manuscript and collaborated on the design of the review.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: As this was a review of published data there were no participants to be approached for informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sam Hubley, Assistant Professor, Helen and Arthur E Johnson Depression Center, Department of Family Medicine, 13199 E. Montview Blvd, Suite 330, Aurora, CO 80045, United States.
Telephone: +1-303-724882 Fax: +1-303-7244698
Received: October 28, 2015
Peer-review started: November 3, 2015
First decision: December 4, 2015
Revised: January 27, 2016
Accepted: March 14, 2016
Article in press: March 15, 2016
Published online: June 22, 2016

AIM: To conduct a review of the telepsychiatry literature.

METHODS: We conducted a systematic search of the literature on telepsychiatry using the search terms, “telepsychiatry”, “telemental health”, “telecare”, “telemedicine”, “e-health”, and “videoconferencing”. To meet criteria for inclusion, studies had to: (1) be published in a peer-reviewed journal after the year 2000; (2) be written in English; (3) use videoconferencing technology for the provision of mental health assessment or treatment services; and (4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in PubMed (Medline database), Ovid medline, PsychInfo, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories: (1) satisfaction; (2) reliability; (3) treatment outcomes; (4) implementation outcomes; (5) cost effectiveness; and (6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion.

RESULTS: Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry.

CONCLUSION: A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.

Keywords: Telepsychiatry, Telemental health, Videoconferencing, Treatment access, Implementation

Core tip: Telepsychiatry represents a highly promising approach to reducing the treatment gap by making it easier for patients, especially those in isolated contexts, to access expert mental health care. There is a robust evidence base for the use of telepsychiatry as a delivery method for mental health services. Given sufficient empirical justification for telepsychiatry in routine clinical settings, future research studies should focus on clarifying best practices for implementing and sustaining telepsychiatry services.