Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches

Table 1 Reliability of videoconferencing-based assessments: Comparisons with face-to-face evaluations

Ref.	Patient group	Scale used	Study design	Results
Baer et al[40]	16 adults with OCD	YBOCS, HAM-D, HAM-A	Non-RCT	VC = F2F
Montani et al[41]	10 elderly psychiatric inpatients with no cognitive impairment	MMSE, CFT	Non-RCT	VC inferior to F2F
Montani et al[42]	15 elderly psychiatric inpatients with no cognitive impairment	MMSE, CFT	Non-RCT	VC inferior to F2F in certain aspects
Baigent et al[43]	63 adult inpatients	BPRS	Non-RCT	BPRS ratings similar; differences in ratings of affect
Zarate et al[44]	45 patients with schizophrenia	BPRS, SANS, SAPS	Non-RCT	Global severity and BPRS similar, SANS not reliably rated, higher BW better
Montani et al[45]	25 elderly psychiatric inpatients, 10 with dementia	MMSE, CFT	Non-RCT	VC inferior to F2F in non-cognitively impaired elderly; VC = F2F in those with dementia
Ruskin et al[46]	30 adult inpatients	SCID	Non-RCT	VC = F2F
Ball et al[47]	11 elderly psychiatric patients	CAMCOG	Non-RCT	VC = F2F
Ball et al[48]	99 responses of elderly psychiatric patients	MMSE	Non-RCT	VC = F2F
Stevens et al[49]	40 adult psychiatric patients	SCID	RCT	Similar satisfaction with both methods
Kirkwood et al[50]	27 inpatients with history of alcohol abuse	Neuropsychological battery	Non-RCT	Cognitive assessment by VC = F2F
Chae et al[51]	30 adult patients with schizophrenia	BPRS	Non-RCT	VC = F2F; BW did not matter
Elford et al[52]	23 children referred for psychiatric assessments	Semi-structured interview	RCT	VC = F2F
Jones et al[53]	30 elderly patients	BPRS	Non-RCT	Reliability better for objective than subjective items; BW did not matter
Yoshino et al[54]	42 adult inpatients with chronic schizophrenia	BPRS	Non-RCT	Reliability low with narrow BW
Grob et al[55]	27 elderly nursing home residents	BPRS, MMSE, GDS	Non-RCT	VC = F2F
Bishop et al[56]	24 adult psychiatric patients	CSQ	RCT	VC = F2F on patient satisfaction
Guilfoyle et al[57]	12 elderly nursing home residents	Health assessments	Non-RCT	VC = F2F
Loh et al[58]	20 elderly psychiatric patients	MMSE, GDS	Non-RCT	VC = F2F
Kobak[59]	42 patients with mood disorders	HAM-D	Non-RCT	VC = F2F
Poon et al[60]	22 community-dwelling elderly with mild dementia or mild cognitive impairment	MMSE, RBMT, HDS	RCT	VC = F2F
Cullum et al[61]	33 elderly with mild cognitive impairment or dementia	Neuropsychological battery	Non-RCT	VC = F2F
Lexcen et al[62]	72 adult psychiartric patients in forensic settings	BPRS, Mac CAT-CA	Non-RCT	VC = F2F
Loh et al[63]	20 elderly patients with dementia	MMSE, GDS and other scales	Non-RCT	VC = F2F
Martin-Khan et al[64]	42 patients over 50 yr referred for cognitive assessment	Neuropsychological battery	Non-RCT	VC = F2F
Singh et al[65]	37 adult patients with psychiatric disorders	DSM-IV	RCT	VC = F2F
Shore et al[66]	53 male American Indian veterans with psychiatric disorders	SCID	RCT	VC = F2F
Manguno-Mire et al[67]	21 inpatients from a forensic psychiatric facility	GCCT-MSH	RCT	VC = F2F
Kobak et al[68]	35 adult patients with mood disorders	MADRS	Non-RCT	VC = F2F
McEachern et al[69]	71 elderly patients from a memory clinic	MMSE	RCT	VC = F2F
Ciemins et al[70]	73 elderly patients with diabetes	MMSE	Non-RCT	VC = F2F
Porcari et al[71]	20 male veterans with PTSD	CAPS	Non-RCT	VC = F2F
Thompson et al[72]	138 transplant recipients receiving follow-up	CES-D	RCT	VC = F2F
Morgan et al[73]	169 elderly from a memory clinic	Satisfaction assessment	RCT	Similar satisfaction with both methods
Stain et al[74]	11 adolescents/young adults (14-30 yr) with early psychosis	Diagnosis, quality of life, neurocognition on standardized scales	Non-RCT	VC = F2F
Bui[75]	30 undergraduates with subclinical OC symptoms	YBOCS	Non-RCT	VC = F2F
Martin-Khan et al[76]	205 patients over 50 yr referred for cognitive assessment	Neuropsychological battery	Non-RCT	VC = F2F
Wong et al[77]	42 elderly psychiatric inpatients	RUDAS	Non-RCT	VC = F2F
Seidel et al[78]	73 adult psychiatric patients in emergency settings	Interview	RCT	VC = F2F
Litwack et al[79]	75 veterans with PTSD	CAPS	Non-RCT	VC = F2F

F2F: Face to face or in-person assessment; VC: Videoconferencing; BW: Bandwidth; RCT: Randomized controlled trial (i.e., a study in which patients were randomly assigned to VC or F2F assessment); OCD: Obsessive compulsive disorder; PTSD: Posttraumatic stress disorder; YBOCS: Yale-Brown Obsessive-Compulsive Scale; HAM-D: Hamilton Rating Scale for Depression; HAM-A: Hamilton Rating Scale for Anxiety; BPRS: Brief Psychiatric Rating Scale; SANS: Scale for the Assessment of Negative Symptoms; SAPS: Scale for the Assessment of Positive Symptoms; SCID: Structured Clinical Interview for DSM-III-R; MMSE: Mini-Mental State Examination; GDS: Geriatric Depression Scale; RBMT: Rivermead Behavioural Memory test; HDS: Hierarchic Dementia Scale; CSQ: Client Satisfaction Questionnaire; CFT: Clock Face Test; RUDAS: Rowland Universal Dementia Assessment Scale; CAPS: Clinician-Administered PTSD Scale; MADRS: Montgomery-Asberg Depression Rating Scale; Mac CAT-CA: MacArthur Competence Assessment Tool-Criminal Adjudication; CES-D: Center for Epidemiologic Studies-Depression; GCCT-MSH: Georgia Court Competency Test-Mississippi State Hospital revision.

Table 2 Outcome of videoconferencing-based interventions: Randomized-controlled trials of comparisons with face-to-face interventions

Ref.	Patient group	Treatment details	Outcome measures	Results
Day et al[87]	80 adult clients with a wide range of problems, from weight concerns to personality disorders	5 sessions of CBT	BSI, GAF, TC and working alliance and satisfaction scales	VC = F2F treatment on outcome and process measures
Nelson et al[88]	28 children 8-14 yr with DSM-IV depression	Eight weekly CBT sessions with child and parent	KSADS-P, CDI, satisfaction questionnaire	VC = F2F treatment on depression scores and satisfaction
Ruskin et al[89]	119 adult patients with depression according to SCID with HAM-D scores greater than 16	Eight sessions over a 6 mo; medication, psychoeducation, brief supportive counseling	Treatment response, adherence, patient and psychiatrist satisfaction, cost effects	VC = F2F treatment on all aspects; costs same if travel considered
Bouchard et al[90]	21 adult patients with panic disorder and agoraphobia according to SCID	Weekly CBT for 12 wk; follow-up for 6 mo	Self-assessment and ratings on anxiety and disability scales	VC = F2F treatment on symptom reduction, functioning and alliance
Poon et al[60]	22 community-dwelling elderly with mild dementia or mild cognitive impairment	Cognitive intervention programme for older patients	MMSE, RBMT, HDS	VC = F2F treatment in terms of cognitive improvement
De Las Cuevas et al[91]	140 adult psychiatric outpatients; ICD-10 diagnoses as per CIDI	8 consultations over 24 wk; medication and CBT	CGI-S and CGI-I, SCL-90R	VC = F2F treatment on symptom reduction
O’Reilly et al[92]	495 adult psychiatric patients	Medication management, psychoeducation, supportive counseling, triage to other local services	BSI, CSQ-8, SF-36 , satisfaction	VC = F2F treatment on symptom reduction and satisfaction; VC 10% less expensive per patient
Fortney et al[93]	395 adult primary care patients with PHQ-9 depression severity scores ≥ 12	Medication management and psychotherapy for 12 mo	Antidepressant prescribing, medication adherence, treatment response and remission health status, quality of life and satisfaction on standardized scales	VC > F2F treatment on mental health status, health-related quality of life, and satisfaction
Frueh et al[94]	97 adult patients with combat-related PTSD	14 weekly treatment sessions for 3 mo	Self-report, symptom severity, BDI, SCL, satisfaction, adherence and other process measures	VC = F2F treatment on symptom-severity and satisfaction
Hilty et al[95]	121 adult patients with depression according to SCID	Intensive modules using telepsychiatric educational interventions provided by primary-care providers	BDI, SCL, SF-36	VC = F2F treatment on symptom reduction; VC > F2F on satisfaction and retention
Mitchell et al[96]	128 adults with DSM-IV bulimia nervosa or other eating disorders; binge eating or purging at least once per week	20 sessions of manual-based, CBT for bulimia over 16 wk	HAM-D, BDI, self-esteem, quality of life, functioning, alliance and symptom-severity	VC = F2F treatment on most measures
Thompson et al[72]	138 adult transplant recipients with depression; CES-D score > 16	Medications and counseling over 12 mo	CES-D	VC = F2F treatment on symptom reduction
Morland et al[97]	125 adult male veterans with PTSD according to SCID	Anger management therapy - 12 session CBT intervention over 6 wk; follow-up for 6 mo	CAPS, STAXI-2, NAS-T, attrition, adherence, satisfaction and alliance assessments	VC = F2F treatment on anger reduction and process variables; alliance better in F2F treatment
Chong et al[98]	167 adult Hispanic patients with major depression	Monthly telepsychiatry sessions for 6 mo; medications and counselling	Appointment adherence, alliance, satisfaction, antidepressant use, depression and functional outcomes	VC > F2F treatment on adherence, alliance, satisfaction: VC = F2F treatment on depression and functional outcomes
Moreno et al[99]	167 adult Hispanic patients with major depression according to PHQ-9 and MINI	Medication management and counseling for 6 mo	PHQ-9, MADRS, Q-LES-Q, SDS	VC > F2F treatment on all outcomes
Dunstan et al[100]	6 adults with anxiety or mixed anxiety-depressive disorder	6-8 sessions of CBT; 1-mo follow-up	Self-reports and symptom-severity	VC = F2F treatment
Fortney et al[101]	364 adult patients with major depression according to PHQ-9 and MINI	Telemedicine-based collaborative care vs practice-based collaborative care for 18 mo; medication management and psychosocial treatment	Depression outcomes module, HSCL, QOL-DTA, DSSS, DHBI	VC > F2F treatment on depression outcomes
Stubbings et al[102]	26 adult patients with mood or anxiety disorder according to SCID	12 sessions of CBT; 6-wk follow-up	Symptom-severity, self-reports, alliance, quality of life and satisfaction on standardized scales	VC = F2F treatment on all outcome measures
Choi et al[103]	158 homebound individuals > 50 yr with depression, HAM-D score > 15	PST-telehealth problem-solving therapy vs IP-PST; 6 PST sessions over 6 wk; follow-up for 36 wk	HAM-D, WHODAS	VC = F2F treatment, but VC effects more sustained
Choi et al[104]	121 homebound individuals > 50 yr with depression, HAM-D score > 15	PST-telehealth problem-solving therapy vs IP-PST; 6 PST sessions over 6 wk; follow-up for 24 wk	Acceptability on the TEI, HAM-D	VC = F2F treatment

VC treatment: Treatment through videoconferencing; F2F treatment: Face-to-face or in-person treatment; CBT: Cognitive behavioral therapy; PTSD: Post-traumatic stress disorder; HAM-D: Hamilton Rating Scale for Depression; SCID: Structured Clinical Interview for DSM-IV; KSADS-P: Schedule for Affective Disorders and Schizophrenia for School Age Children-Present Episode; CDI: Children’s Depression Inventory; MMSE: Mini-Mental State Examination; RBMT: Rivermead Behavioural Memory test; HDS: Hierarchic Dementia Scale; CIDI: Composite International Diagnostic Interview; CGI-S and CGI-I: Clinical Global Impressions-Severity of Illness and Improvement; SCL: Symptom Checklist; BSI: Brief Symptom Inventory; CSQ: Client Satisfaction Questionnaire; SF-36: Medical Outcomes Study Short Form; PHQ: Patient Health Questionnaire; BDI: Beck’s Depression Inventory; CES-D: Center for Epidemiologic Studies–Depression; MPSS: Modified PTSD Symptom Scale; BAI: Beck Anxiety Inventory; CAPS: Clinician-Administered PTSD Scale; STAXI-2: State-Trait Anger Expression Inventory-2; NAS-T: Novaco Anger Scale total score; MINI: Mini-International Neuropsychiatric Interview; PHQ-9: Patient Health Questionnaire-nine item version; MADRS: Montgomery-Åsberg Depression Rating Scale; Q-LES-Q: Quality of Life Enjoyment and Satisfaction Questionnaire; SDS: Sheehan Disability Scale; HSCL: Hopkins Symptom Checklist; QOL-DTA: Quality Improvement for Depression Treatment Acceptability scale; DSSS: Duke Social Support and Stress Scale; DHBI: Depression Health Beliefs Inventory; WHO: World Health Organization; WHODAS: WHO Disability Assessment Schedule; TEI: Treatment Evaluation Inventory; GAF: Global Assessment of Functioning; TC: Target Complaints method.