Review of key telepsychiatry outcomes

Table 1 Review of telepsychiatry randomized controlled trials

Ref.	Participants				Interventions			Results
	n	Recruitment source	Mean age (SD)	Target disorder	Conditions	Duration (# of visits)	Provider	Attrition	Findings
Nelson et al[82]	38	Urban schools	10.3 (2.0)	Childhood depression	CBT TP	8	dnr	26%	Child Depression Inventory scores reduced from 14.36 (SD = 9.85) at baseline to 6.71 (SD = 4.78) at post-treatment for CBT TP and from 13.57 (SD = 8.75) to 11.64 (SD = 4.78) for CBT FTF [Wilks’ L (1, 26) = 0.83; Eta2 = 0.17]
					CBT FTF	8	dnr	26%
Ruskin et al[83]	119	VA outpatient mental health clinics	49.6 (12.8)	Depression	Pharmacotherapy TP	8	Psychiatrist	27%	Mean scores not reported. Differences between response rates according to the Hamilton Rating Scale for Depression for TP (49%) and FTF (43%) were not statistically significant (χ2 = 0.4, P > 0.05)
					Pharmacotherapy FTF	8	Psychiatrist	30%
Fortney et al[79]	395	VA community-based outpatient clinics	59.2 (12.2)	Depression	Stepped collaborative care TP	Flexible number of visits up to 12 mo	On-site PCP + Off-site psychiatrist, care manager, PharmD	10%	At 12 mo, TP participants had greater odds of qualifying for remission than usual care participants (OR = 2.4, P = 0.04) but were not more likely to qualify for treatment response (OR = 1.4, P = 0.18) using the Hopkins Symptom Checklist
					Usual care in primary care setting	Flexible number of visits up to 12 mo	PCP	9%
Hilty et al[80]	94	Rural primary care clinics	46	Depression	Psychiatric consultation TP, PCP training, disease management modules	5 with psychiatrist 5 with PCP	Psychiatrist, PCP	dnr	Mean scores not reported. Differences between response rates according to the Beck Depression Inventory-13 for TP (42%) and augmented usual care (42%) were equivalent and not analyzed with odds ratios. Similarly, response rates according to the Hopkins Symptom Checklist-90 for TP (53%) and augmented usual care (42%) were not analyzed with odds ratios
					Disease management modules, usual care in primary care setting	5 with PCP	PCP	dnr
Chong et al[77]	167	Community health center	43.0 (12.0)	Depression	Pharmacotherapy via TP + integrated primary care	7 with psychiatrist, no limit on other visits	Psychiatrist, PCP, mental health specialist	13.8%	Patient Health Questionnaire-9 scores reduced from 17.3 (SD = 4.9) at baseline to 6.8 (SD = 6.0) at post-treatment for TP and from 18.3 (SD = 4.5) to 4.7 (SD = 5.1) for FTF (F =1.1, P > 0.05. Eta2 = 0.17)
					Integrated primary care	No limit	PCP, mental health specialist	10.3%
Moreno et al[81]	167	Community health center	43.2 (11.9)	Depression	Pharmacotherapy via TP + integrated primary care	7 with psychiatrist, no limit on other visits	Psychiatrist, PCP, mental health specialist	dnr	Patient Health Questionnaire-9 scores reduced from 17.6 (SD = 7.6) at baseline to 5.1 (SD = 6.8) at post-treatment for TP and from 18.4 (SD = 4.9) to 4.5 (SD = 5.3) for FTF (t =2.30, P < 0.05. Eta2 =0 .11)
					Integrated primary care	No limit	PCP, mental health specialist	dnr
Fortney et al[79]	364	Federally qualified health centers	47.2 (12.6)	Depression	Enhanced collaborative care TP	Flexible number of visits in 12 mo	On-site PCP + Off-site psychiatrist, care manager, behavioral health, PharmD	23%	At 12 mo, TP participants had greater odds of qualifying for remission than usual care participants (25.8% vs 9.9%; OR = 3.2, P < 0.001) and were more likely to qualify for treatment response (47.7% vs 21.9%; OR=3.3, P < 0.001) using the Hopkins Symptom Checklist-20
					Collaborative care in primary care setting	Flexible number of visits in 12 mo	PCP, care manager	19%
Fortney et al[11]	265	VA community-based outpatient clinics	52.2 (13.8)	PTSD	Enhanced collaborative care TP	Flexible number of visits in 12 mo	On-site PCP + Off-site psychiatrist, care manager, psychologist, PharmD	16%	At 12 mo, Posttraumatic Diagnostic Scale scores decreased 4.17 (SD = 9.8) for TP and 1.32 (SD = 8.8) for FTF (t = 2.30, P < 0.05. Cohen’s d = 0.31)
					Collaborative care in primary care setting	Flexible number of visits in 12 mo	PCP, care manager, social worker	11%
Morland et al[84]	125	VA clinical sites and VA Vet Centers	54.7 (9.6)	PTSD	Group CBT TP	12	Clinical psychologist	10%	In a non-inferiority trial, State-Trait Anger Expression scores reduced from 56.7 (SD = 12.0) to 46.6 (SD = 12.2) in TP and from 55.0 (SD = 10.3) at baseline to 46.6 (SD = 12.2) at post-treatment for FTF. Using CIs and a priori cut-offs, criteria for non-inferiority met (Cohen d = 0.44 in favor of CBT TP)
					Group CBT FTF	12	Clinical psychologist	11%
Morland et al[85]	125	VA clinical sites and VA Vet Centers	55.3 (12.5)	PTSD	CPT-C TP	12	Clinical psychologist or master’s level social worker	18%	In a non-inferiority trial, Clinician-Administered PTSD Scale scores reduced from 72.0 (SD = 14.6) to 55.6 (SD = 18.8) in CPT-C TP and from 68.9 (SD = 13.0) at baseline to 58.7 (SD = 21.0) at post-treatment for CPT-C FTF. Using CIs and a priori cut-offs, criteria for non-inferiority met (Cohen d = 0 .27 in favor of CBT TP)
					CPT-C FTF	12	Clinical psychologist or master’s level social worker	14%
Myers et al[86]	233	Primary care	9.2 (2)	ADHD	Pharmacotherapy via TP + caregiver training	6	Psychiatrist, master’s level therapist	13%	At 12 mo, TP participants had greater odds of no longer meeting diagnostic criteria for ADHD-inattentive subtype according to Vanderbilt ADHD Rating Scale at post-treatment (12% vs 26%; OR = 0.149, P < 0.001)
					Psychiatric consultation with PCP + caregiver training	1	Psychiatrist, PCP	5%
Mitchell et al[87]	128	Patient panels of rural physicians and therapists	29.0 (10.7)	Bulimia nervosa	CBT TP	20	Clinical psychologist	34%	At post-treatment, abstinence from binge-eating episodes, purging episodes, and combined episodes ranged from 27%-50% for TP CBT and 29%-50% for FTF CBT with non-significant trend in favor of FTF. TP participants reported significantly more binge episodes (M = 6.2, SD = 12.3) than FTF participants (M = 3.7, SD = 11.2) at post-treatment (F = 6.76; P < 0.05)
					CBT FTF	20	Clinical psychologist	41%
De Las Cuevas et al[88]	140	Community mental health center	Adults	Psychiatric disorders	Pharmacotherapy, CBT TP	8	Psychiatrist	6%	Differences between improvement rates according to the Clinical Global Impressions scale for TP (67.2%) and FTF (62.5%) were not statistically significant (P > 0.05)
					Pharmacotherapy, CBT FTF	8	Psychiatrist	7%
O’Reilly et al[89]	495	Rural hospital and primary care clinics	Adults	Psychiatric disorders	Psychiatric consultation TP	Flexible number of visits in 4 mo	Psychiatrist	7%	In a non-inferiority trial, 22% of TP participants and 20% of FTF participants returned to functional status at post-treatment according to the Brief Symptom Inventory. Using CIs and a priori cut-offs, criteria for non-inferiority met
					Psychiatric consultation FTF	Flexible number of visits in 4 mo	Psychiatrist	3%

ADHD: Attention deficit hyperactivity disorder; CBT FTF: Cognitive behavioral therapy delivered face to face; CBT TP: Cognitive behavioral therapy delivered via telepsychiatry; CPT-C: Cognitive processing therapy-cognitive version only; dnr: Did not report; PCP: Primary care provider; PTSD: Post-traumatic stress disorder.