Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials

Katsuhiko Hagi; Shunya Kurokawa; Akihiro Takamiya; Mayu Fujikawa; Shotaro Kinoshita; Mari Iizuka; Shota Furukawa; Yoko Eguchi; Taishiro Kishimoto

doi:10.1192/bjp.2023.86

Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials

Br J Psychiatry. 2023 Sep;223(3):407-414. doi: 10.1192/bjp.2023.86. Epub 2023 Sep 1.

Authors

Katsuhiko Hagi¹, Shunya Kurokawa², Akihiro Takamiya², Mayu Fujikawa³, Shotaro Kinoshita⁴, Mari Iizuka², Shota Furukawa⁵, Yoko Eguchi², Taishiro Kishimoto⁶

Affiliations

¹ Medical Affairs, Sumitomo Pharma Co., Tokyo, Japan.
² Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
³ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; and Department of Epileptology, Tohoku University School of Medicine, Miyagi, Japan.
⁴ Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; and Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Japan.
⁵ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; and Tsutsuji Mental Hospital, Gunma, Japan.
⁶ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; and Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, USA.

Abstract

Background: The COVID-19 pandemic has transformed healthcare significantly and telepsychiatry is now the primary means of treatment in some countries.

Aims: To compare the efficacy of telepsychiatry and face-to-face treatment.

Method: A comprehensive meta-analysis comparing telepsychiatry with face-to-face treatment for psychiatric disorders. The primary outcome was the mean change in the standard symptom scale scores used for each psychiatric disorder. Secondary outcomes included all meta-analysable outcomes, such as all-cause discontinuation and safety/tolerability.

Results: We identified 32 studies (n = 3592 participants) across 11 mental illnesses. Disease-specific analyses showed that telepsychiatry was superior to face-to-face treatment regarding symptom improvement for depressive disorders (k = 6 studies, n = 561; standardised mean difference s.m.d. = -0.325, 95% CI -0.640 to -0.011, P = 0.043), whereas face-to-face treatment was superior to telepsychiatry for eating disorder (k = 1, n = 128; s.m.d. = 0.368, 95% CI 0.018-0.717, P = 0.039). No significant difference was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (k = 26, n = 2290; P = 0.248). Telepsychiatry had significantly fewer all-cause discontinuations than face-to-face treatment for mild cognitive impairment (k = 1, n = 61; risk ratio RR = 0.552, 95% CI 0.312-0.975, P = 0.040), whereas the opposite was seen for substance misuse (k = 1, n = 85; RR = 37.41, 95% CI 2.356-594.1, P = 0.010). No significant difference regarding all-cause discontinuation was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (k = 27, n = 3341; P = 0.564).

Conclusions: Telepsychiatry achieved a symptom improvement effect for various psychiatric disorders similar to that of face-to-face treatment. However, some superiorities/inferiorities were seen across a few specific psychiatric disorders, suggesting that its efficacy may vary according to disease type.

Keywords: Telepsychiatry; meta-analysis; teleconferencing; telemedicine; videoconferencing in psychiatry.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

COVID-19*
Cognitive Dysfunction*
Humans
Pandemics
Psychiatry*
Randomized Controlled Trials as Topic
Telemedicine*