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

Abstract

The COVID-19 pandemic has transformed healthcare significantly and telepsychiatry is now the primary means of treatment in some countries. To compare the efficacy of telepsychiatry and face-to-face treatment. 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. We identified 32 studies (<i>n</i> = 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 (<i>k</i> = 6 studies, <i>n</i> = 561; standardised mean difference s.m.d. = -0.325, 95% CI -0.640 to -0.011, <i>P</i> = 0.043), whereas face-to-face treatment was superior to telepsychiatry for eating disorder (<i>k</i> = 1, <i>n</i> = 128; s.m.d. = 0.368, 95% CI 0.018-0.717, <i>P</i> = 0.039). No significant difference was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (<i>k</i> = 26, <i>n</i> = 2290; <i>P</i> = 0.248). Telepsychiatry had significantly fewer all-cause discontinuations than face-to-face treatment for mild cognitive impairment (<i>k</i> = 1, <i>n</i> = 61; risk ratio RR = 0.552, 95% CI 0.312-0.975, <i>P</i> = 0.040), whereas the opposite was seen for substance misuse (<i>k</i> = 1, <i>n</i> = 85; RR = 37.41, 95% CI 2.356-594.1, <i>P</i> = 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 (<i>k</i> = 27, <i>n</i> = 3341; <i>P</i> = 0.564). 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.