Do mental health services lose any effectiveness via video conferencing?
Batastini and colleagues (2020) conducted the most comprehensive and rigorous meta-analysis of studies comparing video-conferencing to in-person delivery of mental health services on mental health outcomes. Studies were only included in the meta-analysis if: they were published in English; evaluated mental health outcomes such as symptom reduction or hospitalisation (vs client satisfaction); the mental health service was delivered via live broadcast of audio and video simultaneously; and used a between-group design comparing video-conferencing to in-person delivery (vs pre-post comparison of videoconferencing). The literature search was up-to-date in May 2020, although no studies published after 2019 met inclusion criteria. The meta-analytic methodology was carefully conducted including both conventional and multilevel analyses (to account for dependence between different outcomes derived from the same study). They found 43 studies (83% randomized) involving 4,336 participants producing an average of 6.5 outcome measures per study. Most studies focused on trauma or anxiety (35% outcomes) or depressive or mood disorders (25% outcomes) with psychosocial or psychotherapy as the intervention (72% outcomes).
In the conventional meta-analysis, there was no significant difference in outcomes between video-conference and in-person mental health service provision (g = -.02[-.12, .94]). There was significant heterogeneity (Q(42)=160.41, p < .001, I2 = 72.5%). Gender accounted for 19.8% heterogeneity. In studies with mostly female participants, video-conferencing was significantly more effective than in-person services, by about 1/3 of a standard deviation of the outcome measure. In studies with mostly male participants, in-person services were significantly more effective than video-conferencing, by ~16% of a standard deviation in outcome measure. Whether this is really a gender effect or because all male-only samples were also military veterans remains to be determined. There was also a difference between modes when delivered in medical service settings: video-conferencing was significantly more effective than in-person services by about 1/3 of a standard deviation. The authors speculate that this might be because medical facilities had access to more technologically advanced equipment or because by accessing the service in a medical facility it was also easier to then access other high-quality services and providers. It may also be because they service higher severity clients for which having access to videoconferencing makes a bigger difference to whether they comply with (or accept) treatment or not. Otherwise, no other factors affected the difference between modalities. There was no evidence of publication bias. Multilevel meta-analysis indicated that differences in the effect of gender and site between studies had little to do with differences in the way outcomes were measured.
The authors also looked at 14 studies of psychological and psychiatric assessment involving 332 participants producing an average of 5.9 outcomes per study, with a view to investigating the concordance between the assessment conduced via each mode (video conference or in-person). For example, Kobak and colleagues (2008) had 35 adults assessed via the Montgomery-Asberg Depression Scale, twice: once in person, and once via video-conferencing (the order was counter-balanced so that half the people received their first assessment via video-conference and the other half received the first assessment in person). Intraclass correlations were computed across participants and administrations and the mean difference in scores obtained via in-person or video-conference administrations was calculated. The meta-analysis found no significant difference in the decisions obtained between assessment modalities, whether this be arriving at a different diagnosis, a significant difference in score totals or the decision to provide or withhold a treatment (g = 0.07[-0.02, 0.17]).
So, the literature to date does not support concerns about delivering psychological assessment or intervention services via videoconference. However, the authors highlighted that of all the literature on videoconferencing for mental health, there are relatively few direct comparisons of videoconference and in-person modalities and those that most have very small sample sizes. The authors note the demographic profile within the studies reviewed was mainly limited to Caucasian adults, with male Veteran clients over-represented. The authors highlighted other surprising limitations of the literature including that 39% did not name the technology used to deliver services, many failed to report the actual mental health service delivered, and many did not report participant demographics or statistical analyses appropriately. The ability to assess risk of bias was compromised by poor reporting. Importantly for this point in our history, none of these studies were conducted during a pandemic.
Hopefully those of you who may feel forced to provide your services via telehealth platforms can have some confidence in this mode of delivery. Hope this finds you well and if COVID is enforcing an interruption to work, I hope you can invest that time in self- and family care.
Take Home: Clinical Implications
There is no significant difference between outcomes of mental health services delivered via videoconference compared to in-person, across 43 studies, 4336 clients and a range of outcomes
There is no significant difference in the decisions arrived at from psychological assessments conducted via videoconference compared to in-person
There are relatively few head-to-head comparisons and much more and better quality research is still needed, but for now, there is no basis for concerns that videoconferencing will diminish the quality of service psychotherapists provide
For the original article, go to:
https://www.sciencedirect.com/science/article/pii/S027273582030132X
REFERENCES
Batastini, A.B., Paprzycki, P., Jones, A.C.T., & MacLean, N. (2020). Are videoconferenced mental and behavioral health services just
as good as in-person? A meta-analysis of a fast-growing practice. Clinical Psychology Review, 1-99.
https://doi.org/10.1016/j.cpr.2020.101944
Kobak, K.A., Williams, J.B.W., Jeglic, E., Salvucci, D., & Sharp, I.R. (2008). Face-to-face versus remote administration of the Montgomery-Asberg Depression Rating Scale using videoconferencing and telephone. Depression and Anxiety, 25: 913-919.