A Telephone- and Text Message-Based Telemedicine Concept for Patients with Mental Health Disorders: Results of a Randomized Controlled Trial

Abstract

Background: A telemedicine care concept based on telephone contacts and individualized text messages was developed for patients with mental disorders to continue treatment after therapy in a psychiatric day hospital. The primary objective of this study was to evaluate the effectiveness of the telemedicine interventions. Methods: The study had a 3-armed, randomized design with 2 intervention arms (intervention 1: telephone contacts; intervention 2: telephone contacts and short text messages; both took place over a period of 6 months and in addition to usual care), and a control group with usual care. Primary outcomes were 18-item Brief Symptom Inventory (BSI-18) scores for anxiety, depression and somatization. All participants were recruited from psychiatric day hospitals. The study was registered in the German Clinical Trials Register (DRKS00000662). Results: 113 participants were analyzed 6 months after starting the intervention. The average BSI-18 anxiety score after 6 months was -2.04 points lower in intervention group 2 than in the control group (p value: 0.042). The difference in BSI depression score between these two groups was marginally significant (p value: 0.1), with an average treatment effect of -1.73. In an exploratory sensitivity analysis restricted to the 75% of patients with the highest symptom scores at baseline, intervention group 1 yielded a significant effect for anxiety and depression compared to the control group (p = 0.036 and 0.046, respectively). Conclusions: Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline.

Randomized controlled pilot trial of supportive text messages for patients with depression

“…Text messages tended to be more highly correlated with symptom reduction than email messages - although the difference was not statistically significant [ 28 ]. Text messages have been also used, for various purposes, in other depression studies: to cost-effectivly screen at-risk persons for depression [ 29 ], to send reminders to complete psychotherapeutic homework [ 30 – 35 ], and to collect data on the changes in the depressive mood or other clinical variables during treatment [ 28 , 30 , 34 , 36 – 38 ].…”

Tecla: a telephone- and text-message based telemedical concept for patients with severe mental health disorders – study protocol for a controlled, randomized, study

“…A previous study for patients with anxiety, depressive symptoms and somatization showed positive effects on the symptom scores for anxiety and depression [ 50 ]. Based on these results, the outlined study was initiated to improve the medical care for patients with severe mental disorders.…”

Clinical Factor 2015

“…Two studies discussed above [15,17] demonstrated implementation of CBT via the web/Internet and its feasibility and acceptability in special populations or situations. Several other recent studies demonstrated efficacy of CBT delivered via modern technologies in recurrent depression [[21], via mobile phone], anxiety and depression [[22], via telemedicine], postnatal depression [[23], via telephone] and generalized anxiety [[24], via telephone]. One may ask whether there is a use for technology beyond delivering CBT in different variations, locations and indications.…”