Effects of integrated telehealth-delivered cognitive-behavioral therapy for depression and insomnia in rural older adults.

Scogin, Forrest; Lichstein, Kenneth L.; DiNapoli, Elizabeth A.; Woosley, Julie A.; Thomas, Stephen J.; LaRocca, Michael; Byers, Haley D.; Mieskowski, Lisa; Parker, Christina Pierpaoli; Yang, Xin; Parton, Jason; McFadden, Anna C.; Geyer, James D.

doi:10.1037/int0000121

Cited by 47 publications

(36 citation statements)

References 72 publications

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“…This is consistent with previous research showing that providers may hesitate to use TMH due to concerns about the alliance [50][51][52], as well as studies that find that patients tend to give higher ratings of the alliance during TMH than providers [53]. However, there are a number of studies that support the notion that the working alliance can be developed and maintained over TMH [51], and can even be comparable to face-to-face care [54]. Importantly, the technology and connectivity problems that can and do occur in TMH care have been demonstrated to negatively impact perceptions of the alliance [37,55,56], highlighting the importance of optimizing technology to support TMH service delivery.…”

Section: Discussionsupporting

confidence: 90%

The Impact of COVID-19 on Provider Perceptions of Telemental Health

Doran

Lawson

2021

Psychiatr Q

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The present study was designed to assess mental health provider attitudes and perceptions of telemental health (TMH) prior to and during the COVID-19 Pandemic, as well as the nature of their TMH utilization. The study aimed to gather information about positive and negative attitudes towards TMH, perceptions and correlates based on the modality of care, and beliefs about the overall effectiveness of TMH as compared to face-to-face care. The current study is part of a larger mixed methods project utilizing a repeated cross-sectional design. An online survey was administered to a sample of 1448 mental health providers and included demographic and professional information, experiences with and perceptions of TMH prior to and during the COVID-19 Pandemic, as well as a brief measure of pandemic-related stress. The COVID-19 Pandemic resulted in an increased use of TMH in the study sample. During COVID-19, providers reported increased agreement with TMH being necessary, important, and effective for care delivery. Providers who primarily used video, compared with telephone, reported that TMH was more useful, satisfying, and effective. While negative attitude towards TMH was predicted only by prior attitudes and belief in TMH effectiveness, positive attitude towards TMH was also predicted by female sex and current level of pandemic related stress. TMH use during the pandemic was predicted by primary use of video platform and previous TMH use. The 2020 COVID-19 Pandemic resulted in increased use of TMH and significantly increased positive perceptions about TMH among mental health providers.

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Section: Discussionsupporting

confidence: 90%

The Impact of COVID-19 on Provider Perceptions of Telemental Health

Doran

Lawson

2021

Psychiatr Q

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“…The outcomes for remission were comparable to those for response, with the exception that combined treatment was not significantly different from psychotherapy. The SMDs for CAU ranged from 0.70 (95% , [44][45][46][47][48][49] women with postpartum depression (Chibanda, 2014; Sharp, 2010), [50][51] minorities (Dwight-Johnson, 2011; Gater, 2010), [52][53] and patients with comorbid headache/migraine. 54 See Supplemental Appendix 4 for complete references for all studies.…”

Section: Network Meta-analysismentioning

confidence: 99%

Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis

et al. 2021

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PURPOSE Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care. METHODSWe conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50% improvement of depressive symptoms from baseline to end point). RESULTSA total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95% CI, 1.40-1.83 and RR = 1.65; 95% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95% CI, 1.57-3.51 and RR = 2.43; 95% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy. CONCLUSIONS Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.

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“…A total of 11 records were relevant, and among these, 6 systematic reviews show that, in general, telemedicine interventions for mental health conditions seem to be effective [ 13 - 18 ]. Concerning the integration of telepsychiatry services in primary care, several observational and interventional studies have demonstrated that mental health specialist video consultations contribute to overcoming geographical barriers and treating the increasing number of multimorbid patients often cut off from specialized care [ 19 - 24 ]. Randomized trials evaluating video consultations have been conducted either in the unique setting of the US Veterans Health Care Administration in Rural Federally Qualified Health Centers [ 19 , 20 ] or included patients from inpatient health care settings [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…Concerning the integration of telepsychiatry services in primary care, several observational and interventional studies have demonstrated that mental health specialist video consultations contribute to overcoming geographical barriers and treating the increasing number of multimorbid patients often cut off from specialized care [ 19 - 24 ]. Randomized trials evaluating video consultations have been conducted either in the unique setting of the US Veterans Health Care Administration in Rural Federally Qualified Health Centers [ 19 , 20 ] or included patients from inpatient health care settings [ 23 , 24 ]. The implementation of telemedical approaches within mental health care has generally been promoted more in the United States than in Europe through passing guidelines by the American Telemedicine Association [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Mental Health Specialist Video Consultations Versus Treatment-as-Usual for Patients With Depression or Anxiety Disorders in Primary Care: Randomized Controlled Feasibility Trial

Tönnies¹,

Hartmann²,

Wensing³

et al. 2021

JMIR Ment Health

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Background Most people affected by depression or anxiety disorders are treated solely by their primary care physician. Access to specialized mental health care is impeded by patients’ comorbidity and immobility in aging societies and long waiting times at the providers’ end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in primary care settings. Objective The study aims to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression or anxiety disorders. Methods Participants were recruited by their primary care physicians during regular practice visits. Patients who had experienced at least moderate symptoms of depression and/or anxiety disorders were considered eligible for the study. Patients were randomized into 2 groups receiving either treatment-as-usual as provided by their general practitioner or up to 5 video consultations conducted by a mental health specialist. Video consultations focused on systematic diagnosis and proactive monitoring using validated clinical rating scales, the establishment of an effective working alliance, and a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment, and attendance at sessions. Effectiveness outcomes included depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale-12), recovery (Recovery Assessment Scale-German [RAS-G]), and perception of chronic illness care (Patient Assessment of Chronic Illness Care), which were measured at baseline and 16 weeks postallocation by assessors blinded to the group allocation. Results A total of 50 patients with depression and/or anxiety disorders were randomized, 23 in the intervention group and 27 in the treatment-as-usual group. The recruitment yield (number randomized per number screened) and the consent rate (number randomized per number eligible) were 69% (50/73) and 86% (50/58), respectively. Regarding acceptability, 87% (20/23) of the participants in the intervention group completed the intervention. Of the 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 96% (22/23) and 85% (23/27) for the intervention and control groups, respectively. The change from baseline scores at postmeasurement for the No Domination by Symptoms domain of recovery (RAS-G) was somewhat higher in the intervention group than in the control group (Mann-Whitney U test: rank-biserial r=0.19; 95% CI −0.09 to 0.46; P=.18). We did not detect any notable differences between the intervention and control groups in terms of other effectiveness outcomes. We did not observe any serious adverse events related to the trial. Conclusions The intervention and study procedures were found to be feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate their effectiveness in routine care. Trial Registration German Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812.

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Effects of integrated telehealth-delivered cognitive-behavioral therapy for depression and insomnia in rural older adults.

Cited by 47 publications

References 72 publications

The Impact of COVID-19 on Provider Perceptions of Telemental Health

The Impact of COVID-19 on Provider Perceptions of Telemental Health

Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis

Mental Health Specialist Video Consultations Versus Treatment-as-Usual for Patients With Depression or Anxiety Disorders in Primary Care: Randomized Controlled Feasibility Trial

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