Objective: To review the evidence of benefit from use of telemental health (TMH) in studies that reported clinical or administrative outcomes.Method: Relevant publications were identified through computerized literature searches using several electronic databases. Included for review were scientifically valid articles that described controlled studies, comparing TMH with a non-TMH alternative, and uncontrolled studies that had no fewer than 20 participants. Quality of the evidence was assessed with an approach that considers both study performance and study design. Judgments were made on whether further data were needed to establish each TMH application as suitable for routine clinical use.Results: Included in the review were 72 papers that described 65 clinical studies; 32 (49%) studies were of high or good quality. Quality of evidence was higher for Internet-and telephone-based interventions than for video conferencing approaches. There was evidence of success with TMH in the areas of child psychiatry, depression, dementia, schizophrenia, suicide prevention, posttraumatic stress, panic disorders, substance abuse, eating disorders, and smoking prevention. Evidence of success for general TMH programs and in the management of obsessive-compulsive disorder were less convincing. Further study was judged to be necessary or desirable in 53 (82%) of the studies.
Conclusion:Evidence of benefit from TMH applications is encouraging, though still limited. There is a need for more good-quality studies on the use of TMH in routine care. The emerging use of Internet-based applications is an important development that deserves further evaluation.
Can J Psychiatry 2008;53(11):769-778
Clinical Implications· There is encouraging evidence of the successful use of TMH in several applications. However, further work to establish its suitability in routine practice is desirable. · Internet-based approaches to TMH are likely to increase in importance.
Limitations· The evidence base for TMH outcomes remains small. · Assessment of quality is based in part on subjective judgments on study attributes. · Findings on TMH success and need for further study are based on published material and do not necessarily reflect specific clinical experience.