The effectiveness of telepsychology with veterans: A meta-analysis of services delivered by videoconference and phone.

Abstract

Veterans face a variety of stressors due to their military service and are more likely to develop psychological problems as a result. Research suggests that as many as half of veterans with mental health conditions go untreated due to barriers including lack of accessibility to services and stigma. The present study builds on previous research by using meta-analytic techniques to determine the effectiveness of telepsychologydelivered therapy with veterans. Empirical studies were included if they reported veteran-related outcome data on a psychological intervention used to treat a mental health condition remotely using either videoconferencing or telephone. Twenty-seven studies including 2,648 total participants (1,667 in treatment conditions and 981 in control conditions) met our inclusion criteria and were incorporated into our analysis. Twenty-five studies provided pre-post data to evaluate various therapy outcomes, and 18 studies used a randomized clinical trials (RCTs) design that allowed a comparison between telehealth and traditional inperson therapy. Publication bias was evaluated using correlations between sample and effect sizes for posttraumatic stress disorder (PTSD) and depression for pretest-posttest and RCT designs; risk was determined to be minimal. Weighted average pre-post effect sizes were moderate-to-strong for depression and trauma, and videoconferencing was more effective than telephone for depression (d = 0.86 and 0.46, respectively) and trauma (d = 1.00 and 0.51, respectively). Weighted average effect sizes computed from RCT studies suggest telepsychology is similarly effective as services provided face-to-face. More research is needed for telepsychology-delivered treatments for other mental health conditions faced by veterans. Impact StatementOnly about half of veterans who meet criteria for a mental health condition obtain treatment due to barriers including service accessibility and embarrassment associated with waiting in line at provider offices. Telepsychology, specifically videoconferencing and telephone, can help reduce these barriers to treatment by eliminating some challenges associated with geographic distances to providers, and by allowing patients to skip office visits. Services delivered by technology are an effective way to alleviate mental health symptoms in this population and are comparable to services provided face-to-face.

Perceptions and Use of Telehealth Among Mental Health, Primary, and Specialty Care Clinicians During the COVID-19 Pandemic

“…Indeed, given that telehealth was being used for MH care well before the onset of the COVID-19 pandemic, there is a strong body of evidence demonstrating that video care is noninferior to in-person MH services, 22 , 23 , 24 as well as an emerging literature suggesting that phone care may sometimes be inferior in quality to video care. 7 , 25 , 26 Findings from this survey suggest that clinician and perhaps leadership decision-making has been influenced by these data. There is less literature regarding telehealth effectiveness in PC and SC, but publication of high-quality studies has increased since the start of the pandemic 27 ; this work will be critical in informing PC and SC clinicians’ and leadership’s decision-making regarding the choice of care modalities.…”

Clinicians’ Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study

“…Additionally, clinicians reported greater intention to continue using video services over telephone services. These findings suggest that the perceived utility of technologies varies in AMH care [ 25 ], and the merits of and attitudes toward each require consideration when integrating them into routine practice.…”

“…The literature offers comparisons of telepsychology (either telephone or video) [ 13 , 24 ] to in-person services, but few comparisons between telepsychology modalities. One meta-analysis indicated that videoconferencing was more effective than telephone for depression and posttraumatic stress disorder in veterans [ 25 ], yet a comparison between telepsychology modalities is a major gap in the literature.…”

Psychotherapy via Telehealth during the COVID-19 Pandemic in Australia–Experience of Clients with a Diagnosis of Borderline Personality Disorder

“…A meta-analysis that included 2,648 veterans previously reported similar effectiveness in treatment outcomes using both telehealth (video-conferencing and telephone) and in-person psychotherapies. Participants in the meta-analysis had a variety of mental health conditions, mostly trauma, depression, and anxiety (McClellan et al, 2021). Another meta-analysis examined the effectiveness of video-conferencing in the delivery of mental health services.…”