Treating Childhood Depression over Videoconferencing

Abstract

Effective cognitive-behavioral treatments for childhood depression have developed over the last decade, but many families face barriers to such care. Telemedicine increases access to psychological interventions by linking the child and the clinician using videoconferencing (VC). The current study evaluated an 8-week, cognitive-behavioral therapy (CBT) intervention for childhood depression either face-to-face (F2F) or over VC. The telemedicine setup included two PC-based PictureTel systems at 128 kilibits per second (kbps). Success was defined by (1) decreasing depressive symptoms at similar rates in both the VC group and the F2F group and (2) demonstrating the feasibility of a randomized controlled trial in telemental health. Children were assessed for childhood depression using the mood section of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present Episode (K-SADS-P). Twenty-eight children were randomized to either F2F or VC treatment. The participants completed the K-SADS-P and the Children's Depression Inventory (CDI) at pre- and post-treatment. The CBT treatment across the two conditions was effective. The overall response rate based on post-evaluation with the K-SADS-P was 82%. For the CDI total score, both the Time and the Group by Time effects were significant (p < 0.05). The interaction effect reflected a faster rate of decline in the CDI total score for the VC group. The study serves as a model for building on past research to implement a randomized controlled trial. This information provides persuasive research data concerning treatment effectiveness for clinicians, families, and funders.

Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence

“…Three systematic reviews rated the quality of the studies but did not use this information to make recommendations and none of them assessed the likelihood of publication bias. Common limitations in the systematic reviews were: grading of the evidence was not evident in the recommendations; studies were assessed for quality but were not linked to recommendations; all of the systematic reviews reported on the same 10 RCTs; 6,58-66 two child and adolescent RCTs [67][68] and two of the systematic reviews 23,39 included information from a further 8 moderate quality control studies. [69][70][71][72][73][74][75][76] The systematic reviews also only included studies up until 2008.…”

The Association Between Rural Residence and the Use, Type, and Quality of Depression Care

“…These findings underscore the importance of developing and disseminating innovative modalities for delivering evidence-based psychotherapies to remote locations. While evidencebased psychotherapies have been shown to be effective when delivered via telephone, 23 interactive video, 24,25 and computer/Internet, 26 third-party payers frequently do not reimburse for these treatment modalities. Reimbursement for interactive video visits often requires payments to both the off-site psychotherapist and the on-site host organization (eg, primary care clinic).…”

Review of key telepsychiatry outcomes

“…We identified 13 RCTs that evaluated treatment outcomes for mental health interventions delivered via telepsychiatry (Table 1). Seven studies targeted depression [77][78][79][80][81][82][83] , two targeted symptoms of PTSD [11,84,85] , two targeted ADHD [86] , one targeted bulimia nervosa [87] , and two targeted common psychiatric disorders presented in an outpatient medical and mental health settings.…”