Telepsychiatry—the practice of psychiatry at a distance via
videoconferencing—is coming of age in the United States.
A number of clinical telepsychiatry programs burst upon the American scene
during the 1990s (Psychiatric News, March 19). Telepsychiatry can be
used reliably to assess people with symptoms of various mental and behavioral
states (Psychiatric News, December 5, 2003). And now telepsychiatry
appears to be effective for treating people with depression, a new study has
found. It was headed by Paul Ruskin, M.D., of the Veterans Administration
Maryland Health Care System in Baltimore and reported in the August
American Journal of Psychiatry.
"To our knowledge, this study is the first to demonstrate that
symptom improvement and remission of depression treated by means of
telepsychiatry is similar to improvement with in-person treatment,"
Ruskin and his colleagues wrote.
"This study is a major step forward in research on the efficacy of
telepsychiatry," Christopher Thomas, M.D., a professor of psychiatry at
the University of Texas Medical Branch at Galveston and a psychiatrist who has
had experience with telepsychiatry, told Psychiatric News.
In this study, 119 depressed veterans referred for outpatient treatment
were randomly assigned to either treatment by means of telepsychiatry or
in-person treatment. Eight psychiatrists provided treatment throughout the
study, and each psychiatrist saw patients in both treatment conditions.
Psychiatric treatment lasted six months and consisted of psychotropic
medication, psychoeducation, and brief supportive counseling.
The treatment outcomes for patients in each group were compared. The
depressive symptoms of patients in each group significantly improved over the
treatment period, and improvement did not differ by treatment group. The two
groups were found equally adherent on appointment adherence and medication
adherence, and patient satisfaction was equally high in both groups.
With regard to cost, telepsychiatry was found to be more expensive per
treatment session, but this difference vanished when the costs of
psychiatrists' travel to remote clinics more than 22 miles away from the
medical center were taken into consideration.
Thus, "treatment of depression by means of telepsychiatry and
in-person treatment of depression have comparable outcomes and equivalent
levels of patient adherence, patient satisfaction, and health care
cost," Ruskin and his colleagues concluded in their study report.
On a somewhat less positive note, however, the psychiatrists who
participated in the study reported significantly higher satisfaction with
face-to-face encounters than with telepsychiatry sessions. Thomas found this
finding intriguing and thinks it might be due, at least in part, to the
psychiatrists' lack of experience with telepsychiatry. He said that he was
concerned about whether he could use telepsychiatry to "connect with
severely traumatized domestic violence victims, but was surprised to find that
in some ways it may have facilitated establishing therapeutic
Mitchel Kling, M.D., a staff clinician at the National Institute of Mental
Health and one of the study authors, told Psychiatraic News that one
implication of the study findings is that "remote treatment of
depression by telepsychiatry can be carried out safely and effectively in most
"One caveat is that in our study, patients presented to a remote
clinic where there were staff members trained in mental health care who could
help the patients with the technology if they became acutely distressed. I
don't think we can say yet that these findings are generalizable to allowing
remote treatment of patients in their homes."
The study was financed by the VA Office of Research and Development Health
Services Research and Development Service, the VA Maryland Health Care System,
and the VISN 5 Mental Illness Research, Education, and Clinical Center.
The study, "Treatment Outcomes in Depression: Comparison of
Remote Treatment Through Telepsychiatry to In-Person Treatment," is
posted online at<http://ajp.psychiatryonline.org/cgi/content/full/161/8/1471?>.▪
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