Real-Time Telehealth Versus Face-to-Face Management for Patients With PTSD in Primary Care: A Systematic Review and Meta-Analysis

Anna Mae Scott, PhD; Mina Bakhit, PhD; Hannah Greenwood, BSc(Hons); Magnolia Cardona, PhD; Justin Clark, BA; Natalia Krzyzaniak, PhD; Ruwani Peiris, MD; Paul Glasziou, PhD

J Clin Psychiatry 2022;83(4):21r14143

ABSTRACT

Objective: We conducted a systematic review and meta-analysis of randomized controlled trials comparing real-time telehealth (video, phone) with face-to-face therapy delivery to individuals with posttraumatic stress disorder (PTSD), by primary or allied health care practitioners.

Data Sources: We searched MEDLINE, Embase, CINAHL, and Cochrane Central (inception to November 18, 2020); conducted a citation analysis on included studies (January 7, 2021) in Web of Science; and searched ClinicalTrials.gov and WHO ICTRP (March 25, 2021). No language or publication date restrictions were used.

Study Selection: From 4,651 individual records screened, 13 trials (27 references) met the inclusion criteria.

Data Extraction: Data on PTSD severity, depression severity, quality of life, therapeutic alliance, and treatment satisfaction outcomes were extracted.

Results: There were no differences between telehealth and face-to-face for PTSD severity (at 6 months: standardized mean difference [SMD] = −0.11; 95% CI, −0.28 to 0.06), depression severity (at 6 months: SMD = −0.02; 95% CI, −0.26 to 0.22; P = .87), therapeutic alliance (at 3 months: SMD = 0.04; 95% CI, −0.51 to 0.59; P = .90), or treatment satisfaction (at 3 months: mean difference = 3.09; 95% CI, −7.76 to 13.94; P = .58). One trial reported similar changes in quality of life in telehealth and face-to-face.

Conclusions: Telehealth appears to be a viable alternative for care provision to patients with PTSD. Trials evaluating therapy provision by telephone, and in populations other than veterans, are warranted.

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References (56)

Ng LC, Stevenson A, Kalapurakkel SS, et al. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2020;17(5):e1003090. PubMed CrossRef
Goldstein RB, Smith SM, Chou SP, et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016;51(8):1137–1148. PubMed CrossRef
Alonso J, Angermeyer MC, Bernert S, et al; ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand suppl. 2004;(420):21–27. PubMed
McEvoy PM, Grove R, Slade T. Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2011;45(11):957–967. PubMed CrossRef
Bisson JI, Roberts NP, Andrew M, et al. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 2013;2013(12):CD003388. PubMed CrossRef
Gillies D, Taylor F, Gray C, et al. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database Syst Rev. 2012;12:CD006726. PubMed CrossRef
Bothe T, Jacob J, Kröger C, et al. How expensive are post-traumatic stress disorders? Estimating incremental health care and economic costs on anonymised claims data. Eur J Health Econ. 2020;21(6):917–930. PubMed CrossRef
Tanielian T, Jaycox LH. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND Corporation; 2008.
American Psychiatric Association (APA). Clinical Practice Guideline for the Treatment of PTSD. 2017.
Hamblen JL, Norman SB, Sonis JH, et al. A guide to guidelines for the treatment of posttraumatic stress disorder in adults: an update. Psychotherapy (Chic). 2019;56(3):359–373. PubMed CrossRef
Lethbridge R. Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder, and Complex Posttraumatic Stress Disorder (version 5.6). NHMRC. Magicapp website. https://files.magicapp.org/guideline/357a1e08-05d4-44b1-89dd-e15a971b3bbf/published_guideline_4672-5_6.pdf. Published 2020. Accessed October 8, 2021.
World Health Organization. Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009. World Health Organization; 2010.
Martinez KA, Rood M, Jhangiani N, et al. Patterns of use and correlates of patient satisfaction with a large nationwide direct to consumer telemedicine service. J Gen Intern Med. 2018;33(10):1768–1773. PubMed CrossRef
Centers for Disease Control and Prevention. Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic. CDC website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html. Published 2020. Updated June 10, 2020. Accessed 8 October 2021.
Olden M, Shingleton R, Finkelstein-Fox L, et al. Telemedicine exposure therapy and assessment for PTSD: a systematic clinical practice narrative review. J Technol Behav Sci. 2016;1(1–4):22–31. CrossRef
Varker T, Brand RM, Ward J, et al. Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: a rapid evidence assessment. Psychol Serv. 2019;16(4):621–635. PubMed CrossRef
Shigekawa E, Fix M, Corbett G, et al. The Current State Of Telehealth Evidence: a Rapid Review. Health Aff (Millwood). 2018;37(12):1975–1982. PubMed CrossRef
Olthuis JV, Wozney L, Asmundson GJ, et al. Distance-delivered interventions for PTSD: a systematic review and meta-analysis. J Anxiety Disord. 2016;44:9–26. PubMed CrossRef
Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020;20(1):1193. PubMed CrossRef
Hazarika M, Math SB. Tele-mental health during the coronavirus disease 2019 (COVID-19) pandemic. Open J Psychiatry Allied Sci. 2020;11(2):77–79. PubMed CrossRef
Moher D, Liberati A, Tetzlaff J, et al; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. PubMed CrossRef
Clark J, Glasziou P, Del Mar C, et al. A full systematic review was completed in 2 weeks using automation tools: a case study. J Clin Epidemiol. 2020;121:81–90. PubMed CrossRef
Clark JM, Sanders S, Carter M, et al. Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial. J Med Libr Assoc. 2020;108(2):195-207.
Higgins J, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions (version 6.0). The Cochrane Collaboration; 2019. https://onlinelibrary.wiley.com/doi/book/10.1002/9781119536604
Morland LA, Greene CJ, Rosen CS, et al. Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: a randomized noninferiority trial. J Clin Psychiatry. 2010;71(7):855–863. PubMed CrossRef
Acierno R, Gros DF, Ruggiero KJ, et al. Behavioural activation and therapeutic exposure for posttraumatic stress disorder: a noninferiority trial of treatment delivered in person versus home-based telehealth. Depress Anxiety. 2016;33(5):415–423. PubMed CrossRef
Strachan M, Gros DF, Ruggiero KJ, et al. An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings. Behav Ther. 2012;43(3):560–569. PubMed CrossRef
Strachan M, Gros DF, Yuen E, et al. Home-based telehealth to deliver evidence-based psychotherapy in veterans with PTSD. Contemp Clin Trials. 2012;33(2):402–409. PubMed CrossRef
Acierno R, Knapp R, Tuerk P, et al. A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: in person versus home-based telehealth. Behav Res Ther. 2017;89:57–65. PubMed CrossRef
Gros DF, Allan NP, Lancaster CL, et al. Predictors of treatment discontinuation during prolonged exposure for PTSD. Behav Cogn Psychother. 2018;46(1):35–49. PubMed CrossRef
Gros DF, Lancaster CL, López CM, et al. Treatment satisfaction of home-based telehealth versus in-person delivery of prolonged exposure for combat-related PTSD in veterans. J Telemed Telecare. 2018;24(1):51–55. PubMed CrossRef
Franklin CL, Cuccurullo LA, Walton JL, et al. Face to face but not in the same place: a pilot study of prolonged exposure therapy. J Trauma Dissociation. 2017;18(1):116–130. PubMed CrossRef
Frueh BC, Monnier J, Grubaugh AL, et al. Therapist adherence and competence with manualized cognitive-behavioral therapy for PTSD delivered via videoconferencing technology. Behav Modif. 2007;31(6):856–866. PubMed CrossRef
Frueh BC, Monnier J, Yim E, et al. A randomized trial of telepsychiatry for post-traumatic stress disorder. J Telemed Telecare. 2007;13(3):142–147. PubMed CrossRef
Gilmore AK, Davis MT, Grubaugh A, et al. “Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?” home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals. Contemp Clin Trials. 2016;48:59–64. PubMed CrossRef
Gilmore AK, Lopez C, Muzzy W, et al. Emotion dysregulation predicts dropout from prolonged exposure treatment among women veterans with military sexual trauma-related posttraumatic stress disorder. Womens Health Issues. 2020;30(6):462–469. PubMed CrossRef
Liu L, Thorp SR, Moreno L, et al. Videoconferencing psychotherapy for veterans with PTSD: results from a randomized controlled non-inferiority trial. J Telemed Telecare. 2020;26(9):507–519. PubMed CrossRef
Maieritsch KP, Smith TL, Hessinger JD, et al. Randomized controlled equivalence trial comparing videoconference and in person delivery of cognitive processing therapy for PTSD. J Telemed Telecare. 2016;22(4):238–243. PubMed CrossRef
Morland LA, Pierce K, Wong MY. Telemedicine and coping skills groups for Pacific Island veterans with post-traumatic stress disorder: a pilot study. J Telemed Telecare. 2004;10(5):286–289. PubMed CrossRef
Greene CJ, Morland LA, Macdonald A, et al. How does tele-mental health affect group therapy process? secondary analysis of a noninferiority trial. J Consult Clin Psychol. 2010;78(5):746–750. PubMed CrossRef
Mackintosh MA, Morland LA, Kloezeman K, et al. Predictors of anger treatment outcomes. J Clin Psychol. 2014;70(10):905–913. PubMed CrossRef
Morland LA, Greene CJ, Grubbs K, et al. Therapist adherence to manualized cognitive-behavioral therapy for anger management delivered to veterans with PTSD via videoconferencing. J Clin Psychol. 2011;67(6):629–638. PubMed CrossRef
Morland LA, Hynes AK, Mackintosh MA, et al. Group cognitive processing therapy delivered to veterans via telehealth: a pilot cohort. J Trauma Stress. 2011;24(4):465–469. PubMed CrossRef
Morland LA, Raab M, Mackintosh MA, et al. Telemedicine: a cost-reducing means of delivering psychotherapy to rural combat veterans with PTSD. Telemed J E Health. 2013;19(10):754–759. PubMed CrossRef
Morland LA, Mackintosh MA, Greene CJ, et al. Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: a randomized noninferiority clinical trial. J Clin Psychiatry. 2014;75(5):470–476. PubMed CrossRef
Morland LA, Mackintosh MA, Glassman LH, et al. Home-based delivery of variable length prolonged exposure therapy: a comparison of clinical efficacy between service modalities. Depress Anxiety. 2020;37(4):346–355. PubMed
Morland LA, Mackintosh MA, Rosen CS, et al. Telemedicine versus in-person delivery of cognitive processing therapy for women with posttraumatic stress disorder: a randomized noninferiority trial. Depress Anxiety. 2015;32(11):811–820. PubMed CrossRef
Morland LA, Wells SY, Glassman LH, et al. What do veterans want? understanding veterans’ preferences for PTSD treatment delivery. Mil Med. 2019;184(11-12):686–692. PubMed CrossRef
Yuen EK, Gros DF, Price M, et al. Randomized controlled trial of home-based telehealth versus in-person prolonged exposure for combat-related PTSD in veterans: preliminary results. J Clin Psychol. 2015;71(6):500–512. PubMed CrossRef
Ziemba SJ, Bradley NS, Landry LA, et al. Posttraumatic stress disorder treatment for Operation Enduring Freedom/Operation Iraqi Freedom combat veterans through a civilian community-based telemedicine network. Telemed J E Health. 2014;20(5):446–450. PubMed CrossRef
Turgoose D, Ashwick R, Murphy D. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. J Telemed Telecare. 2018;24(9):575–585. PubMed CrossRef
Amos T, Stein DJ, Ipser JC. Pharmacological interventions for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2014;(7):CD006239. PubMed CrossRef
Danielsson FB, Schultz Larsen M, Nørgaard B, et al. Quality of life and level of post-traumatic stress disorder among trauma patients: a comparative study between a regional and a university hospital. Scand J Trauma Resusc Emerg Med. 2018;26(1):44. PubMed CrossRef
Lewis C, Roberts NP, Bethell A, et al. Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 2018;12(12):CD011710. PubMed
Blandford A, Wesson J, Amalberti R, et al. Opportunities and challenges for telehealth within, and beyond, a pandemic. Lancet Glob Health. 2020;8(11):e1364–e1365. PubMed CrossRef
Hernandez-Tejada MA, Zoller JS, Ruggiero KJ, et al. Early treatment withdrawal from evidence-based psychotherapy for PTSD: telemedicine and in-person parameters. Int J Psychiatry Med. 2014;48(1):33–55. PubMed CrossRef