Background: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. Methods: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. Results: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI −0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI −0.40 to 0.39), function (SMD 0.13, 95% CI −0.16 to 0.42), working alliance client (SMD 0.11, 95% CI −0.34 to 0.57), working alliance therapist (SMD −0.16, 95% CI −0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI −0.30 to 0.53), or at any other time point (3, 6, and 12 months). Conclusions: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions.

中文翻译：

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针对不太常见的心理健康状况的远程医疗与面对面心理治疗：随机对照试验的系统评价和荟萃分析

背景：精神障碍是全世界痛苦和残疾的主要原因。为了满足患者的需求，有必要增加获得高质量、循证心理保健的机会。远程医疗在治疗疾病（包括心理健康状况）方面已经很成熟。目的：本研究旨在进行强有力的证据综合，以评估远程医疗和面对面护理在管理需要心理治疗的不太常见的心理和身体健康状况方面是否存在差异。方法：在本系统评价中，我们纳入了比较远程医疗（电话、视频或两者兼有）与面对面心理治疗对不太常见的心理健康状况和需要心理治疗的身体健康状况的随机对照试验。提供的心理治疗必须在远程医疗组和面对面组之间具有可比性，并且必须由全科医生、初级保健护士或专职医疗人员（如心理学家和顾问）提供。包括患者（症状严重程度、心理症状和功能的整体改善）、过程（工作联盟和客户满意度）和财务（成本）结果。结果：共纳入 12 项随机对照试验，共 931 名患者；疗法包括在包括成瘾症、饮食失调、儿童心理健康问题和慢性病的人群中提供的认知行为和家庭疗法。远程医疗在 7 项试验中通过视频提供，在 3 项试验中通过电话提供，在 1 项试验中通过电话提供，并且在 1 项试验中提供方式不清楚。对于大多数领域，12 项试验的偏倚风险较低或不清楚，除了由于比较的性质而缺乏参与者的盲法。远程医疗和面对面治疗在治疗后立即（标准化平均差 [S​​MD] 0.05, 95% CI -0.17 至 0.27）或任何其他随访时间点的症状严重程度没有显着差异。相似地，结论：关于有效治疗不太常见的心理健康状况和需要心理支持的身体状况，没有足够证据表明通过远程医疗提供的心理治疗与面对面提供的相同治疗之间存在差异。然而，在这篇综述中，对于一些严重的心理健康状况，例如精神分裂症和双相情感障碍，没有包含的证据，需要进一步的高质量研究来确定远程医疗是否是一种可行的、等效的治疗方案。