Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.
Psychol Med. 2022 Oct;52(14):2852-2860. doi: 10.1017/S0033291722002331. Epub 2022 Aug 12.
Ensuring continuity of care for patients with major depressive disorders poses multiple challenges. We conducted a systematic review and meta-analysis of randomised controlled trials comparing real-time telehealth to face-to-face therapy for individuals with depression. We searched Medline, Embase, and Cochrane Central (to November 2020), conducted a citation analysis (January 2021), and searched clinical trial registries (March 2021). We included randomised controlled trials comparing similar or identical care, delivered via real-time telehealth (phone, video) to face-to-face. Outcomes included: depression severity, quality of life, therapeutic alliance, and care satisfaction. Where data were sufficient, mean differences were calculated. Nine trials (1268 patients) were included. There were no differences between telehealth and face-to-face care for depression severity at post-treatment (SMD -0.04, 95% CI -0.21 to 0.13, = 0.67) or at other time points, except at 9 months post-treatment (SMD -0.39, 95% CI -0.75 to -0.02, = 0.04). One trial reported no differences in quality-of-life scores at 3- or 12-months post-treatment. One trial found no differences in therapeutic alliance at weeks 4 and 14 of treatment. There were no differences in treatment satisfaction between telehealth and face-to-face immediately post-treatment (SMD -0.14, 95% CI -0.56 to 0.28, = 0.51) or at 3 or 12-months. Evidence suggests that for patients with depression or depression symptoms, the provision of care via telehealth may be a viable alternative to the provision of care face-to-face. However, additional trials are needed with longer follow-up, conducted in a wider range of settings, and with younger patients.
确保患有重度抑郁症患者的护理连续性存在多重挑战。我们对比较实时远程医疗与面对面治疗抑郁症患者的随机对照试验进行了系统评价和荟萃分析。我们检索了 Medline、Embase 和 Cochrane Central（截至 2020 年 11 月），进行了引文分析（2021 年 1 月），并检索了临床试验登记处（2021 年 3 月）。我们纳入了比较实时远程医疗（电话、视频）与面对面提供的类似或相同护理的随机对照试验。结局包括：抑郁严重程度、生活质量、治疗联盟和护理满意度。如果数据足够，计算平均差。纳入了 9 项试验（1268 名患者）。在治疗后（SMD -0.04，95%CI -0.21 至 0.13， = 0.67）或其他时间点，远程医疗与面对面护理在抑郁严重程度方面无差异，除了治疗后 9 个月（SMD -0.39，95%CI -0.75 至 -0.02， = 0.04）。一项试验报告在治疗后 3 或 12 个月时生活质量评分无差异。一项试验发现治疗联盟在治疗第 4 周和第 14 周时无差异。在治疗后即刻（SMD -0.14，95%CI -0.56 至 0.28， = 0.51）或治疗后 3 或 12 个月时，远程医疗与面对面护理在治疗满意度方面无差异。证据表明，对于患有抑郁症或抑郁症状的患者，通过远程医疗提供护理可能是面对面护理的可行替代方案。然而，需要更多具有更长随访时间、在更广泛的环境中进行、并纳入年轻患者的试验。
