Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
J Med Internet Res. 2023 Nov 3;25:e40710. doi: 10.2196/40710.
The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues.
This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention.
This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.
From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome.
In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
COVID-19 大流行促使医疗保健服务迅速改变，包括从面对面转变为数字方式提供心理治疗。虽然这些变化有助于确保及时提供心理治疗，但仍存在许多问题，包括临床、文化、实践、隐私和安全问题。
本范围综述系统地描述了针对已诊断精神疾病个体的同步、治疗师提供的基于网络的心理治疗的现有同行评议研究。通过艾伯塔省健康质量矩阵 (AQMH) 对数据进行分析，以评估该文献在何种程度上解决了医疗保健质量的关键指标。该分析有助于识别和组织基于网络的心理治疗知识差距，突出先前优先考虑的护理维度与需要进一步关注的维度之间可能存在的差异。
本综述遵循 PRISMA-ScR（系统评价和荟萃分析扩展的首选报告项目，用于范围综述）指南。我们纳入了以英语发表的同行评议的原始研究，研究对象为成年人（年龄在 18 岁及以上），患有精神疾病诊断和统计手册或国际疾病分类的精神疾病。排除所有其他引文。通过 MEDLINE、APA PsycINFO、Embase（OVID）、Web of Science：核心集合（Clarivate）、Cochrane 图书馆（Wiley）和 Scopus（Elsevier）数据库确定相关研究。数据库于 2021 年 3 月 18 日进行搜索。对于每一篇被考虑的出版物，两名审查员独立对数据进行图表绘制，如果出现差异，首席研究员将验证选择提取器的正确性。结果根据 AQMH 的 6 个维度进行主题描述：可接受性、可及性、适当性、有效性、效率和安全性。
从 13209 篇文献中，纳入了 48 篇文章，主要来自北美研究。大多数研究都测量了治疗效果（n=48，100%）和可接受性（n=29，60%）健康质量维度。超过 80%（40/48）的研究调查了创伤后应激障碍或情绪或焦虑障碍的认知或暴露干预，通常表明与面对面治疗结果相当。安全性（n=5，10%）在较少的研究中进行了测量，而治疗的可及性、适当性和效率在任何研究中都没有明确测量，尽管这些维度被提及为未来的方向、假设或潜在结果。
在基于网络的治疗师提供的针对已诊断精神疾病患者的心理治疗方面，医疗保健质量的重要方面（可及性、适当性、效率和安全性）很少受到科学检验，这突显了需要解决这些差距。该文献还存在与普遍性相关的重要问题，包括许多地理区域、文化、人群、临床环境和心理治疗模式的代表性不足。在代表性不足的人群和环境中进行定性研究，可能会发现对未来实施高质量基于网络的心理治疗至关重要的患者和背景因素。
