Telepsychiatry at forty: what have we learned?

We examined all articles describing video applications of telemedicine for psychiatry (i.e., "telepsychiatry") that have been published in peer-reviewed journals. We found three reports of video application to continuing education, eight uncontrolled studies or anecdotal clinical reports of video application to assessment or consultation, five clinical investigations including a control group or control condition, three studies evaluating the reliability of administering psychological rating scales by video, and two studies of the cost-effectiveness of telepsychiatry. Although the conclusions of all studies reviewed recommended the use of telepsychiatry, evidence currently available is insufficient to suggest its widespread implementation. Additional studies are needed to determine when and for what age groups and conditions telepsychiatry is an effective way to deliver psychiatric services, and whether it is cost-effective. We recommend that telepsychiatry be employed on a limited basis and be restricted to research settings and underserved communities (where it may be the only option) until further evidence is available.