Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies.
OBJECTIVE
The authors conducted a review and meta-analysis of the literature comparing telepsychiatry with "in-person" psychiatric assessments.


METHODS
Approximately 380 studies on telepsychiatry published between 1956 and 2002 were identified using MEDLINE, PsycINFO, and cross-referenced bibliographies. Of these, 14 studies with an N > 10 compared telepsychiatry with in-person psychiatry (I-P) using objective assessment instruments or satisfaction instruments. Three of these studies compared high bandwidth (HB) with low bandwidth (LB) telepsychiatry.


RESULTS
Fourteen studies of 500 patients met inclusion criteria and were included in the meta-analysis. Telepsychiatry was found to be similar to I-P for the studies using objective assessments. Effect sizes were on average quite small, suggesting no difference between telepsychiatry and I-P. Bandwidth was found to be a significant moderator. Three moderators were tested, effect sizes remained largely heterogeneous, and further analyses are needed to determine the direction of effect. There was no difference between I-P and telepsychiatry between the HB and LB groups, although there are anecdotal data suggesting that HB was slightly superior for assessments requiring detailed observation of subjects.


CONCLUSIONS
Out of a large telepsychiatry literature published over the past 40+ years, only a handful of studies have attempted to compare telepsychiatry with I-P directly using standardized assessment instruments that permit meaningful comparisons. However, in those studies, the current meta-analysis concludes there is no difference in accuracy or satisfaction between the two modalities. Over the next few years, we expect telepsychiatry to replace I-P in certain research and clinical situations.
Hyler
Steven E
SE
Department of Psychiatry, Columbia University, New York, NY, USA. seh5@columbia.edu
Gangure
Dinu P
DP
Batchelder
Sarai T
ST
D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D011570:Psychiatry / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*; D017216:Telemedicine / Q000379:methods*