Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis

Utilization of Outpatient Mental Health Services During and 2 Years after the COVID-19 Pandemic

Objective: Analyze the impact of COVID-19 on outpatient mental health (OP-MH) utilization patterns, particularly telehealth, across eight different MH conditions with a 2-year follow-up. Methods: This population-based cohort study uses a 5% random sample of Medicare beneficiaries aged ≥18 and newly diagnosed with one of the eight MH disorders: psychotic, depressive, bipolar, anxiety, trauma-related, substance-use, other MH disorders, and two or more MH disorders. Monthly OP-MH utilization patterns were compared among patients in 2020-2021 newly diagnosed in 2019 to comparable prepandemic cohorts newly diagnosed in 2017. Multiple logistic regression models were conducted to examine differences in telehealth utilization across MH conditions. Results: Across groups, patients were mostly aged 65-84 (n = 39,749 [72.4%] in 2017 and n = 40,513 [75.5%] in 2019), female (n = 33,387 [60.8%] in 2017 and n = 32,193 [60.0%] in 2019), and White (n = 48,314 [88.0%] in 2017 and n = 47,282 [88.1%] in 2019). Total OP-MH utilization dropped (a 27.5% decrease at its lowest) for all MH conditions at the pandemic's onset compared with the nonexposure group. Although utilization increased postpandemic, slight disruptions remained until the end of 2021. Telehealth visits rose from 0.5% in January 2020 to 55% in April 2020, decreasing to 18% by December 2021. Regression analysis showed that patients with psychotic, bipolar, or trauma-related, and two or more MH disorders had higher odds of telehealth usage compared with those with anxiety, while patients with substance-use disorders had lower odds. Rural residents, older adults (65+), and men had lower odds of using telehealth, with residents of the Northeast and West regions showing higher odds compared with the South. Telehealth disparity profiles were uniquely associated with different MH conditions. Conclusion and Relevance: Findings highlight the need for tailored telehealth strategies among Medicare beneficiaries to address specific demographic and geographical disparities across MH conditions.

Telehealth-Facilitated Mental Health Care Access and Continuity for Patients Served at the Health Resources and Services Administration-Funded Health Centers

Objective: The Health Resources and Services Administration (HRSA)-funded health centers provide critical behavioral health services to historically and medically underserved individuals with complex health and social needs. As health centers rapidly expanded telehealth in response to COVID-19, the objective of the study was to assess whether telehealth use was associated with utilization and continuity within mental health care received by patients of HRSA-funded health centers. Methods: Cross-sectional analyses, using a nationally representative sample of adult patients with mental health needs from the 2022 Health Center Patient Survey (n = 1,044), explored associations between telehealth use and utilization of mental health services from primary care providers (PCP) and continuity of counseling services. Multivariate logistic regression models accounted for predisposing, enabling, and need factors to assess the influence of telehealth use on utilization and continuity outcomes. Results: After adjusting for patient-level factors, telehealth users with mental health needs had statistically significant and higher odds of receiving mental health services from a PCP at a health center compared with nontelehealth users (adjusted odds ratios [aOR] = 2.60, p < 0.001; 95% confidence interval [CI] [1.50, 4.52]). Telehealth-using patients receiving counseling services had statistically significant and higher odds of receiving all counseling services at a health center compared with nontelehealth users (aOR = 3.65, p < 0.001, 95% CI [2.04, 6.53]). Conclusions: Telehealth facilitates mental health care utilization and continuity for historically and medically underserved patients at health centers and can be an important tool for care management and coordination for patients with mental health needs, particularly during and following public health emergencies.

Telemedicine-Related Opioid Use Disorder Services in Underserved Populations: A Qualitative Evaluation of the Waiver Era

Introduction: This pilot study examined access to telemedicine-related opioid use disorder (OUD) treatment in underserved communities in Houston, Texas before July 30, 2023. Methods: Participants, both patients and providers, were recruited in partnership with local substance use treatment clinics. Both groups shared experiences before and after the waiver era. Rapid qualitative analysis was conducted by the research team. Results: Fourteen qualitative interviews were conducted via Zoom with 5 treatment providers and 9 self-identified Black or Hispanic patient participants. Participants generally approved telemedicine for OUD treatment due to its technological accessibility and flexibility. However, concerns about technology, care quality, relationship building, and privacy were common among both patients and providers. Discussion: Our study highlights the underutilization of telemedicine for OUD treatment in underserved Houston communities. Efforts to address current limitations and leverage recent policy changes can help bridge the utilization gap in underserved areas.

Race and Ethnicity and Diffusion of Telemedicine in Medicaid for Schizophrenia Care After Onset of the COVID-19 Pandemic

Importance

Delivery of mental health care through telehealth (telemental health care) increased after the onset of the COVID-19 pandemic. Little is known about the speed of adoption (diffusion) of telemental health in the care in the care of individuals with schizophrenia.

Objectives

To characterize telemental health care diffusion in mental health agencies serving Medicaid beneficiaries with schizophrenia and the beneficiary-level association of telemental health care use with race and ethnicity.

Design, Setting, and Participants

This retrospective cohort study used New York State Medicaid data from March 1, 2019, to February 29, 2020 (prepandemic period), and from March 11, 2020, to March 31, 2021 (pandemic period), from 261 agencies serving 30 990 beneficiaries with schizophrenia with 1 or more mental health visits during the pandemic period. Statistical analysis was performed from November 2021 through September 2024.

Exposure

Agency percentage of patients belonging to racial and ethnic minority groups among all Medicaid-covered patients between March 2019 and February 2020; agency type, categorized as freestanding, hospital affiliated, or state operated; beneficiary-level race and ethnicity, categorized as Asian or other (American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander), Black, Latinx, White, and unknown; and pandemic severity, operationalized as COVID-19 hospitalization rates per 10 000 population in administratively defined catchment areas.

Main Outcomes and Measures

Days to 10% cumulative telemental health care use within agencies, as well as beneficiary-level time to first telemental health care visit and any telemental health care visit in catchment areas in times of varying pandemic severity.

Results

In this cohort study of 261 agencies (18 [7%] state operated, 79 [30%] hospital affiliated, and 164 [63%] free standing) and 30 990 beneficiaries with schizophrenia (mean [SD] age, 43 [13] years; 59% male; 7% Asian or other, 38% Black, 20% Latinx, and 25% White), 6 agencies (2%) never adopted telemental health care, and 248 (95%) reached 10% cumulative telemental health care visits in a mean of 18 days. Mean (SD) agency prepandemic shares of beneficiaries belonging to racial or ethnic minority groups (56% [23%]) were not associated with telemental health care diffusion. Diffusion was faster in state-operated vs free-standing agencies (hazard ratio [HR], 2.44 [95% CI, 1.21-4.95]). Relative to White beneficiaries, time to first telemental health care visit was slower in every racial and ethnic minority group (Asian or other: HR, 0.93 [95% CI, 0.88-0.98]; Black: HR, 0.90 [95% CI, 0.87-0.93]; Latinx: HR, 0.95 [95% CI, 0.91-0.99]). Beneficiaries from at least 1 racial or ethnic minority group were less likely than White beneficiaries to have a telemental health care visit regardless of pandemic severity and area; differences narrowed when pandemic severity was higher (eg, in New York City, the odds ratio of Black beneficiaries having a telemental health care visit relative to White beneficiaries when the pandemic severity was high was 0.70 [95% CI, 0.63-0.79] but decreased to 0.59 [95% CI, 0.53-0.67] when the pandemic severity was low).

Conclusions and Relevance

In this cohort study of Medicaid beneficiaries with schizophrenia, telemental health care diffused rapidly after the onset of the COVID-19 pandemic, particularly in state-operated agencies. Together, agency-level and beneficiary-level race and ethnicity findings suggest within-agency racial and ethnic differences in diffusion of telemental health care. States should monitor the diffusion of innovations across vulnerable populations.

Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals

The COVID-19 public health emergency (PHE) caused significant disruptions in the delivery of care, with in-person visits decreasing and telehealth use increasing. We investigated the impact of these changes on mental health services for Medicaid-enrolled adults and youth in Washington State. Among enrollees with existing mental health conditions, the first year of the PHE was associated with a surge in specialty outpatient mental health visits (13% higher for adults and 7% higher for youth), returning to pre-PHE levels in the second year. Conversely, youth with new mental health needs experienced a decline in specialty outpatient visit rates by ∼15% and 37% in the first and second years of the PHE, respectively. These findings indicate that while mental health service use was maintained or improved for established patients, these patterns did not extend to Medicaid-enrolled youth with new mental health needs, potentially due to barriers such as difficulty in finding providers and establishing new patient-provider relationships remotely. To bridge this gap, there is a need for a multi-faceted approach that includes improving service accessibility, enhancing provider availability, and optimizing initial care encounters, whether in-person or virtual, to better support new patients.

Differences in self-reported disruptions in mental health treatment during COVID-19 in a national household sample: impact of severity of functional impairment

Objective

This report uses data from Mental Disorders Prevalence Study (MDPS), a large epidemiologic study that provided national prevalence estimates of seven mental disorders based on the Structured Clinical Interview for DSM-5 (SCID), to assess the odds of treatment disruption during COVID for SMI and non-SMI groups.

Methods

This cross-sectional study conducted from 2020 to 2022 included 2,810 household participants with any lifetime mental health treatment. Weighted logistic regressions estimated the odds of reporting disruptions in access to mental health care or psychotropic prescriptions due to COVID. SMI was broadly defined as having an MDP diagnosis and serious functional impairment (GAF ≤50, a validated and widely used cutoff). Non-SMI groups were a mental diagnosis without serious impairment (MDPS diagnosis, GAF >50) and any lifetime treatment and no serious impairment (no MDPS diagnosis, GAF >50).

Results

The SMI and mental disorder without serious impairment groups had approximately 6.4- and 2.4-greater odds, respectively, of reporting inability to access mental health care and 4- and 3- greater odds, respectively, of having prescriptions delayed, relative to the group with any lifetime treatment. Among those with serious mental illness, having Medicare insurance increased the odds of reporting inability to access mental health care.

Conclusions

Individuals with SMI were much more likely to experience treatment disruptions throughout the pandemic than non-SMI groups.

Telehealth Use and Health Equity for Mental Health and Substance Use Disorder During the COVID-19 Pandemic: A Systematic Review

Background: As a result of the COVID-19 public health emergency (PHE), telehealth utilization accelerated to facilitate health care management and minimize risk. However, those with mental health conditions and substance use disorders (SUD)-who represent a vulnerable population, and members of underrepresented minorities (e.g., rural, racial/ethnic minorities, the elderly)-may not benefit from telehealth equally. Objective: To evaluate health equality in clinical effectiveness and utilization measures associated with telehealth for clinical management of mental health disorders and SUD to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability. Methods: We performed a systematic review in PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL through November 2022. Studies included those with telehealth, COVID-19, health equity, and mental health or SUD treatment/care concepts. Our outcomes included general clinical measures, mental health or SUD clinical measures, and operational measures. Results: Of the 2,740 studies screened, 25 met eligibility criteria. The majority of studies (n = 20) evaluated telehealth for mental health conditions, while the remaining five studies evaluated telehealth for opioid use disorder/dependence. The most common study outcomes were utilization measures (n = 19) or demographic predictors of telehealth utilization (n = 3). Groups that consistently demonstrated less telehealth utilization during the PHE included rural residents, older populations, and Black/African American minorities. Conclusions: We observed evidence of inequities in telehealth utilization among several underrepresented groups. Future efforts should focus on measuring the contribution of utilization disparities on outcomes and strategies to mitigate disparities in implementation.

Addressing the Increasing Mental Health Distress and Mental Illness Among Young Adults in the United States

ABSTRACT

Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults.

Paper promises: Peruvian frontline health workers' perspectives on mental health policies during COVID-19

Governments globally deployed various non-pharmacological public health measures to respond to the COVID-19 pandemic (i.e. lockdowns and suspension of transportation, amongst others); some of these measures had an influence on society's mental health. Specific mental health policies were therefore implemented to mitigate the potential mental health impact of the pandemic. We aimed to explore the implementation of mental health regulations adopted by the Peruvian health system by focusing on the care services at Community Mental Health Centres (CMHCs), based on the experiences of health workers. We conducted a phenomenological qualitative study to understand the implementation of mental health policies launched in Peru during the COVID-19 pandemic. Data were obtained from a document review of 15 national policy measures implemented during the pandemic (March 2020 to September 2021), and 20 interviews with health workers from CMHCs (September 2021 to February 2022). The analysis was conducted using thematic content analysis. Most implemented policies adapted CMHC care services to a virtual modality during the COVID-19 pandemic; however, various challenges and barriers were evidenced in the process, which prevented effective adaptation of services. Workers perceived that ineffective telemedicine use was attributed to a gap in access to technology at the CMHCs and also by users, ranging from limited access to technological devices to a lack of technological skills. Further, although mental health promotion and prevention policies targeting the community were proposed, CMHC staff reported temporary interruption of these services during the first wave. The disparity between what is stated in the regulations and the experiences of health workers is evident. Policies that focus on mental health need to provide practical and flexible methods taking into consideration both the needs of CMHCs and socio-cultural characteristics that may affect their implementation.

Engagement of individuals with serious mental illness in outpatient mental health services and telehealth use during the COVID-19 pandemic

Questions remain regarding whether the transition and continued use of telehealth was associated with changes in treatment engagement among patients with serious mental illness (SMI). Using NYS Medicaid claims, we identified 116,497 individuals with SMI receiving outpatient mental health services from September 1, 2019-February 28, 2021 and a comparison cohort of 101,995 from September 1, 2017-February 28, 2019 to account for unmeasured and seasonal variation. We characterized engagement in three 6-month increments (T0-T1-T2) using clinically meaningful measures of high, partial, low, and none. Subgroup differences were compared, and telehealth users were compared to those with only in-person visits. Engagement, as characterized, was largely maintained during COVID. The 19.0 % with only in-person visits during COVID had different characteristics than telehealth users. Telehealth use was greater among younger people by T2 (33.1 %), women (57.7 %), non-Hispanic White people (38.9 %), and those with MDD (18.0 %), but lower among non-Hispanic Black people, in NYC, and those with schizophrenia or SUD. Most telehealth users were highly engaged (77.1 %); most using only in-person services had low engagement (47.5 %). The shift to telehealth preserved access to many outpatient services for this SMI population. Exploring reasons for not using telehealth may identify opportunities to increase care access.

Trends in telemedicine utilization for mental illness during the COVID-19 pandemic: an analysis of a nationwide database in Korea

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has worsened mental health and reduced access to mental health services. During the pandemic, the demand for telemedicine has increased and related laws have been enacted. This study aimed to investigate telemedicine use for cases of major mental illnesses during the COVID-19 pandemic and to compare the characteristics of patients who received telemedicine service with those of patients who received in-person care.

METHODS

This population-based, cross-sectional, observational study was based on health insurance claims data, and included 2,749,872 patients who received outpatient treatment for mental illness from February 24, 2020 to June 30, 2022. Logistic regression was performed to assess the relationships between patient characteristics and telemedicine service use. Patients who received telemedicine services were analyzed in subgroups of each mental illness.

RESULTS

During the study period, 80,157 patients (2.9%), with an average age of 63 years, received at least one telemedicine treatment. There was a predominance of women and medical aid recipients. The lowest proportion of telemedicine treatments was for depression (2.1%), and the highest was for dementia (6.7%). The proportion of patients receiving telemedicine in long-term care hospitals was high (22.6%), with the highest odds ratio (OR) (5.84), compared with that in tertiary or general hospitals, followed by that in psychiatric hospitals and clinics. The proportions were high in the departments of internal medicine, neurology, and psychiatry. Patients aged > 80 years received most telemedicine treatment (OR: 1.23) across all diagnoses. Cases of dementia and other mental disorders had higher ORs (2.60 and 2.36, respectively) compared with cases of depression. Except for dementia and behavioral/emotional disorders, hospitalization increased the probability of telemedicine treatment. Comorbidities were positively associated with telemedicine treatment.

CONCLUSIONS

Older people and people with other physical illnesses were more likely to use telemedicine treatments temporarily provided during the pandemic. Telemedicine maintained continuity of treatment for patients with dementia and severe mental illnesses. Telemedicine can be useful for filling the medical gaps for vulnerable populations other than those with mild mental illnesses. This aspect should be considered for the future establishment of telemedicine systems.

Assumptions, Perceptions, and Experiences of Behavioral Health Providers Using Telemedicine: Qualitative Study

BACKGROUND

The urgent and reactive implementation of telemedicine during the pandemic does not represent a long-term, strategic, and proactive approach to optimizing this technology. The assumptions, perceptions, and experiences of the behavioral health providers using telemedicine can inform system-wide and institutional-level strategies to promote longitudinal maintenance of care delivery, which can reduce the use of high-cost care due to new symptom onset and symptom exacerbation related to service interruptions.

OBJECTIVE

We aim to identify the assumptions, perspectives, and experiences of behavioral health clinicians and providers using telemedicine to inform the development of an optimized, sustainable approach to telemedicine implementation.

METHODS

This qualitative study applies the domains of the Consolidated Framework for Implementation Research (CFIR) to structure data collection and analysis from behavioral health providers using telemedicine via an audiovisual connection in the New England region. In total, 12 providers across levels of care were recruited for a 60-minute interview, developed from the CFIR interview guide. Atlas Ti Qualitative Software (version 23; ATLAS.ti Scientific Software Development GmbH) was used to coordinate and facilitate coding among 3 reviewers. Deductive coding was provided from the CFIR interview guide, allowing for data to be categorized by domain and construct. Constructs were analyzed for descriptive themes and tabulated for response frequency. Uncoded data were reviewed and coded in vivo to explore variables contributing to participant perceptions of experience with telemedicine use. Descriptive themes, then analytical themes, were identified. Analytical themes and tabulated frequency of response data were summarized. Finally, a sentiment analysis was completed to derive tone and meaning from the data.

RESULTS

Results are reported within the CFIR domains: intervention characteristic, outer setting, inner setting, characteristics of individuals, and process. The findings with ≥90% agreement include "best practice standards were not known"; "telemedicine was believed to be efficient and time-saving for the patient and provider, maximizing productivity and thus increasing access to care"; "telemedicine provided an additional option for patients to access services, promoting sustained continuity and timeliness of care"; "participants did not identify any clear goals related to telemedicine use"; "demonstrated positive affective responses to telemedicine use"; "expressed high efficacy with telemedicine utilization"; and "strong leadership support."

CONCLUSIONS

These findings support the development of interstate compacts advancing licensure across state lines; payment parity across modalities of care to ensure the financial vitality of behavioral health services; improved dissemination of telehealth training and resources, and telehealth training in academic programs of the health professions; seamless, dynamic workflows to accommodate the changing needs of patient and care continuity; emergency response protocols; and community partnerships to provide private spaces needed for a therapeutic encounter. Future research exploring the patient's experience with telemedicine is needed for all stakeholders to be represented in developing a sustainable, integrated system.

Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review

BACKGROUND

Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing.

OBJECTIVE

The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic.

METHODS

This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology.

RESULTS

Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity).

CONCLUSIONS

The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services.

TRIAL REGISTRATION

PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5.

Effects of COVID-19 pandemic on depression in patients with schizophrenia: A mini-review of the current evidence

BACKGROUND

Since the emergence of COVID-19, there have been concerns about the psychological effects of the pandemic on people's mental health around the world. People with psychotic disorders like schizophrenia (SCZ) may be more prone to develop mood disorders during the lockdowns due to their limited access to healthcare, reduced social support, and probable cognitive impairment.

METHODS

We conducted a systematic search on PubMed and Scopus to explore the effects of the pandemic on depressive symptoms in individuals with SCZ. A total of 12 studies were included.

RESULTS

Overall, studies suggested higher depression rates in patients with SCZ compared to healthy controls. Isolation due to the COVID-19 infection emerged as a risk factor for the development of depressive symptoms. However, results regarding the longitudinal changes of depression in SCZ patients during the lockdowns were inconsistent.

LIMITATIONS

The small sample sizes of studies, different depression scales and stages of the lockdowns, as well as the different government policies and restriction levels across the countries limit the conclusions of the present review.

CONCLUSIONS

Our review suggests an increased probability of depression in patients with SCZ during the pandemic. Identifying the risk factors for developing depression in this population helps find new, suitable approaches to address patients' needs and lower the adverse psychological effects of the pandemic.

Patients with affective disorders profit most from telemedical treatment: Evidence from a naturalistic patient cohort during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic telemedicine became essential in maintaining diagnostic procedures and treatment in psychiatry. However, it is still an open question if telemedicine is a feasible treatment option for all groups of psychiatric patients alike. This prospective monocentric observational trial was conducted to assess the general applicability of telemedical treatment in a naturalistic psychiatric outpatient cohort and to identify groups of disorders and clusters of psychopathology that respond particularly well to telemedical treatment considering sociodemographic characteristics and patients' perspectives.

METHODS

Patients were recruited April 2020-April 2021 and asked to fill out the WHO-5 and the SCL-90R at baseline, after 4-6 and 8-12 weeks and a feedback-survey. Additionally, medical records, psychopathology, psychosocial functioning, and socio-demographic data were analyzed. Primary outcomes were well-being, psychopathology and functioning during treatment. Secondly, diagnostic groups and psychopathology linked to a superior treatment-response were determined with respect to patients' subjective experiences.

RESULTS

Out of 1.385 patients, 254-mostly with hyperkinetic (35.3%) and depressive disorders (24.6%)-took part. Well-being and SCL-90R total scores improved substantially (both p < 0.001). CGI and GAF scores were worse in depressed subjects (both p < 0.05). Improvement was mainly seen in depressed patients; chronic disorders experienced a decline in well-being. Sociodemographic characteristics could not explain this difference. Particularly female (r = 0.413) patients found telepsychiatry equivalent to conventional treatment. The more virtual sessions participants attended the more likely they were to find telepsychiatry equal to conventional treatment (r = 0.231).

CONCLUSION

Telemedicine is an effective treatment for patients with depression under naturalistic conditions. Telemedical consultations are a simple and reliable way of monitoring symptom severity and directing treatment choices during the treatment of depressive disorders. Patients with depression benefited more from telemedical treatment compared to participants with chronic non-episodic psychiatric disorders. Future research needs to concentrate on improving telemedical treatment options suited for the latter conditions. Psychiatric telemedicine yielded overall high degrees of satisfaction among users.