The effects of treatment via telemedicine interventions for patients with depression on depressive symptoms and quality of life: a systematic review and meta-analysis

Figures & data

Figure 1. PRISMA flow diagram of study selection process.

Table 1. Participants and intervention programs in reviewed randomized controlled trials.

Author and year	Country	Study subject	Sample size	Comparison: Intervention group	Comparison: Control group	Intervention period/time/type	Outcome measures
Rickhi, 2015 [21]	Canada	Major depressive disorder (DSM IV-TR)	Intervention  = Younger13–18yr (n  = 18) Older 19–24yr(n = 16) Control = Younger(n = 13) Older(n = 16)	Online spirituality informed e-mental health intervention	Waitlist group	8 week	CDRS, HAM-D, SWBS, SIBS, Piers Harris 2, SFSCS
Hunkeler, 2000 [22]	USA	Major depressive disorder (DSM IV-TR)	Intervention= 179 Control = 123 Baseline participants are different from outcome’s (n)	Nurse Telehealth Care	Usual Physician Care	1 to 2 telephone calls per week during 16 weeks Calls were limited to 10 min	HDRS, BDI, SF-12 MCS, SF-12 PCS
Meyer, 2019 [13]	Germany	Diagnosis of active epilepsy with a current depressive disorder (MINI)	Intervention= 100 Control = 100	Internet Cognitive Behavioral Therapy + Care as usual	Care as usual	3‐month, 6‐month, and 9‐month	PHQ‐9, NDDIE, GAD-7, DASS-21, WSAS, QOLIE‐10
Kim, 2018 [23]	Korea	Breast cancer patients with mild to moderate depression (SCID-5-CV)	Intervention = 17 Control = 18	Game group were asked to play the serious game ‘‘Hit the Cancer’’ for at least 30 + typical care	Nongame group received typical care for 3 weeks.	Hit the Cancer’’ game for at least 30 min/day, 5 days/week, for 3 weeks.	BDI, BAI, SRI
Yeung, 2016 [11]	USA	Chinese American Immigrants with MDD (MINI)	Intervention= 97 Control = 93	Telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT)	Treatment as usual (TAU)	6 months	HDRS-17, CGI-S, CGI-I, Q-LES-Q
Beiwinkel, 2017 [24]	Germany	Mild to moderate depression (ICD)	Intervention= 100 Control = 80	Web-based program based on cognitive-behavioral therapy, awareness training, and systemic counseling and therapist support upon request.	Waitlist control	12 week Web-based program	PHQ-9, BDI-II
Place, 2020 [25]	USA	Varying mental health and physical diagnoses	Intervention= 33 Control= 35	Usual care plus the mobile monitoring system	Usual care	6-month	PHQ-9, Schwartz Outcome Scale
Gili, 2020 [26]	Spain	Major depression or dysthymia, older than 18 years, able to understand and read Spanish, with mild or moderate depression (MINI) according to the PHQ-9	Intervention: 1.54 2.54 3.56 control: 57	Healthy lifestyle program + iTAU Mindfulness program + iTAU positive affect promotion program + iTAU	Improved Treatment as Usual (iTAU)	Pretreatment, posttreatment, 6-month, 12- month posttreatment assessments; 4 web-based, individual, and interactive therapeutic modules.	PHQ-9, EQ-VAS, SF-12 MCS, SF-12 PCS, PHI
Newby, 2017 [27]	Australia	Comorbid MDD and DM	Intervention = 42 Control = 49	Internet Cognitive Behavioral Therapy + TAU	TAU	3 months; 6 lessons	PHQ-9, SF-12 MCS, SF-12 PCS
Moreno, 2012 [10]	USA	Self-identified Hispanic patients with a major depressive episode	Intervention = 80 Control = 87	Webcam intervention + TAU	TAU	6 months; 6sessions (20–30 min)	MADRS, PHQ-9, Q-LES-Q, SDS
Dobkin, 2020 [28]	USA	Parkinson disease + depressive disorder diagnosis (DSM-5)	Intervention = 37 Control = 35	Telephone-based cognitive-behavioral treatment (T-CBT) + Enhanced TAU	Enhanced TAU	10 one-hour sessions, weekly for 3 months	HAM-D, BDI, SF-36 MCS
Martinez, 2018 [29]	Chile	Adolescents with MDD	Intervention = 65 Control = 78	Remote collaborative depression care (RCDC) +usual care	Enhanced TAU	3 months	BDI, KIDSCREEN-27
Erikksson, 2017 [30]	Sweden	Diagnosed with depression according to DSM-IV (assessed via MINI); aged 18 years and older	Intervention = 52 Control = 38	Internet-delivered cognitive behavioral therapy (ICBT) +TAU	TAU	3 months-12 months	BDI-II, EQ-5D
Anguera, 2016 [31]	USA	Major depressive disorder (SCID; DSM-IV)	Intervention = 12 Control = 10	Enhance cognitive control faculties (EVO) [video game]	Problem solving therapy	4 weeks intervention + 4 weeks clinical management	HAM-D, PHQ-9
Kühn, 2018 [12]	Germany	18–65 years old; major depression or dysthymia according to MINI	Intervention = 34 Control = 34	Video game	Waitlist control group	6 weeks	PHQ-9, BDI
Egedes, 2015, 2016^a [32,33]	USA	Veterans aged 60 years or older meeting DSM-IV criteria for major depressive disorder	Intervention = 120 Control = 121	In-home videoconferencing technology	Face-to-face therapy	12 months	GDS, BDI, SF-36

DSM IV-TR: Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision; MINI: Mini-International Neuropsychiatric Interview; SCID-5-CV: Structured Clinical Interview for DSM-5 Disorders—Clinician Version; ICD: International Classification of Diseases; MDD: Major Depressive Disorder; DM: Diabetes Mellitus; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders: fourth edition; SCID: Structured Clinical Interview for DSM Disorders; DSM-5: Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition; TAU: Treatment As Usual; iTAU: Improved Treatment as Usual; CDRS-R: Children’s Depression Rating Scale Revised; HAM-D: Hamilton Rating Scale for Depression; SWBS: Spiritual Well-Being Scale; SIBS: Spiritual Involvement and Belief Scale; SFSCS: Six-Factor Self-Concept Scale; HDRS: Hamilton Depression Rating Scale; BDI: Beck Depression Inventory; BDI-II: Beck Depression Inventory-II; SF-12 MCS: Short Form-12 Items Health Survey (Mental Component Summary); SF-12 PCS: Short Form-12 Items Health Survey (Physical Component Summary); PHQ‐9: Patient Health Questionnaire–9; NDDIE: Neurological Disorders Depression Inventory for Epilepsy; DASS‐21: Depression Anxiety Stress Scales–21; GAD-7: General Anxiety Disorder-7; MADRS: Montgomery-Asberg Depression Rating Scale; QOLIE‐10: Quality of Life in Epilepsy–10; Q-LES-Q: Quality of Life Enjoyment and Satisfaction Questionnaire; SF-36 MCS: Short Form-36 Items Health Survey (Mental Component Summary); EQ-5D: EuroQol-5 Dimension; EQ-VAS: EuroQol-Visual Analogue Scale; WSAS: Work and Social Adjustment Scale; BAI: Beck Anxiety Inventory; SRI: Stress Response Inventory; CGI-S: Clinical Global Impressions Scale-Severity of illness; CGI-I: Clinical Global Impressions Scale- Global Improvement; PHI: Pemberton Happiness Index; SDS: Sheehan Disability Scale; GDS: Geriatric Depression Scale.

^a Trial on the same patient cohort with different outcome measures reported across distinct peer-reviewed journal articles.

Figure 2. Forest plots of comparison: intervention and control, outcomes: depressive symptoms.

Table 2. Summary of results on outcome measures in reviewed studies.

Author and year	Measure	N	Intervention Group		N	Control group
			Baseline Mean (SD)	Follow-up Mean (SD)		Baseline Mean (SD)	Follow-up Mean (SD)
Depression score
Rickhi, 2015[21]	CDRS-R Young	18	57.18 (7.93)	44.94 (12.13)	13	61.67 (7.97)	58.93 (12.15)
Rickhi, 2015 [21]	HAM-D Old	15	22.14 (2.52)	14.07 (4.38)	16	20.9 (2.60)	17.79 (4.48)
Meyer, 2019 [13]	PHQ-9	82	14.51 (2.89)	10.04 (4.13)	100	15.27 (3.35)	12.73 (4.19)
Meyer, 2019 [13]	NDDIE	82	16.90 (2.91)	14.13 (3.21)	100	17.30 (2.84)	16.02 (3.15)
Meyer, 2019 [13]	DASS-21	82	28.20 (11.06)	18.08 (9.40)	100	28.84 (9.32)	23.90 (8.52)
Kim, 2018 [23]	BDI	17	25.1 (9.10)	18.9 (10.20)	18	23.00 (8.40)	21.60 (6.00)
Beiwinkel, 2017 [24]	PHQ-9	44	11.53 (4.35)	6.50 (3.85)	44	10.56 (4.53)	7.95 (4.62)
Beiwinkel, 2017 [24]	BDI-II	44	20.07 (7.99)	14.86 (8.05)	44	18.78 (9.84)	15.32 (10.34)
Newby, 2017 [27]	PHQ-9	31	15.95 (5.25)	7.72 (4.96)	46	14.29 (5.25)	11.70 (5.15)
Moreno, 2012 [10]	MADRS	64	29.95 (7.59)	9.52 (10.73)	68	26.86 (8.81)	13.46 (12.57)
Moreno, 2012 [10]	PHQ-9	69	18.41 (4.50)	4.94 (5.30)	75	17.58 (5.12)	7.59 (6.82)
Dobkin, 2020 [28]	HAM-D	37	20.97 (4.40)	14.44 (4.55)	35	21.06 (4.40)	21.33 (4.66)
Dobkin, 2020 [28]	BDI	37	21.00 (7.82)	13.09 (8.14)	35	20.89 (7.81)	19.03 (8.37)
Martinez, 2018 [29]	BDI	73	27.80 (10.20)	18.80 (13.70)	65	27.10 (9.30)	16.90 (11.5)
Erikksson, 2017 [30]	BDI-II	36	25.80 (8.60)	13.39 (10.71)	28	26.50 (9.90)	12.46 (10.88)
Anguera, 2016 [31]	HAM-D,	12	21.50 (3.31)	12.54 (6.28)	10	25.13 (2.62)	15.00 (2.87)
Anguera, 2016 [31]	PHQ-9	12	12.75 (3.52)	8.55 (2.83)	10	15.33 (3.94)	9.14 (3.63)
Kühn, 2018 [12]	PHQ-9	21	8.33 (3.40)	7.81 (3.50)	29	11.45 (5.2)	10.45 (5.2)
Kühn, 2018 [12]	BDI	21	14.76 (7.10)	11.76 (7.40)	29	19.86 (9.9)	17.72 (9.5)
Quality of life
Meyer, 2019 [13]	QOLIE‐10	98	31.11 (5.68)	33.28 (4.75)	100	30.11 (5.24)	30.91 (5.05)
Newby, 2017 [27]	SF-12 MCS	31	30.22 (10.22)	39.26 (9.80)	46	29.79 (10.01)	32.70 (9.97)
Newby, 2017 [27]	SF-12 PCS	31	40.15 (12.49)	41.10 (11.46)	46	42.94 (11.27)	42.80 (11.12)
Moreno, 2012 [10]	Q-LES-Q	70	0.43 (0.11)	0.72 (0.20)	74	0.44 (0.12)	0.64 (0.19)
Dobkin, 2020 [28]	SF-36 MCS	37	34.06 (11.27)	42.54 (11.38)	35	36.36 (10.99)	38.06 (11.61)
Martinez, 2018 [29]	KIDSCREEN-27	69	3.60 (0.70)	3.50 (0.60)	65	3.60 (0.70)	3.60 (0.8)
Erikksson, 2017 [30]	EQ-5D	36	0.73 (0.14)	0.81 (0.18)	28	0.70 (0.16)	0.81 (0.14)
Work and social function
Meyer, 2019 [13]	WSAS	82	19.54 (7.33)	14.22 (7.75)	100	20.14 (6.58)	18.70 (6.83)

CDRS-R: Children’s Depression Rating Scale Revised; HAMD: Hamilton Rating Scale for Depression; PHQ‐9: Patient Health Questionnaire–9; NDDIE: Neurological Disorders Depression Inventory for Epilepsy; DASS‐21: Depression Anxiety Stress Scales–21; BDI: Beck Depression Inventory; MADRS: Montgomery-Asberg Depression Rating Scale; QOLIE‐10: Quality of Life in Epilepsy–10; SF-12 MCS: Short Form-12 Items Health Survey (Mental Component Summary); SF-12 PCS: Short Form-12 Items Health Survey (Physical Component Summary); SF-36 MCS: Short Form-36 Items Health Survey (Mental Component Summary); Q-LES-Q: Quality of Life Enjoyment and Satisfaction Questionnaire; SF-36 MCS: Short Form-36 Items Health Survey (Mental Component Summary); EQ-5D: EuroQol-5 Dimension; WSAS: Work and Social Adjustment Scale

Figure 3. Forest plots of comparison: intervention and control, outcomes: quality of life.

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Data availability statement

Data are available to investigators after request.