Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews

  1. Phoebe Barnett
  2. Lucy Goulding
  3. Cecilia Casetta
  4. Harriet Jordan
  5. Luke Sheridan-Rains
  6. Thomas Steare
  7. Julie Williams
  8. Lisa Wood
  9. Fiona Gaughran
  10. Sonia Johnson

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Abstract

Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic.

Objective

We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature.

Methods

Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings.

Results

In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people’s services and inpatient settings, was found to be lacking.

Conclusions

This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.

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  1. Version published to 10.2196/26492
  2. ScreenIT

    SciScore for 10.1101/2020.11.30.20240721: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy and selection criteria: The search strategy implemented a combination of keyword and subject heading searches across PsycINFO (01/01/2010-26/08/2020), PubMed (01/01/2010-26/08/2020) and the Cochrane Database of Systematic Reviews (01/01/2010-26/08/2020).
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Cochrane Database of Systematic Reviews
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: The findings of this umbrella review should be considered alongside a number of limitations. Firstly, umbrella reviews by their nature aim to present an overview of findings from systematic reviews (46), making conclusions reliant on the quality and reporting accuracy of included reviews and necessarily resulting in some loss of nuance when findings are pooled. Although we included only reviews considered to be systematic (defined here as searching at least three databases, and conducting a quality assessment when synthesising quantitative data), it was apparent from our quality assessment that the majority of reviews lacked several attributes characteristic of a high-quality review with robust conclusions, for example pre-specified protocols and duplicate study selection. However, our aim was to gain a rapid overview, relevant especially to current and future rapid implementation of tele-mental health, of the extent of supporting evidence to be drawn from previous literature regarding tele-mental health: the umbrella review provides a useful route to achieving this. Inclusion of systematic reviews focused on methods other than randomised controlled trials and on guidance further increases the methodological variability of included reviews and studies, but is a choice made to maximise retrieval of material from which real-world important lessons can be learnt regarding feasibility, acceptability and implementation barriers and facilitators (47). This review also ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.2196/preprints.26492
  4. Version published to 10.1101/2020.11.30.20240721v1 on medRxiv