Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review

  1. Rebecca Appleton
  2. Julie Williams
  3. Norha Vera San Juan
  4. Justin J Needle
  5. Merle Schlief
  6. Harriet Jordan
  7. Luke Sheridan Rains
  8. Lucy Goulding
  9. Monika Badhan
  10. Emily Roxburgh
  11. Phoebe Barnett
  12. Spyros Spyridonidis
  13. Magdalena Tomaskova
  14. Jiping Mo
  15. Jasmine Harju-Seppänen
  16. Zoë Haime
  17. Cecilia Casetta
  18. Alexandra Papamichail
  19. Brynmor Lloyd-Evans
  20. Alan Simpson
  21. Nick Sevdalis
  22. Fiona Gaughran
  23. Sonia Johnson

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Abstract

Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care.

Objective

To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation.

Methods

Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis.

Results

A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified.

Conclusions

Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these.

Trial Registration

PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025

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  1. Version published to 10.2196/31746
  2. ScreenIT

    SciScore for 10.1101/2021.07.05.21260018: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy: Four electronic databases (PubMed, PsycINFO, CINAHL and Web of Science), preprint servers medRxiv, PsyArXiv, Wellcome Open Research, and JMIR were searched for research relating to COVID-19, mental illness, and remote working from 1st January – 9th December 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)

    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:
    Strengths and limitations: The studies included in this review identified outcomes across different settings and healthcare systems, which may help findings generalise to different settings. This review also captured recent findings on the use of telemental health during the COVID-19 pandemic, allowing findings to be used to improve both existing and future models of remote mental health care. However, it is also important to take some limitations into account when interpreting the findings from this review. Firstly, the results from quality assessment indicated that whilst around half of primary research studies and the majority of the service evaluations were high quality, around half of primary research studies were scored as moderate to low. This reflects the short nature of studies and often quick turnaround from data collection to publication. Some studies were also published in preprint form and therefore had not undergone peer review. The majority of studies used cross-sectional data, rather than more rigorous methods. Secondly, there was a lack of high quality quantitative evidence for the clinical effectiveness of telemental health care. Clinical effectiveness outcomes were only reported in 9/77 included studies, with some of these findings only based on qualitative evidence or a small number of service users. It is also important to note that the voices of those who dropped out of care may not be included. The short time scale for data collection and assessment of ...

    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.

    Results from scite Reference Check: We found no unreliable references.

    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 10.1101/2021.07.05.21260018v1 on medRxiv
  4. Version published to 10.2196/preprints.31746