Telehealth Likely as Effective as In-Person Care for MDD

A switch from in-person to virtual care did not appear to have a negative impact on the health of patients with major depressive disorder (MDD) being treated in a partial-hospital setting, according to a new report.

This study, published in Journal of Affective Disorders, could offer important insights for providers as they navigate an era where many of the most restrictive pandemic-era precautions are being lifted, the study investigators noted.

The COVID-19 pandemic led directly and indirectly to medical crises for millions of people, with the public health emergency leading to social isolation, financial strain, and losses of loved ones, which in turn may also have contributed to an increase in depression, noted the authors. And yet, although the pandemic may have increased the risk of depression, it also upended the way treatment for depression is delivered.

“As one of the core elements of psychotherapeutic approaches toward treating depression is behavioral activation and increased social contact, the psychosocial limitations imposed by COVID-19 might make it more difficult to treat depression during the pandemic,” the investigators said.

The new study comes from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, an ongoing clinical research study designed to integrate research methodology into clinical practice. Patients with MDD who were treated through a partial-hospital program (PHP) before the pandemic, when care was delivered in-person, and after the start of the pandemic, when care transitioned to a virtual telehealth model. The PHP is an intensive outpatient program, in which patients receive care 5 days per week, and each daily session lasts 6 hours.

The investigators asked patients to complete self-administered assessments of several parameters that included patient satisfaction, symptoms, coping ability, functioning, and general well-being.

In total, 294 people who were treated virtually between May 2020 and December 2021 completed a survey. Their results were compared with those of 542 people who were treated in person in the 2 years prior to the start of the pandemic.

The results were encouraging to the study authors.

“In both the in-person and telehealth groups, patients with MDD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge,” they found. “Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning.”

In fact, insofar as there were differences between the 2 groups—including the likelihood of staying in treatment and length of stay—the authors said the telehealth cohort reported more favorable outcomes. They added that the patients in the telehealth group may have stayed in treatment longer because of the social isolation associated with the pandemic; for some patients, the virtual visits amounted to their primary opportunity for social engagement.

The authors said the findings are important data points, as they and other clinicians consider the future of MDD treatment. They noted that some patients preferred the virtual format, not just due to concerns about COVID-19, but because they had limited transportation or health issues that made it difficult to travel.

“Thus, we hope that telehealth partial hospital treatment is here to stay,” they wrote.

However, they said insurance coverage could be the determining factor in whether telehealth care continues. In the absence of a regulatory prohibition, they said they fear insurers might eliminate coverage for virtual visits.

“If this occurs, it will be done despite considerable evidence that telehealth behavioral treatment is as effective as in-person care,” they concluded.

Reference

Zimmerman M, D'Avanzato C, King BT. Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment. J Affect Disord. 2023;323:624-630. doi:10.1016/j.jad.2022.12.015