Therapy Without Borders: A Systematic Review on Telehealth's Role in Expanding Mental Health Access

Abstract

Background: The COVID-19 pandemic has accelerated the adoption of telehealth services in mental healthcare. This systematic review aims to evaluate the effectiveness of telehealth interventions for mental health conditions compared to traditional face-to-face treatment. Methods: We searched major electronic databases (PubMed, PsycINFO, CINAHL, and Cochrane Library) for randomized controlled trials published between 2010 and 2023. Studies comparing telehealth interventions to face-to-face treatment for adults with mental health disorders were included. Two independent reviewers assessed study quality and extracted data. Meta-analyses were conducted where appropriate. Results: Thirty-five studies met the inclusion criteria, encompassing 4,827 participants across various mental health conditions. Telehealth interventions demonstrated non-inferiority to face-to-face treatment for depression (standardized mean difference [SMD] = -0.03, 95% CI [-0.15, 0.09]) and anxiety disorders (SMD = -0.06, 95% CI [-0.19, 0.07]). For post-traumatic stress disorder, telehealth showed a small but significant advantage (SMD = -0.21, 95% CI [-0.37, -0.05]). Patient satisfaction and therapeutic alliance were comparable between telehealth and face-to-face interventions. However, dropout rates were slightly higher in telehealth conditions (risk ratio = 1.27, 95% CI [1.11, 1.46]). Conclusion: This review suggests that telehealth interventions are generally as effective as face-to-face treatment for common mental health disorders. While promising, these findings should be interpreted cautiously due to heterogeneity in study designs and interventions. Future research should focus on long-term outcomes, cost-effectiveness, and strategies to improve engagement in telehealth settings.