Diagnosis and symptom assessment in telepsychiatry vs. face-to-face settings: A systematic review and meta-analysis.

Abstract

Aim: Telepsychiatry is increasingly integral to psychiatric practice. However, few reviews have examined the concordance between assessments conducted in telepsychiatric and face-to-face settings. This systematic review and meta-analysis evaluated the agreement between telepsychiatric and face-to-face settings in the diagnosis and symptom assessment of various psychiatric disorders.

Methods: A literature search was conducted using MEDLINE/PubMed, Cochrane Library, Scopus, EMBASE, CINAHL, and PsycINFO. Studies evaluating the concordance between telepsychiatric and face-to-face settings in the diagnosis and symptom assessment of various psychiatric disorders were included and analyzed.

Results: Of the 6875 studies in the initial search, 22 studies that met the inclusion criteria were included in the analyses. The diagnostic concordance for 16 psychiatric disorders was "almost perfect" between the two settings (N = 16, n = 848, Cohen's κ = 0.824, confidence interval [CI] = 0.466 to 0.950, P < 0.001). Additionally, the concordance for the symptom rating scales between the two settings ranged from "substantial" in the Brief Psychiatric Rating Scale (N = 1, n = 533, Cohen's κ = 0.789, CI = 0.699 to 0.855, P < 0.001) to "almost perfect" in the Autism Diagnostic Observation Schedule (N = 1, n = 92, intraclass correlation coefficients = 0.943, CI = 0.798 to 0.985, P < 0.001).

Conclusions: Telepsychiatry is highly concordant with face-to-face settings regarding psychiatric diagnoses and symptom assessment. In contrast, the present results also suggest that the suitability of telepsychiatry varies across disease types, specific symptoms, and assessment modalities. Although the present results must be interpreted with caution owing to the small number of studies for each assessment and disease, our findings suggest that telepsychiatry may have greater utility in psychiatric diagnostic assessment settings.