P Ruskin, VA Maryland Health Care System

Objectives: The major goal of this study is to demonstrate that treatment of depressive disorders via telepsychiatry is as effective as live treatment. In addition, this study will show that depressed patients are as compliant and as satisfied with telepsychiatry as with live treatment. Another goal is to demonstrate that telepsychiatry is less expensive than and as cost-effective as live treatment.

Methods: In this randomized controlled trial, veterans who present with depression to any of three VA Maryland Health Care facilities are evaluated using the Structured Clinical Interview for DSM-IV (SCID-IV) and the 24-item Hamilton Depression Scale (Ham-D). Veterans with a SCID-IV depression diagnosis and a Ham-D score of 16 or above are eligible for participation. Eligible veterans are randomized to either "live" treatment or "remote" treatment. Psychiatrists from each of the three facilities conduct both "live" and "remote" treatment, which involves eight sessions over the six-month study period. Treatment consists of psychotropic medication and psycho-education concerning the disease, medications, and side effects. The major outcome variables include changes in HAM-D depression ratings and BDI depression ratings.

Results: Of the first 90 patients who entered the study, 60 (67 percent) successfully completed the study while 30 (33 percent) discontinued. Of the 30 dropouts, 16 were in the live group and 14 were in the remote group. There was no statistical difference in dropout rates between the live and remote groups, chi square =.88. As predicted, depressive symptoms on the HAM-D were shown to significantly improve over the treatment period, (F=44.6, p<.001) and this effect did not differ by treatment group (F=.89, ns). The average HAM-D score at the first visit was 24.6 (SD=6.8) and by the final visit it had decreased to 14.6 (SD=10.3). Additionally, there was no significant difference in the levels of depression for the two treatment groups (F=.20, ns), even when the initial level of depression was held constant statistically (F=.00,ns). Similar results were found when using a self-report measure of depression, the BDI. As expected, the depression scores on the BDI significantly improved for the 90 patients altogether (F=23.2.6, p<.001) and this effect did not differ for the two treatment groups (F=.44, ns). The average score on the BDI at the first visit was 23.2 (SD=9.8) and by the final visit it had dropped to 13.4 (SD=10.5). There were no significant differences in the levels of depression of the two treatment groups (F=.14,ns). This was the case even when the initial level of depression was held constant statistically (F=.88,ns).

Conclusions: The results indicate that depressed patients who see their psychiatrist via telepsychiatry show similar improvement to depressed patients who see their psychiatrist in person. Over the six month period of treatment, their depression decreased and they were no more likely to drop out of treatment than patients seen in person.

Impact: The preliminary data indicates that treatment efficacy is similar for patients treated live and remotely. VA healthcare can be widely expanded, at great convenience to veterans and without incurring high costs, with the use of telepsychiatry.