The COVID-19 pandemic has transformed healthcare significantly and telepsychiatry is now the primary means of treatment in some countries.

To compare the efficacy of telepsychiatry and face-to-face treatment.

A comprehensive meta-analysis comparing telepsychiatry with face-to-face treatment for psychiatric disorders. The primary outcome was the mean change in the standard symptom scale scores used for each psychiatric disorder. Secondary outcomes included all meta-analysable outcomes, such as all-cause discontinuation and safety/tolerability.

We identified 32 studies (n = 3592 participants) across 11 mental illnesses. Disease-specific analyses showed that telepsychiatry was superior to face-to-face treatment regarding symptom improvement for depressive disorders (k = 6 studies, n = 561; standardised mean difference s.m.d. = −0.325, 95% CI −0.640 to −0.011, P = 0.043), whereas face-to-face treatment was superior to telepsychiatry for eating disorder (k = 1, n = 128; s.m.d. = 0.368, 95% CI 0.018–0.717, P = 0.039). No significant difference was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (k = 26, n = 2290; P = 0.248). Telepsychiatry had significantly fewer all-cause discontinuations than face-to-face treatment for mild cognitive impairment (k = 1, n = 61; risk ratio RR = 0.552, 95% CI 0.312–0.975, P = 0.040), whereas the opposite was seen for substance misuse (k = 1, n = 85; RR = 37.41, 95% CI 2.356–594.1, P = 0.010). No significant difference regarding all-cause discontinuation was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (k = 27, n = 3341; P = 0.564).

Telepsychiatry achieved a symptom improvement effect for various psychiatric disorders similar to that of face-to-face treatment. However, some superiorities/inferiorities were seen across a few specific psychiatric disorders, suggesting that its efficacy may vary according to disease type.

Videoconferencing in psychiatry allows psychiatric counseling to be dealt remotely. A number of human randomised clinical trials (RCTs) on this topic were conducted but not systematically analysed since 2005.

A meta-analysis was undertaken to test the hypothesis of non-inferiority of remote psychiatric counseling, including both assessment and treatment, compared to face-to-face setting. Focus of research was the general psychiatric approach, which includes pharmacotherapy, counseling and some not specific psychotherapeutic techniques such as listening, reformulation and clarification among others. Specific forms of psychotherapies were not included in this analysis.

RCTs including ≥ 10 subjects per arm were identified in Medline, the Cochrane Library, Embase and the reference list of single papers. A random-effect and a mixed-effect model served for test the hypothesis under analysis.

Twenty-six RCTs were included in the analysis, involving 765 (assessment) and 1585 patients (efficacy). The non-inferiority of remote psychiatric counseling was reported both for assessment and treatment. Heterogeneity could not be excluded for assessment, but was excluded for treatment while taking into account clinical and study related variables (P-values = 0.003 and 0.06, respectively).

High levels of consistency between remote and in vivo psychiatric assessment is reported. Efficacy of remote psychiatric counseling was shown to be not inferior compared to in vivo settings. Heterogeneity could not be excluded for assessment, and further analyses are mandatory. The presence of multiple diagnoses included in the analysis was a limit of the present investigation.