Building a Connection: Telehealth for PTSD and Bipolar Disorder Treatment

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According to a study conducted before the COVID-19 pandemic, a virtual connection to a psychiatrist office may be enough to help individuals with posttraumatic stress disorder (PTSD) and bipolar disorder who live in more rural communities get effective care.^1,2

The randomized study examined approximately 1000 participants with PTSD, bipolar disorder, or both conditions. Results showed that most participants engaged well with 2 types of telehealth: (1) telepsychiatry collaborative care, in which a psychiatrist makes the initial diagnosis via video and the local clinic team provides psychotherapy while the local primary care physician handles prescriptions with consultation from the telepsychiatrist, and (2) telepsychiatry/telepsychology enhanced referral, in which a psychiatrist makes the initial diagnosis and handles medication prescriptions, and a psychologist provides psychotherapy by telehealth. The data came from the Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) trial, which involved participants from 24 clinics in Michigan, Washington, and Arkansas.

Leading this secondary analysis of the SPIRIT data was Jennifer Severe, MD, of the Department of Psychiatry at Michigan Medicine, along with Paul Pfeiffer, MD, MS, codirector of the Mental Health Innovation, Services and Outcomes Program within the U-M Department of Psychiatry, and John Fortney, PhD, from the Department of Psychiatry and Behavioral Sciences at the University of Washington.

“The study started at a time where clinicians had reservations about treating psychiatrically complex patients with telehealth or integrated care models. Understandably, engagement in care was one of the many concerns,” said Severe. “This study showed that patients with multiple psychiatric conditions and who also struggle with several chronic physical health problems can engage well in mental health treatment with their primary care doctors or remote mental health specialists.”²

While participants responded well to both types of therapy, participants who were assigned to get a form of psychotherapy from a specially trained nurse or social worker on staff at their local clinic ended up completing 60% more such sessions than those who were assigned to connect with a clinician via videocall. The ongoing in-person contact with their nurses or social workers checking on their other health needs may have been a contributing factor.

Another such study using data from the SPIRIT trial demonstrated patients in both groups reported statistically significant improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life.

This current study took more of a look at how patients’ own clinical characteristics affected their experience with telehealth, and how well they stuck with the treatment course. For example, results showed that participants who have issues with drugs, and those experiencing manic symptoms from their bipolar disorder, may need additional support to get started on psychotherapy or to stay with it. Additionally, those who have multiple physical health conditions may be most likely to maintain their mental health medications and talk therapy programs.

The findings were published in the Journal of General Internal Medicine.

References

1. Severe J, Pfeiffer PN, Palm-Cruz K, et al. Clinical predictors of engagement in teleintegrated care and telereferral care for complex psychiatric disorders in primary care: a randomized trial. J Gen Intern Med. 2022 Feb 2. Online ahead of print.

2. Where mental health help is scarce, telehealth makes a big difference. News release. February 7, 2022. Accessed March 22, 2022. https://www.newswise.com/articles/where-mental-health-help-is-scarce-telehealth-makes-a-big-difference