Association Between Therapeutic Alliance and Clinical Outcomes in Virtual Telepsychiatry: A Retrospective Analysis of Data from Talkiatry (Preprint)
Notice bibliographique
Résumé
BACKGROUND: Given the increasing demand for accessible mental health services, fully virtual telepsychiatry has become a vital component of modern health care delivery. Therapeutic alliance, the collaborative and affective bond between patients and therapists, is a well-established predictor of clinical outcomes in traditional face-to-face and teletherapy. However, the relationship between therapeutic alliance and clinical outcomes in an outpatient telepsychiatry setting remains less understood. OBJECTIVE: Our primary objective was to evaluate the relationship between therapeutic alliance and clinical outcomes for depression and anxiety in an outpatient telepsychiatry practice. METHODS: This retrospective study analyzed data from treatment-seeking adults receiving services from Talkiatry, a single commercial telepsychiatry practice. Treatments included a comprehensive psychiatric evaluation, supportive psychotherapy, and medication management conducted by a psychiatrist utilizing a fully virtual platform. Assessment of anxiety and depressive symptoms using the Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire scale (PHQ-8), respectively, allowed us to identify patients with at least moderate baseline symptoms (PHQ-8 and/or GAD-7≥10). Patients completed a baseline clinical assessment within 1 week of their first visit. Therapeutic alliance ratings from the patients' perspective were collected using the Working Alliance Inventory-Short Revised (WAI-SR). Follow-up clinical assessments were conducted between 8 and 16 weeks after their first visit. We used regression models to assess whether therapeutic alliance was associated with clinically significant improvement, which was defined as having ≥50% improvement in depression and/or anxiety symptoms at follow-up after adjusting for demographic (age, region, sex, insurance type, urban/rural), baseline clinical score (PHQ-8 or GAD-7), time from baseline to follow-up, and baseline prescription status covariates. RESULTS: After application of the inclusion criteria (PHQ-8 and/or GAD-7≥10), we identified 170 patients for depression analyses and 157 for anxiety analyses. Mean baseline symptom severity scores for PHQ-8 and GAD-7 were 14.90 (SD 3.81) and 14.64 (SD 3.39), respectively. In response to telepsychiatry treatment, patients showed a 41.1% reduction in anxiety symptoms from baseline (d=1.16, P<.001) and a 38.8% reduction in depressive symptoms (d = 1.07, P<.001). After controlling for other covariates, higher WAI-SR scores were significantly associated with greater likelihood of clinically significant improvement for both anxiety (OR=1.07, P<.001, 95% CI: [1.03, 1.11]) and depression (OR=1.04, P=.03, 95% CI: [1.01, 1.09]). In addition, receipt of prescription within the seven days of the first visit was significantly associated with a greater likelihood of clinical improvement for depression (OR=4.99, P<.001, 95% CI: [2.10, 13.10]), but not anxiety (OR=1.54, P=.33, 95% CI [.65, 3.69]). CONCLUSIONS: Therapeutic alliance scores were associated with significant clinical improvements in both depression and anxiety, whereas medication status was associated with significant improvements for depression but not anxiety. These findings speak to the importance of fostering strong therapeutic relationships between patients and psychiatrists, even when treatment is delivered virtually.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».