Abstract
BACKGROUND: Telehealth services can increase access to care by reducing barriers. Telephone-administered care, in particular, requires few resources and may be preferred by communities in areas that are systemically underserved. Understanding the effectiveness of audio-based care is important to combat the current mental health crisis and inform discussions related to reimbursement privileges. OBJECTIVES: We compared the effectiveness of audio-based care to usual care for managing mental health and substance use disorders (MHSUD). DESIGN: We used systematic review methods to synthesize available evidence. STUDIES: We searched for English-language articles reporting randomized controlled trials (RCTs) of adults diagnosed with MHSUD published since 2012. OUTCOMES: We abstracted data on clinical outcomes, patient-reported health and quality of life, health care access and utilization, care quality and experience, and patient safety. RESULTS: We included 31 RCTs of participants diagnosed with depression, post-traumatic stress disorder (PTSD), other serious mental illness (SMI), anxiety, insomnia, or substance use disorder (SUD). Most of the evidence was for interventions targeting depression, PTSD, and SUD. The evidence demonstrates promise for: (1) replacing in-person care with audio care for depression, other SMI, and SUD (very low to moderate certainty of comparable effectiveness); and (2) adding audio care to monitor or treat depression, PTSD, anxiety, insomnia, and SUD (low to moderate certainty of evidence favoring audio care for clinical outcomes). CONCLUSIONS: MHSUD can be managed with audio care in certain situations. However, more evidence is needed across conditions, and specifically for anxiety and other conditions for which no research was identified.