Advancing mental health and well-being of Nigerian children through public health screening for Fragile X disorders (CHAMP-FX): protocol of a prospective multicentre screening study with longitudinal

The demand for psychotherapeutic treatment remains globally high, and care is still insufficient regarding treatment access, particularly in pandemic situations and emergencies []. The likelihood of receiving psychotherapy for patients experiencing severe mental disorders ranged from 49.7% to 64.5% in highly developed countries. During the COVID-19 pandemic, access to psychotherapeutic treatments was further restricted [], while the need for psychotherapy was growing [,]. Access to psychological treatment is especially limited for vulnerable populations, such as residents of rural areas [-] and ethnic minorities []. In rural areas, the number of professionals offering mental health support is low, despite evidence of an increased need for mental health services []. In this review, we refer to synchronous video-based psychotherapy (VBT) as remote psychotherapy where patients and psychotherapists interact in real time using video conferencing technology similar to face-to-face (F2F) counseling and psychotherapy []. VBT overcomes geographic barriers and provides flexible service delivery []. The pandemic acted as a major catalyst for its widespread implementation [], and VBT continues to be provided at levels above those observed prior to the pandemic [], with high acceptance among digital mental health interventions []. Guidelines for VBT were established in 2013 by experts of the American Psychological Association [] and the American Telemedicine Association []. Previous reviews suggest that VBT achieves outcomes comparable to F2F psychotherapy across several mental health conditions, with similar dropout rates and patient satisfaction [-]. Despite evidence of efficacy, substantial heterogeneity across study samples and critical methodological limitations restrict the strength of the evidence. In the field, it is debated that the wide variation in digital tools and methodologies used in video-based psychotherapy studies makes it difficult to generalize the findings []. Our study aims to contribute scientific evidence to this debate. Prior reviews have often addressed broader or different questions, for example, by synthesizing live psychotherapy by video across diverse clinical populations and treatment contexts [], combining telephone- and video-based telehealth psychotherapy [], focusing on specific disorders such as depression, anxiety-related conditions, or other selected clinical populations [-], examining therapeutic alliance rather than symptom outcomes [], or mapping the broader field of synchronous web-based psychotherapy from a health quality perspective []. Prior evidence has not consistently differentiated between technical modalities (eg, telephone vs VBT) [,,], and therapy duration is rarely controlled for, despite considerable variation across countries and health care systems (eg, up to 12 sessions in the United States vs 41 in Germany). As a result of these broader conceptualizations of VBT, it remains unclear to what extent observed effects reflect the specific impact of the video-based setting itself or other effects of digital psychotherapy. A more specific focus is needed to isolate the effect of the delivery format. In addition, therapy duration is rarely controlled for explicitly, which may further reduce comparability between delivery formats.