Abstract
BackgroundDue to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center.MethodsWe studied all 104 consecutive patients aged 18–65 years with elevated symptoms of depression, anxiety and/or burnout who registered at the center during the first six months after implementation. They were offered a five week guided online treatment. At baseline, five weeks and twelve weeks we measured depressive (BDI-II), anxiety (HADS-A) and burnout symptoms (MBI).ResultsA total of 55 patients (53%) agreed to start with the online treatment. Patients who accepted the online treatment were more often female, younger and lower educated than those who refused. There were no baseline differences in clinical symptoms between the groups. There were large between group effect sizes after five weeks for online treatment for depression (d = 0.94) and anxiety (d = 1.07), but not for burnout (d = −.07). At twelve weeks, when both groups had started regular face-to-face treatments, we no longer found significant differences between the groups, except for anxiety (d = 0.69).ConclusionThe results of this study show that the majority of patients prefer online guided online treatment instead of waiting for face-to-face treatment. Furthermore, online PST increases speed of recovery and can therefore be offered as a first step of treatment in mental healthcare.
Highlights
Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session
We report on (1) the uptake of the Internet treatment, which is defined as the percentage of patients who accept the offer of online treatment during waiting for face-toface treatment and the percentage of drop-out, (2) the demographic and clinical profile of patients who prefer online treatment, and (3) the symptom reduction due to the online treatment compared to the symptom reduction in the group of patients who declined the offer and decided to wait for regular face-to-face sessions
We examined the effects between the two groups on the three outcome measures separately
Summary
Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. Depression and anxiety disorders are common mental disorders with a lifetime prevalence of 20% for depression, and 16% for anxiety disorders [1] This results in loss of quality of life and substantial costs for the individual as well as for the society [2,3]. The most well-known example of integrating self-help in everyday mental health care is the Improving Access to Psychological Therapies (IAPT) initiative in the UK, which offers low to high-intensity treatments according to a stepped care model. First patients with mild to moderate anxiety and depression receive guided self-help, delivered by psychological wellbeing practitioners. The two year data show large uncontrolled effect sizes for depression (1.07, 95% CI: 0.88-1.29) and for anxiety (1.04, 95% CI: 0.88-1.23) with reliable and clinically significant change in 55% of cases [11]
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