e-Mental Health Use Expanding Globally

Deborah Brauser

January 09, 2014

The use of e–mental health interventions, which involve providing care via computer to patients in a geographic location different from that of the health care provider, is expanding globally and may eventually lead to improved access and reduced mental health care costs, 2 new studies show.

One literature review showed that populations most frequently targeted for e–mental health applications were adults with depression or an anxiety disorder, and that "an encouraging amount of rigorous research" supports the effectiveness of e–mental health applications, including therapist-assisted cognitive-behavioral therapy.

Top benefits identified were lower cost, greater accessibility and interactivity, the flexibility to provide greater standardization and personalization, and increased patient engagement.

"E-mental health applications are proliferating and hold promise to expand access to care," write investigators led by Shalini Lal, PhD, from the Department of Psychiatry at McGill University Institute and the Douglas Mental Health University Institute, both in Montreal, Canada.

The second, smaller review showed that individuals with mental illness were able and willing to use these services and that interventions delivered in this manner "are at least as effective" as usual care or nontechnologic approaches.

"This review shows that research into the usability and effectiveness of information and communication technology in self-management interventions for people with psychotic disorders has rapidly increased in the past 5 years," lead author Lian van der Krieke, from the University Center for Psychiatry at University Medical Center Groningen in the Netherlands, and colleagues write.

However, both reviews call for more studies, including ones with detailed economic analyses.

The articles were published in the January issue of Psychiatric Services.

Breaking Down Barriers to Care

In the first study, investigators examined 115 e–mental health articles published between 2000 and 2010, including 108 that were peer-reviewed. Of these, 91 were published in the last 3 years of the review period, and 76% originated in the United States, the Netherlands, or Australia.

Although computerized screening and assessment tools have been around for many years, the development of Internet-based versions have allowed more individuals to self-assess and more providers to provide care, note the researchers.

"Many believe that e-mental health has enormous potential to address the gap between the identified need for services and the limited capacity and resources to provide conventional treatment," they write.

The review identified Web-based discussion groups, chat rooms, blogs, social media, and bulletin boards as ways e–mental health can provide social support.

Interventions identified included those that were self-led or led by a therapist, were provided as primary therapy or as an adjunct to in-person therapy, or were delivered to individuals or to groups.

"Typically, e-mental health interventions mimicked traditional treatment approaches in that they often addressed single disorders; none were designed for individuals with comorbid mental and substance use disorders," write the researchers.

There were several significant benefits, including increased engagement and reduced costs, although the researchers note that the latter refers to long-term costs, inasmuch as start-up and development expenses will be needed at first.

Still, the technology is considered especially promising for rural populations, individuals with barriers to access, those who are afraid of stigma, and youth ― especially because 90% are current Internet users.

Concerns identified include a potential lack of quality control and standards, ethical and liability issues, a reluctance among some healthcare professionals that may be due in part to "technological phobia," and worries that conventional services could be completely replaced.

In addition, "some question the ability of professionals to establish therapeutic relationships online and the feasibility of online treatment for certain population groups (for example, patients with severe depression)," write the study authors.

"The apparent promise and pitfalls of e-mental health and the increasing interest of policy makers in its potential…indicate that careful monitoring of the evidence base is warranted," they add.

Lower Costs

In the second review, investigators from the Netherlands examined 28 studies that assessed several e–mental health interventions, including medication management, peer support, psychoeducation, real-time self-monitoring, shared decision making, and daily functioning and lifestyle management.

The largest summary effect size was found for medication management (0.92 compared with care as usual). The effect sizes for communication/shared decision making and psychoeducation were 0.21 and 0.37, respectively.

None of the studies that were included in the review reported any negative effects.

The researchers report that reduced costs for service providers and service users were the greatest potential benefit cited. They also agree that more research into this field is needed.

"Results must be interpreted cautiously, because they are based on a small number of studies," they write.

None of the authors have disclosed any relevant financial relationships.

Psychiatr Serv. 2014;65:24-32, 33-49. Abstract, Abstract

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