Mental Health Care Websites Used More by Patients with Severe Depression

The rise in the use of e-mental health websites (MHW) worldwide for treatment of mental illnesses led Australian researchers to conduct a longitudinal cohort study on the characteristics of primary care patients with depressive systems who use MHW.

Jane Gunn, MD, PhD, MBBS, Head of the Department of General Practice and Chair of Primary Care Research at the University of Melbourne's Medical School, led the study which recruited 789 individuals with depressive symptoms from primary care for a baseline study with 9-year follow-up period.

Study data on participants showed that although the use of MHW is seen by 36% of participants "across the spectrum of depressive systems," uptake of MHW is "higher amongst those with more severe depressive symptoms" particularly "younger, female, highly educated and employed" primary care patients with severe depressive symptoms.

Gunn and colleagues reported that they are particularly interested in the fact that usage of MHW by those with severe depression counters current guidelines in countries (such as Australia and the UK) recommending MWH for patients with "mild disorders, as the first level of treatment in stepped care models."

They wrote that "since 2001, Australia has been at the forefront of the development of e-mental health interventions and therapeutic websites" recommended for use by "people with subthreshold or mild depressive symptoms." In 2005, Gunn and colleagues began the DIAMOND [Diagnosis, Management, and Outcomes of Depression] longitudinal study, which collected data on the use, treatment, and results of primary care patients that had depressive symptoms at the time of recruitment.

Gunn said that she and her colleagues were particularly interested in "documenting the self-help and health care use of primary care attendees experiencing the wide range of depressive symptoms."

Surveys and assessments from the DIAMOND longitudinal study included an item on the use of MWH, although, as Gunn and colleagues write, the use of MHW "were in their infancy." Gunn stated that the "unique primary care cohort" provided by the DIAMOND longitudinal study allowed their study to describe MHW users in comparison to guidelines for MWH use, allowing them to compare actual versus expected the use of MHW.

A total of 4059 self-reported study surveys were collected from the DIAMOND cohort over the first 9 years of the study. Data on the use of MHW (defined as mental health focused, professional and self-help use, e-mental health interventions, or therapeutic websites) were collected and compared to demographic data on sex, employment status, education, age, and mental health symptoms. Data on symptom severity, anxiety and collected using the PRIME-MD (Primary Care Evaluation of Mental Disorders screening questionnaire for depressive symptoms), and participants were surveyed about their face-to-face health services, use of antidepressants, use of self-help strategies including MHWs, and general internet use related to social communication.

Data showed that 35.9% (283 out of 789) reported using MHW at least once during the 9-year study. Over the 9-year follow ups "the proportion of respondents reporting MHW use" increased from 7.9% at baseline in 2005 (95% CI: 6.0-9.8), to 25.5% (95% CI: 10.1015.8) in 2014.

Researchers discovered that MHW use was higher in younger (mean 48.4% MHW use versus 53.4% MHW non-use), female (20.6% MHW use female versus 14.6% MHW use male), employed/student (20.3% employed/student MHW use versus 17.2% unemployed MHW use) with a higher level of education (27.0% of Bachelor's degree or higher MHW use versus 140% of 12 year or less [no certificate/diploma] MHW use), and by those reporting increased depression severity (27.9%) versus minimal depression severity (15.7%).

Gunn and colleagues theorized that uptake in use of MHW over the study's duration is "likely to represent the natural diffusion of e-mental health into routine primary care." Knowing the demographic background of MHW users, Gunn states, will be "useful for policy makers as they work out ways to integrate these technologies into primary care" and the knowledge that MHW are used "across the spectrum of depressive symptoms" should be incorporated into the understanding of MHW as the "first level of treatment in stepped care models."

Gunn and colleagues write that "it is likely that the more symptoms one experiences, the more reason one has for seeking information" and that this fact should be taken into consideration for the design and implementation of mental health service models worldwide.

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