e-Mental health - A guide for GPs


Why should GPs consider using e-mental health?
☰ Table of contents


Efficacy


A growing body of evidence from controlled efficacy trials suggests that e-mental health interventions are effective for the management of mild to moderate depression and anxiety.4–14 There is now also evidence to demonstrate that e-mental health interventions for depression15 and anxiety16 can be effectively disseminated within the context of the primary care setting, and the RACGP has endorsed the use of e-mental health interventions for depression and anxiety in the Handbook of Non-Drug Interventions (HANDI).21 Further research is needed on the most effective ways to implement the use of e-mental health interventions in general practice.


Benefits


e-Mental health interventions:

  • present a convenient and flexible option, granting patients the freedom to decide when and where treatment will take place5 and to review educational material as often as they like15
  • can be provided at low or no service cost to patients (although related costs such as mobile data charges should be taken into account)5
  • can provide an introduction to therapy for individuals who are experiencing mental health issues for the first time22,23 or who have long-standing mental health issues but have never sought professional assistance24
  • can provide an alternative for patients who are averse to face-to-face treatment, such as those who have tried traditional approaches in the past without success, or who are reluctant to attend due to feelings of shame, embarrassment, stigma, or concerns about confidentiality5
  • may allow mental health professionals to focus efforts on the face-to-face treatment of patients for whom e-mental health approaches are not appropriate,25 thereby reducing wait lists
  • provide a cost-effective solution to the health system when used with the appropriate target group in that they are inexpensive to deliver once established and can be disseminated to large populations8
  • can resolve access issues in situations where specialist referral is difficult, such as in rural and remote areas26,27 and some lower socioeconomic areas,28 or where patients are prevented from attending for face-to-face therapy as a result of transport difficulties, lack of child care, pain, physical incapacity or anxiety.29
  1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther 2009;38(4):196–205.
  2. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS ONE 2010;5(10):e13196.
  3. Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U. Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS ONE 2014;9(5):e98118.
  4. Griffiths KM, Farrer L, Christensen H. The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Aust 2010;192(11 Suppl):S4–11.
  5. Hedman E, Ljotsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res 2012;12(6):745–64.
  6. Johansson R, Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother 2012;12(7):861–69.
  7. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 2012;32(4):329–42.
  8. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007;37(3):319–28.
  9. Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry 2011;11:131.
  10. Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev 2013;9:CD005330.
  11. Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G. Computer‐aided psychotherapy for anxiety disorders: a meta‐analytic review. Cogn Behav Ther 2009;38(2):66–82.
  12. Andrews G, Williams AD. Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: a model for dissemination into primary care. Clin Psychol Rev 2014; DOI: 10.1016/j.cpr.2014.05.006.
  13. Andersson G, Hedman E. Effectiveness of guided internet-based cognitive behavior therapy in regular clinical settings. Verhaltenstherapie 2013;23(3):140–48.
  14. The Royal Australian College of General Practitioners. Internet based or computerised CBT (iCBT or cCBT): depression and anxiety. The handbook of non-drug interventions (HANDI). Melbourne: RACGP, 2015.
  15. Taylor-Rodgers E, Batterham PJ. Evaluation of an online psychoeducation intervention to promote mental health help seeking attitudes and intentions among young adults: randomised controlled trial. J Affect Disord 2014;168:65–71.
  16. Andersson G, Cuijpers P. Pros and cons of online cognitive-behavioural therapy. Br J Psychiatry 2008;193(4):270–71.
  17. Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry 2014;13(1):4–11.
  18.  Proudfoot JG. Computer-based treatment for anxiety and depression: is it feasible? Is it effective? Neurosci Biobehav Rev 2004;28(3):353–63.
  19. Griffiths KM, Christensen H. Internet-based mental health programs: a powerful tool in the rural medical kit. Aust J Rural Health 2007;15(2):81–7.
  20. Handley TE, Kay-Lambkin FJ, Inder KJ, Attia JR, Lewin TJ, Kelly BJ. Feasibility of internet-delivered mental health treatments for rural populations. Soc Psychiatry Psychiatr Epidemiol 2014;49(2):275–82.
  21. Meadows G, Enticott J, Inder B, Russell G, Gurr R. Better access to mental health care and the failure of the Medicare principle of universality. Med J Aust 2015;202(4):190–94.
  22. Dever Fitzgerald T, Hunter PV, Hadjistavropoulos T, Koocher GP. Ethical and legal considerations for internet-based psychotherapy. Cogn Behav Ther 2010;39(3):173–87.