Exploring uptake of E-Mental Health: What can we learn from a longitudinal study of depression in primary care?
Recent Australian policy initiatives promote the management of depression via E-mental health (E-MH) in primary care. Driving these policies is the belief that E-MH provides an alternative to face-to-face services, and will reduce demand on primary care. Whilst the efficacy of E-MH is known, the uptake of E-MH in ‘real world’ settings is not. The aim of this study was to describe primary care patients’ use of E-MH.
This study presents analysis of survey data from an observational, longitudinal cohort study: Diagnosis, Management & Outcomes of Depression in Primary Care (diamond). Participants (n=789) completed questionnaires over nine years, including a question about their use of websites for emotional wellbeing. Participants were also asked about use of other self-help strategies, visits to health professionals, use of antidepressants, psychological and physical health status and a range of demographic characteristics. Cross–sectional and longitudinal analysis using logistic regressions was employed to investigate associations between Therapeutic Website Use (TWU) and the above.
At baseline, users were mostly female, younger, had higher education and were employed. Users were more likely to be told by a doctor that they have depression (81%; OR=1.87; CI 1.09-3.22) or anxiety (75.9%; OR=2.46; CI 1.21-5), and more likely to be taking antidepressants (61.3%; OR=2.62; CI 1.81-3.80). Psychologist (40.3%; OR=3.76; CI 2.29-6.15) or psychiatrist (41.9%; OR=4.84; CI 2.83-8.29) visits were strongly associated with TWU. Users were more likely use other forms of help including self-help books (75.8%, OR=7.61; CI 4.63-12.53) and telephone help-lines (32.3%; OR=7.14; CI 3.88-13.14). People with moderate (43.7%) or severe depression (39.3%) were most likely to use websites at least once during the study period. TWU was also associated with using the internet for social communication (65.6%; OR=3.95; CI 1.71-9.16). Longitudinal analysis showed 36% of the cohort used therapeutic websites at least once. This group were more likely to report that their GP had ever helped them to talk through their problems (55.4%; OR=1.38; CI 1.17-1.62); gave them information about depression, stress or worries (18.3%; OR=1.45; CI 1.18-1.79); suggested they see another health professional (26.6%; OR=1.47; CI 1.20-1.81) or referred them to another health professional for help (24.9%; OR=1.55; CI 1.24-1.94).
Australia has led the development of E-MH and recent policies actively encourage their continued expansion. However, rather than being an alternative to face-to-face services, our results indicate that E-MH users are also likely to seek other forms of health care support from self-help to specialist care. Therefore, it is unclear whether E-MH will, in fact, alleviate pressure on health services. This study shows use of E-MH is unevenly distributed among depressed primary care patients. Greater understanding of the barriers and facilitators to using E-MH is needed.