Mental Health Screening in General Practices as a Means for Enhancing Uptake of Digital Mental Health Interventions: Observational Cohort Study

Abstract

Background Digital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking. Objective This study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (StepCare) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions. Methods StepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening. Results Screening identified depressive or anxious symptoms in 43.09% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it. Conclusions Implementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits.

Learnings from user feedback of a novel digital mental health assessment

“…Including PPI panels in the development of questionnaires can enhance the validity of the questions asked and ensure a comprehensive question set ( 88 ). Any opportunity to improve the validity of questions asked in a digital mental health assessment should be pursued, particularly as a systematic review of the validity of digital psychiatric assessment tools is lacking high-quality evidence ( 24 ).…”

“…DMHIs are able to address geographical and service level barriers to accessing mental health services, such as understaffing and medical coverage of more remote areas ( 23 ) providing support to healthcare providers. In return, healthcare providers can facilitate engagement with DMHIs, as evidence shows that two-thirds of individuals prescribed a digital intervention for depressive or anxiety symptoms by their GP reported using it ( 24 ). Additionally, DMHIs can address non-service level barriers associated with accessing traditional face-to-face mental health care, such as patients experiencing difficulties or distress in disclosing mental health concerns, or perceived stigmatization ( 23 , 25 , 26 ).…”

“…Perhaps most crucially, when considering possible benefits, digital mental health assessments have been shown to improve identification of mental health disorders ( 24 , 25 ). Previous work has demonstrated that, of those participants who underwent digital screening for common psychiatric disorders in a primary care setting, a quarter of those identified as experiencing depressive or anxiety symptoms were previously unidentified by their GP.…”

“…Previous work has demonstrated that, of those participants who underwent digital screening for common psychiatric disorders in a primary care setting, a quarter of those identified as experiencing depressive or anxiety symptoms were previously unidentified by their GP. The majority of these previously unidentified patients were experiencing mild to moderate symptom severity, however 1-in-10 presented with severe symptoms or reported current suicidal ideation at the time of screening ( 24 ). Additionally, digitized screening may help in removing clinician variability or error by standardizing the questions asked of patients when assessing psychiatric symptoms ( 29 , 30 ).…”

Linking music streaming platform advertisements with a digital mental health assessment and interventions

“…A recent Australian-focused scoping review found 52 evidence-based DMHIs for a range of indications: depression ( n = 9, 17%); anxiety ( n = 15, 29%); general mental well-being ( n = 13, 25%); multiple issues ( n = 13, 25%); and distress in the form of suicidal ideation ( n = 2, 4%) ( 16 ). Although many DMHIs are of a good quality and circumvent many of the barriers to help-seeking ( 17 – 20 ), uptake remains low, particularly in priority populations such as males, indigenous Australians, and those of low socio-economic situations ( 21 – 23 ). Uptake is low because of the overwhelming choice of apps ( 24 ) and uncertainty among both practitioners and consumers in which ones are efficacious ( 25 ).…”