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Australian Digital Mental Health Services for Anxiety and Depression: Meta-Analysis and Comparison Study
Bridget Bassilios1, Katrina J Scurrah1, Amy J Morgan1
1Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia, 61 3 8344 0662.
Background:
Mental Health Online, MindSpot, and THIS WAY UP are 3 Australian Government-funded digital mental health services (DMHSs). These services are free for consumers and deliver a range of (depression and anxiety disorder) psychological assessments and interventions using the internet, with or without clinician support.
Objective:
This study examines the uptake and effectiveness of these services.
Methods:
We used 3 data sources to examine the performance of the three DMHSs: (1) aggregated routinely collected service data to describe uptake of the services from January 2013 to December 2021, (2) peer-reviewed and gray literature reporting treatment outcomes, and (3) treatment outcome data from one evaluation conducted by Mental Health Online. The second and third data sources were used to analyze the effectiveness of the DMHSs compared to other mental health treatment programs (Australian primary, public, and low-intensity mental health care; UK stepped psychological care). We generated pooled mental health symptom (Cohen d) effect sizes for each service's clinician-supported and self-directed treatments and compared those with effect sizes we calculated for the alternative treatment programs.
Results:
The 3 DMHSs offered care to more than 282,000 consumers and therefore contributed to improving overall access to mental health care in Australia. Clinician-supported online treatment significantly improved the mental health of consumers who use these services (Mental Health Online, Cohen d=0.95; MindSpot, Cohen d=1.42; and THIS WAY UP, Cohen d=1.04), and self-directed treatment by Mental Health Online produced a moderate reduction (Cohen d=0.59) in anxiety disorder severity ratings. Clinician-supported treatments produced improvements in mental health symptoms that are close or equivalent to most (face-to-face, phone, and stepped or symptom severity-matched mental health care) comparison treatments examined.
Conclusions:
Mental Health Online, MindSpot, and THIS WAY UP are producing clinically significant improvement for consumers experiencing psychological distress and anxiety and depression symptoms. The magnitude of improvement produced by clinician-supported treatment is comparable with more resource-intensive face-to-face treatment options. Heterogeneity in the magnitude of improvements produced by the 3 DMHSs (and comparator interventions across levels of clinical need) indicates that findings should be interpreted with caution, particularly in relation to the populations for whom DMHSs may be most appropriate.