User characteristics and outcomes from a national digital mental health service: an observational study of registrants of the Australian MindSpot Clinic

Titov, Nickolai; Dear, Blake F; Nielssen, Olav; Wootton, Bethany; Kayrouz, Rony; Karin, Eyal; Genest, Ben; Bennett-Levy, James; Purtell, Carol; Bezuidenhout, Greg; Tan, Rheza; Minissale, Casey; Thadhani, Priti; Webb, Nick; Willcock, Simon; Andersson, Gerhard; Hadjistavropoulos, Heather D; Mohr, David C; Kavanagh, David J; Cross, Shane; Staples, Lauren G

doi:10.1016/s2589-7500(20)30224-7

Cited by 108Digital Mental Health InterventionsTelemedicine and Telehealth ImplementationMental Health Treatment and Access

User characteristics and outcomes from a national digital mental health service: an observational study of registrants of the Australian MindSpot Clinic

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Titov, Nickolai, Dear, Blake F, Nielssen, Olav, Wootton, Bethany, Kayrouz, Rony, Karin, Eyal, Genest, Ben, Bennett-Levy, James +13 more·2020·The Lancet Digital Health

DOI 10.1016/s2589-7500(20)30224-7PMC PMC7571905

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Abstract

Background: Interest is growing in digital and telehealth delivery of mental health services, but data are scarce on outcomes in routine care. The federally funded Australian MindSpot Clinic provides online and telephone psychological assessment and treatment services to Australian adults. We aimed to summarise demographic characteristics and treatment outcomes of patients registered with MindSpot over the first 7 years of clinic operation. Methods: We used an observational design to review all patients who registered for assessment with the MindSpot Clinic between Jan 1, 2013, and Dec 31, 2019. We descriptively analysed the demographics, service preferences, and baseline symptoms of patients. Among patients enrolled in a digital treatment course, we evaluated scales of depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder 7-Item Scale [GAD-7]), as primary measures of treatment outcome, from the screening assessment to post-treatment and a 3 month follow-up. The Kessler Psychological Distress 10-Item Plus Scale was also used to assess changes in general distress and disability, and course satisfaction was measured post-treatment. Outcomes: A total of 121 652 screening assessments were started, of which 96 018 (78·9%) were completed. The mean age of patients was 35·7 years (SD 13·8) and 88 702 (72·9%) were women. Based on available assessment data, 36 866 (34·5%) of 106 811 participants had never previously spoken to a health professional about their symptoms, and most people self-reported symptoms of anxiety (88 879 [81·9%] of 108 494) or depression (78 803 [72·6%] of 108 494), either alone or in combination, at baseline. 21 745 patients started treatment in a therapist-guided online course, of whom 14 503 (66·7%) completed treatment (≥four of five lessons). Key trends in service use included an increase in the proportion of people using MindSpot primarily for assessment and information, from 52·6% in 2013 to 66·7% in 2019, while the proportion primarily seeking online treatment decreased, from 42·6% in 2013 to 26·7% in 2019. Effect sizes and percentage changes were large for estimated mean scores on the PHQ-9 and GAD-7 from assessment to post-treatment (PHQ-9, Cohen's d effect size 1·40 [95% CI 1·37-1·43]; and GAD-7, 1·45 [1·42-1·47]) and the 3 month follow-up (PHQ-9, 1·36 [1·34-1·38]; and GAD-7, 1·42 [1·40-1·44]); proportions of patients with reliable symptom deterioration (score increase of ≥6 points [PHQ-9] or ≥5 points [GAD-7]) were low post-treatment (of 13 058 respondents, 184 [1·4%] had symptom deterioration on the PHQ-9 and 282 [2·2%] on the GAD-7); and patient satisfaction rates were high (12 452 [96·6%] of 12 895 respondents would recommend the course and 12 433 [96·7%] of 12 860 reported the course worthwhile). We also observed small improvements in disability following treatment as measured by days out of role. Interpretation: Our findings indicate improvement in psychological symptoms and positive reception among patients receiving online mental health treatment. These results support the addition of digital services such as MindSpot as a component in contemporary national mental health systems. Funding: None.

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Scoring ≥8 on the GAD-7 suggests a likely generalized anxiety disorder diagnosis.
“Scoring ≥8 suggests a likely generalized anxiety disorder diagnosis. 33”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [33]
The Methods (Treatment outcome measures; page not provided) give a GAD-7 cutoff of 8 or more for the probable presence of an anxiety disorder. They also say the scale is sensitive to generalized anxiety disorder, social phobia, and panic disorder, so the cutoff does not specifically indicate a likely generalized anxiety disorder diagnosis. (LLM, conf=0.89)
Experimental — accuracy not yet measured
The sample characteristics are similar to the Australian sample, except a greater proportion of our patients reported concurrent medication use and treatment.
“The sample characteristics are similar to the Australian sample, 33 except a greater proportion of our patients reported concurrent medication use and treatment.”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [33]
In the Australian study, iCBT effects were stable across years.
“iCBT effects were stable across years.”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [33]
A K10 score > 21 suggests significant distress.
“Score > 21 suggests significant distress. 33”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [33]
In a 7-year Australian study, utilization increased in the first 3 years and subsequently stabilized, with a higher demand for assessment services than iCBT.
“In this 7-year Australian study, utilization increased in the first 3 years and subsequently stabilized, with a higher demand for assessment services than iCBT.”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [33]

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Predictors of functional impairment at assessment and functional improvement after treatment at a national digital mental health service
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Australian Digital Mental Health Services: Consumer Perceptions of Their Usability and Acceptability
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Decision-making about uptake and engagement among digital mental health service users: a qualitative exploration of therapist perspectives
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Suicide after contact with a national digital mental health service
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Acceptability and effectiveness study of therapist-assisted internet-delivered cognitive behaviour therapy for agriculture producers
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Guidelines for the Provision of Remote Psychological Services
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Australian Digital Mental Health Services for Anxiety and Depression: Meta-Analysis and Comparison Study
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Authors: Titov, N., Dear, B. F., Nielssen, O., Wootton, B., Kayrouz, R., Karin, E., Genest, B., Bennett-Levy, J., Purtell, C., Bezuidenhout, G., Tan, R., Minissale, C., Thadhani, P., Webb, N., Willcock, S., Andersson, G., Hadjistavropoulos, H. D., Mohr, D. C., Kavanagh, D. J., Cross, S., & Staples, L. G.
Affiliations: Macquarie University (AU)
University of Technology Sydney (AU)
Linköping University (SE)
University of Regina (CA)
Northwestern University (US)
Queensland University of Technology (AU)
Corresponding author: Staples, Lauren G
ORCID: Titov, Nickolai
Dear, Blake F
Nielssen, Olav
Wootton, Bethany
Kayrouz, Rony
Karin, Eyal
Purtell, Carol
Bezuidenhout, Greg
Willcock, Simon
Andersson, Gerhard
Hadjistavropoulos, Heather D
Kavanagh, David J
Cross, Shane
Staples, Lauren G
Venue: The Lancet Digital Health
Publisher: Elsevier BV
Published: 2020-11
Volume: 2
Issue: 11
Pages: e582-e593
ISSN: 2589-7500 (ISSN-L)
DOI: 10.1016/s2589-7500(20)30224-7
PMC: PMC7571905
OpenAlex: W3092838678
Cited by: 108
References: 34
Citations by year: 2026: 11 · 2025: 18 · 2024: 16 · 2023: 24 · 2022: 16 · 2021: 21 · 2020: 2
FWCI: 14.24
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: The Lancet Digital Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
DiVA (Linkoping University) (submittedVersion, other-oa)
UTS ePRESS (University of Technology Sydney) (submittedVersion, cc-by-nc-nd)
The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
Funders: Australian Government
Macquarie University
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: digital mental health, telemedicine, depression, anxiety, psychological distress, treatment outcomes, treatment completion, help-seeking, user characteristics, Australian adults, usual care, Kessler Psychological Distress Scale, PHQ-9, GAD-7, course satisfaction, mental health service delivery
MeSH terms: Adult, Australia, Demography, Female, Health Surveys, Humans, Male, Mental Health Services, Middle Aged, Treatment Outcome, Telemedicine, Young Adult

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User characteristics and outcomes from a national digital mental health service: an observational study of registrants of the Australian MindSpot Clinic

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