Cross Shane P, Karin Eyal, Staples Lauren G, Bisby Madelyne A, Ryan Katie, Duke Georgia, Nielssen Olav, Kayrouz Rony, Fisher Alana, Dear Blake F, Titov Nickolai
MindSpot Clinic, Macquarie University, Sydney, Australia.
School of Psychological Sciences, Macquarie University, Sydney, Australia.
Internet Interv. 2022 Feb 12;27:100506. doi: 10.1016/j.invent.2022.100506. eCollection 2022 Mar.
Digital mental health services (DMHS) have proven effectiveness and play an important role within the broader mental health system by reducing barriers to evidence-based care. However, improved understanding of the factors associated with successful treatment uptake, treatment completion and positive clinical outcomes will facilitate efforts to maximise outcomes. Previous studies have demonstrated that patient age is positively associated, and initial symptom severity negatively associated with treatment uptake and treatment completion rates in both DMHS and other mental health services. The current study sought to extend these findings by examining the effect of other patient characteristics, in particular, self-reported psychosocial difficulties, using data from a large-scale national DMHS. Using a prospective uncontrolled observational cohort study design, we collected self-reported demographic, psychosocial and clinical data from 15,882 patients who accessed the MindSpot Clinic, Australia, between 1 January and 31 December 2019. Using a series of univariate regression models and multivariate classification algorithms we found that older age, higher educational attainment, and being in a relationship were all positively associated with uptake, completion and significant symptom improvement, while higher initial symptom severity was negatively associated with those outcomes. In addition, self-reported psychosocial difficulties had a significant negative impact on uptake, completion, and symptom improvement. Consistent with previous literature, the presence of these characteristics in isolation or in combination have a significant impact on treatment uptake, completion, and symptomatic improvement. Individual and multiple psychosocial difficulties are associated with reduced capacity to participate in treatment and hence an increased treatment burden. Identifying patients with lower capacity to complete treatment, modifications to treatments and the provision of supports to reduce treatment burden may promote greater engagement and completion of treatments offered by digital mental health services.
数字心理健康服务（DMHS）已被证明具有有效性，并通过减少循证护理的障碍在更广泛的心理健康系统中发挥重要作用。然而，更好地理解与成功接受治疗、完成治疗及取得积极临床结果相关的因素，将有助于努力实现最大治疗效果。先前的研究表明，在数字心理健康服务和其他心理健康服务中，患者年龄与治疗接受率和治疗完成率呈正相关，而初始症状严重程度与之呈负相关。本研究旨在通过使用来自一项大规模全国性数字心理健康服务的数据，检验其他患者特征（特别是自我报告的心理社会困难）的影响，以扩展这些发现。采用前瞻性非对照观察性队列研究设计，我们收集了2019年1月1日至12月31日期间访问澳大利亚MindSpot诊所的15882名患者的自我报告的人口统计学、心理社会和临床数据。通过一系列单变量回归模型和多变量分类算法，我们发现年龄较大、受教育程度较高以及处于恋爱关系中均与治疗接受、完成及症状显著改善呈正相关，而较高的初始症状严重程度与这些结果呈负相关。此外，自我报告的心理社会困难对治疗接受、完成及症状改善有显著负面影响。与先前的文献一致，这些特征单独或组合出现均对治疗接受、完成及症状改善有显著影响。个体和多种心理社会困难与参与治疗的能力降低相关，从而导致治疗负担增加。识别出治疗完成能力较低的患者，对治疗进行调整并提供支持以减轻治疗负担，可能会促进患者更多地参与并完成数字心理健康服务提供的治疗。
