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BACKGROUND Individuals often turn to the internet seeking answers to their mental health problems. In 2014, Mental Health America (MHA) began the online program MHA Screening, including the PHQ-9, and since then has collected data from nearly 2.5 million people. Among those who complete a depression screening online, 83% report moderate to severe depression. Despite a range of evidence-based treatments for depression, 60% of these individuals do not seek care. A lack of both knowledge of and access to treatment are major barriers to help-seeking. Decision aids (DAs) are tools that can increase treatment knowledge, yet it is unclear if individuals with depression symptoms would use such a tool online. OBJECTIVE The objective of this project was to determine the views of individuals with depression toward an online DA for depression, and to determine the characteristics those most likely to review a DA and are willing to seek care online. METHODS MHA offers web-based depression screening using the Patient Health Questionnaire (PHQ-9). For this pilot, MHA made a link to a depression DA available to all individuals completing PHQ-9 screening from October – November 2017. The DA consisted of information on frequently asked questions pertaining to three treatment approaches: watchful waiting, talk therapy and antidepressants. Respondents viewing the DA could complete a short survey assessing the perceived helpfulness of the DA, and whether they would be “willing to consult a doctor online” about symptoms. Descriptive statistics were calculated, while a multiple logistic regression model identified characteristics associated with viewing the DA. RESULTS Of 74,936 PHQ-9 screens completed, 599 (8%) proceeded to review the depression DA; 92% of these respondents screened positive for moderate to severe depression and 86% had never sought prior treatment. Of the 599, 527 (88%) completed the DA survey: 46% found the DA to be helpful, 45% were unsure, while only 8% said the DA was not helpful. Higher levels of depression severity, female sex and older age were associated with increased likelihood of viewing the DA, while higher income levels and Black/African Americans were less likely to view the DA. A majority of respondents (72%) stated they would be willing to discuss their symptoms with a doctor online. CONCLUSIONS Screening for depression and providing DA outside of traditional settings is viewed positively and holds significant potential for those seeking care online. This knowledge is timely given the rising interest in the use online therapies, and the detrimental impact on psychological health of social isolation measures in response to the Coronavirus pandemic. Future work will determine the best placement of such decision support tools to maximize DA access, and assess the potential for an online pathway to treatment facilitated by screening and decision support. |
