In the case of some mental health disorders, such as depression, early detection can often prevent a mild case from developing into a severe one and may even thwart the onset of secondary complications. Now, Dutch researchers have released a new study in support of eDiagnosis — using an online tool to screen adult patients and present a preliminary diagnosis for mental health disorders.
TelePsy, an eDiagnostics system launched in 2011, has only been used in a limited way so far, but the researchers suggest it may become a significant tool for health care providers in the future. Right now, though, they believe more research is needed to investigate whether online diagnosis is reliable and effective.
“It can be concluded that patients are quite satisfied with an eDiagnostic system,” the authors wrote in their new study. “This system may change the management of mental health care by using eDiagnostics prior to a referral to a mental health institution.”
Can TelePsy reliably diagnose patients?
In the Netherlands, patients who experience a mental health issue usually visit their general practitioners (GPs) before they are referred to a specialist. This is similar to many managed health care plans in the U.S., where a patient must see a primary care physician to obtain a referral to a psychiatrist or other specialist. However, research has shown that 40 percent of mental health diagnoses are not recognized by GPs, in part because patients do not ask for help when having problems or because they attribute their symptoms to a physical complaint.
TelePsy was developed not to treat patients for a mental health disorder but to identify symptoms and possible causes of psychological problems. The procedure begins with a general practitioner referring patients to TelePsy; patients receive an e-mail with a secured electronic link to online questionnaires. Second, patients complete a diagnostic and statistic screening questionnaire, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) commonly used to identify mental health disorders. The system recognizes if a disorder is indicated and then progresses a patient to a more specialized questionnaire to rate the severity. Third, a TelePsy psychologist reviews the answers and makes a working hypothesis based on the generated profile. After this, the psychologist consults with the patient by telephone and afterward prepares a report, based on this experience of the patient as well as the profile generated by TelePsy. Finally, the patient and the general practitioner decide together on the necessary next steps.
To understand potential benefits and problems of TelePsy, the researchers conducted a survey that included general practitioners, nurses, and patients. For the survey, evaluations were made during the period of Feb. to June 2012. The patient questionnaire consisted of queries about using the eTool, contact with the psychologist, and an overall impression of TelePsy. The questionnaire for the doctors and nurses consisted of questions about the echelon advice, the use of the eDiagnostic system, the advice given, and their general impression (including, “Do you think TelePsy will benefit patients?”). Questions were scored on a scale from one to five, where one equaled ‘extremely satisfied’ and five equaled ‘extremely unsatisfied.’ A total of 353 patients completed the entire TelePsy procedure and received an invitation for participation in the study. Of these patients, 242 (99 men and 143 women) responded. The age of those who responded varied from 18 to 74 years, with a mean age of 42. The most prevalent diagnoses were mood disorders (36 percent), anxiety disorders (18 percent), and somatoform disorders (eight percent). In total, 26 percent of the patients reported one or more co-morbid disorders, with the two main co-morbid disorders being mood and anxiety disorders.
“Generally, patients were quite satisfied with the eDiagnostic computer system,” the researchers wrote in their study. Patients reported a slight preference for a psychologist rather than an electronic questionnaire; some believed they were less able to adequately express themselves via the system than with a face-to-face psychologist, and some needed help operating their computers or had difficulty navigating through the online questionnaires. Yet, patients also reported less time pressure and less feelings of shame in the absence of a person. Overall, patients reported an overall satisfaction rate of 7.45, graded on a scale of one to 10.
Of the 242 patients, nine patients rated their satisfaction as less than or equal to five, with three patients disagreeing with the results or advice of the psychological examination, and two patients being dissatisfied with the psychologist.
Doctors and nurses reported feeling more satisfied than patients with the eDiagnostic computer system; their mean satisfaction rate was 8.07, graded on a scale from one to 10. They agreed with the preliminary diagnosis and advice, felt strengthened in their function, and thought that the system would benefit the patients. A neutral score on one question — "Did you follow the referral advice?" — stands out, though. Interestingly, the researchers found that TelePsy advised 52 percent of the time to refer a patient for secondary health care (such as a psychiatrist or counselor) while the general practitioners and practice nurses would have referred only 34 percent of the time for secondary health care.
Although on its face, the thought of online diagnosis of mental health seems clinical at best, careless at worst, the system has many human controls built into it. That said, this may be its main flaw; from the description of how it is used in the study, TelePsy still requires a physician to begin the whole process of recommending a patient be diagnosed for a mental health disorder. Since this was the very flaw the developers were attempting to overcome — the inability of primary care physicians to recognize mental health disorders — they might re-think how eDiagnosis might be initiated. Maybe patients could reach out to the system on their own?
Source: Dijksaman I, Dinant G-J, Spigt MG. eDiagnostics: a promising step towards primary mental health care. Family Practice. 2013.