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

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 prop-ortion 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. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd.