Currently submitted to: JMIR Mental Health
Date Submitted: Nov 1, 2024
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of GP-referral vs. self-referral pathways to guided ICBT for depression, panic disorder and social anxiety disorder: a naturalistic study
ABSTRACT
Background:
Therapist guided internet-delivered cognitive behavioral therapy (guided ICBT) appears to be efficacious for depression, panic disorder (PD) and social anxiety disorder (SAD) in routine care clinical settings. However, implementation of guided ICBT is limited partly due to low referral rates from general practitioners (GP). In response, self-referral systems were introduced in mental health care about a decade ago to improve access to care. Yet, little is known about how referral pathways may affect treatment outcomes in guided ICBT.
Objective:
This study aims to compare the overall treatment effectiveness of GP-referral and self-referral to guided ICBT for patients with depression, PD or SAD in a specialized routine care clinic. This study also explores if the treatment effectiveness varies between referral pathways and the respective diagnoses.
Methods:
This naturalistic open effectiveness study compares treatment outcomes from pre-treatment to post-treatment and from pre- to 6-month follow-up across two referral pathways. All participants underwent module based guided ICBT lasting up to 14 weeks, with weekly therapist guidance through asynchronous messaging. Participants self-reported symptoms before, during, immediately after, and 6-months post-treatment. Level and change in symptom severity were measured across all diagnoses.
Results:
In total 460 patients met inclusion criteria, 305 GP-referred (GP), and 155 self-referred (Self). Across the total sample about 60% were female, mean age 32 years, average duration of disorder 10 years. We found no significant differences in pre-treatment symptom levels between referral pathways, across the diagnoses. Estimated effect sizes based on Linear Mixed Modelling showed large improvements from pre- to post-treatment and from pre- to follow-up across all diagnoses, with statistically significant differences between referral pathways (GP: 0.97 - 1.22, Self: 1.34 - 1.58, P: <.001 - .002) and for the diagnoses separately: depression (GP: 0.86 – 1.26, Self: 1.97 -2.07, P: <.001 - .018), PD (GP: 1.32 – 1.60, Self: 1.64 – 2.08, P: .065 - .016 ) and SAD (GP: 0.80 - 0.99, Self: 0.99 – 1.19, P: .178 - .222 ).
Conclusions:
Self-referral to guided ICBT for depression and panic disorder appears to yield greater treatment outcomes compared to GP-referrals. We found no difference in outcome between referral pathway for SAD. This study underscores the potential of self-referral pathways to improve access and treatment outcomes within healthcare services.
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