An Internet-based system could be a useful tool for
screening adults for mental health disorders and giving preliminary diagnoses,
according to a new Dutch study.
This eDiagnostics system is already used in primary care
practices in The Netherlands, the researchers say, but nowhere else, and more
study is needed to determine if it is reliable, valid and
cost-effective. "Using the Internet to diagnose mental health problems in
primary care seem very promising," writes lead author Ies Dijksman and
colleagues from Maastricht University.
"The great advantage of an electronic system is that
patients can complete diagnostic tests at home," Dijksman told Reuters
Health in an email, adding that people may be quicker to reveal themselves over
the Internet and provide genuine responses to questions because of their
perceived anonymity."This could lead to a more accurate information
collection process compared to conventional clinical interviews," Dijksman
Yet conventional interviews may still have a place in
primary care, since the complete use of Internet-based activity may present
some "unforeseen obstacles", the researcher said. "For example,
there are no visual cues to guide the physician." Dr Eric Bender, who was
not involved in Dijksman's study, also noted the importance of visual cues.
"Someone may say, 'I'm feeling fine,' but they may look like they're on
the verge of tears," he told Reuters Health.
Critical to see patients
He also questioned whether the use of an Internet-based tool
may inadvertently cause a delay in diagnosis of mental health disorders among
the elderly and people who are not computer literate. "As a clinical
provider, I want to see people," said Bender, a private-practice child/adolescent,
adult and forensic psychiatrist who also works as a staff psychiatrist at the
University of California, San Francisco. "I think it's critical to see
patients," he said.
For their study Dijksman and her colleagues surveyed general
practitioners (GPs), practice nurses (PNs) and adult patients about their
experiences with TelePsy, an eDiagnostic system that was introduced into
primary care practices in The Netherlands in September 2011. In the Netherlands similar
to the UK, Spain and some managed care plans in the US patients who desire to
see a specialist health care provider must first visit a primary care provider
for a referral.
TelePsy assists those doctors and nurse practitioners in
identifying symptoms and potential causes of psychological problems and gives
advice about a patient's need for referral to specialty care. After an initial
referral from the primary care provider, the eDiagnostics process requires
patients to complete a questionnaire.
The profile created
from those responses is reviewed by a TelePsy psychologist who then does a
telephone consultation with the patient, and afterward prepares a report that
is submitted back to the primary care provider.
The report includes a preliminary diagnosis based on the
standard psychiatric diagnostic manual, DSM-IV, and provides advice on whether
the patient should be referred to mental health care and the extent of care
required primary, secondary or tertiary, with tertiary indicating a need for
inpatient psychiatric treatment. The most common diagnoses identified via
TelePsy were mood disorders, including depression and anxiety, Dijksman and
Other less-common diagnoses included suspicion of a
personality disorder, substance abuse disorder and developmental disorder.
Overall, the 242 patients surveyed said they were generally "quite
satisfied" with the TelePsy system and were neutral about whether they
would prefer a face-to-face consultation with a psychologist over the
The 49 doctors and nurse practitioners surveyed in the study
were very satisfied with the TelePsy system as well. They also tended to agree
with the diagnoses suggested by the eHealth system and the referral advice
given, the researchers note in the journal Family Practice.
There were some differences in the decisions made by the
programme and the doctors, however. For instance, the TelePsy system suggested
patient referral to more serious secondary-level mental health care about half
of the time, compared to primary care providers who arrived at that conclusion
about a third of the time. "In our view the disagreement between the system
and the GPs is a positive result of our study," Dijksman said.
If the system
would give the same results as the GPs expectations, the system would not have
additional value. "If further studies show TelePsy to be valid and
reliable, it could be a useful tool for use outside The Netherlands,"
Bender said, adding that it could be helpful in the early detection of mental
health disorders. Still, "I wouldn't want it to take the place of a
clinical interview," he said.