Remote video consultations can reduce depression and anxiety

Remote video consultations between patients and mental health professionals show small but significant improvements in symptoms of depression and anxiety, according to a study published by The BMJ.

Although the effect is small, the researchers say the effect is still meaningful given the high prevalence of these disorders in the community.

Globally, depression and anxiety disorders are among the leading causes of years lived with disability. However, most people with depression and anxiety are treated in primary care and do not have access to specialized mental health care.

Previous studies have shown that telemedicine can be effective in primary care. However, there is little evidence for remote consultations between primary care patients and mental health specialists at a distance.

To investigate this further, researchers in Germany investigated the effectiveness of a novel video consultation model for mental health (PROVIDE) for treating people with symptoms of depression and anxiety in primary care.

Their findings are based on 376 adults (mean age 45 years; 63% women) who visited their GP between March 24, 2020, and November 23, 2021, with at least moderately severe depression or anxiety, or both.

Symptom severity was measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) and participants were randomly assigned to the PROVIDE model or usual care.

The PROVIDE model consisted of five 50-minute, real-time video-based sessions of brief psychotherapy over eight weeks between the patient in the primary care setting and a mental health specialist at an off-site location. Usual care was provided by a primary care physician and included brief counseling, medication, and referral to specialists.

Compared with usual care, the PROVIDE intervention led to small improvements in the severity of depressive and anxiety symptoms (mean reduction of 2.4 points on the PHQ-ADS score) at six months. The effects were maintained at twelve months (mean reduction of 2.9 points).

The PROVIDE model was also more effective in reducing psychological distress related to physical (somatic) symptoms at both six and twelve months, but did not appear to provide additional benefit for recovery.

No serious adverse events were reported in either group.

The researchers point out a number of limitations, such as the difficulties of obtaining a fully representative and unbiased sample in practice-based clinical research and the potential consequences of missing data.

And while the effect size is small (below the average minimum clinically important difference of 3-5 points on the PHQ-ADS score), they argue that the improvement is still meaningful “given the high prevalence of depression and anxiety in community settings.”

While more research is needed to more effectively tailor interventions and maximize their impact on public health, the researchers conclude, “The PROVIDE model holds promise as a scalable intervention that can collectively benefit public health in the areas of depression and anxiety disorders.”