Video consultations ease symptoms in adults with depression, anxiety

An integrated mental health video consultation approach (PROVIDE model) can modestly reduce symptoms in adults with depression and anxiety disorders, a study has shown.

“Depression and anxiety disorders are prevalent, and therefore the small effect might cumulatively impact on population health in this population,” the researchers said.

This multicentre, randomized controlled trial was conducted in 29 primary care practices in Germany and involved 376 adults (18‒81 years) who presented to their general practitioner (GP) with depression and anxiety or both.

The researchers randomly allocated participants to receive either the PROVIDE model (n=187) or usual care (n=189). GPs provided usual care through interventions such as brief counselling and psychotropic medication prescriptions and may or may not include referrals to mental health specialists.

On the other hand, the PROVIDE model consisted of transdiagnostic treatment given through five real-time video sessions between the patient at the primary care practice and a mental health specialist at an offsite location.

The absolute change in the mean severity of depressive and anxiety symptoms measured using the patient health questionnaire anxiety and depression scale (PHQ-ADS) at 6 months in the intention-to-treat population was the primary outcome.

Other outcomes, which were measured at 6 and 12 months, were as follows: PHQ-ADS subscores, psychological distress related to somatic symptoms, recovery, health-related quality of life, quality and patient centredness of chronic illness care, and adverse events.

Improved symptoms

Participants had a mean age of 45 years and a mean PHQ-ADS score of 26. Majority of the randomized patients (63 percent) were women. [BMJ 2024;386:e079921]

At 6 months, the PROVIDE model resulted in improvements in the severity of depressive and anxiety symptoms (adjusted mean change difference in the PHQ-ADS score, ‒2.4 points, 95 percent confidence interval [CI], ‒4.5 to ‒0.4; p=0.02) compared with usual care.

The beneficial effects of the PROVIDE model persisted at 12 months (adjusted mean change difference in the PHQ-ADS score, ‒2.9, 95 percent CI, ‒5.0 to ‒0.7; p<0.01). Moreover, both groups recorded no serious adverse events.

“The trial findings suggest that mental health specialists virtually co-located in primary care can effectively deliver patient-centred psychological interventions at the most frequent point of care entry, primary care,” the researchers said.

“Moreover, the pragmatic and relatively brief intervention, which featured five sessions of treatment, improved medium term outcomes across a broad spectrum of patients with depression, anxiety, and psychological distress related to somatic symptoms,” they added.

These findings support those found in previous studies that assessed the efficacy of telemental health interventions integrated into primary care settings and the colocation of mental health specialists in primary care practices. [BMJ Open 2020;10:e042052; J Gen Intern Med 2007;22:1086-1093; JAMA Psychiatry 2015;72:58-67]

“Specifically, our findings strongly support evidence that telemental health interventions conveying practical training for specific skills may be particularly suited for treating depression and anxiety disorders,” the researchers said. [Br J Psychiatry 2023;223:407-414; Clin Psychol Psychother 2021;28:1535-1549]