Preferences and Ratings of Service Attributes between Digital and Non-Digital Depression Management Methods: A Survey of Adult Individuals with Depressive Symptoms Above the Clinical Threshold (Preprint)

Abstract

Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings. This research-practice gap results in a shortfall on uptake and adherence of evidence-based digital tools. To enhance uptake and adherence, user-centered research is essential to incorporating user perspectives and considerations into product design, development, and dissemination.

The present study aims to analyze service characteristics that may potentially influence the choice of depression management methods and compare the extent to which various digital and non-digital mental health treatments and management methods fulfill users' expectations in order to provide insights into the market readiness for E-mental health services and their unique strengths and weaknesses.

A total of 114 people with at least moderate level of depressive symptoms (as measured by PHQ-9 equal to or greater than 10) completed an anonymous online questionnaires measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time and more. They were also assessed on their expectations toward 7 common mental health treatments and management methods, including (a) face-to-face psychotherapy, (b) medication, (c) guided Internet-based psychotherapy, (d) face-to-face counseling service, (e) self-guided mental health app for depression, (f) self-help bibliotherapy, and (g) psychotherapy via videoconferencing.

A Friedman test with Dunn's posttest showed the average importance rank of “effectiveness” significantly differed from all other measured attributes. Individuals with depressive symptoms ranked “privacy”, “credibility”, and “cost” as equally important following “effectiveness”. Participants rated face-to-face psychotherapy as the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychotherapy, medication, and counseling were considered to be less satisfactory due to their higher costs and longer waiting times when compared to digital services.. Repeated measures ANOVA showed that some form of management methods was more likely, and equally more likely to be adopted, including guided Internet-based psychotherapy, psychotherapy via videoconferencing, face-to-face psychotherapy and face-to-face counseling services provided by a counselor (F (1,105) = 10.94, partialη2=.39, p<.01) as compared to self-guided mobile apps, self-help bibliotherapy, and medication.

The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to non-digital services, digital services were identified as having specific strengths as perceived by users. The similarity of the likelihood of adoption of digital and non-digital services reflects market readiness for e-mental health. Future dissemination and promotion efforts may focus on debunking myths of guided Internet-based psychotherapy as a less effective option and promoting the particular service strengths of digital services.