The demand for psychotherapy in Germany is high, the gray area probably even higher. Many experts have been warning for years that there is a gap in care for those affected. Internet- and mobile-based interventions (IMIs), i.e. programs, could provide a remedy to the problem. But are they more cost-effective than their alternatives, in addition to being more efficient and effective? Fanny Kählke, Research Associate at the Assistant Professorship of Psychology and Digital Mental Health Care, has investigated this issue by conducting a systematic review study on the economic evaluation of "IMIs". The results were published under the title "Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems" in the Nature Journal "Digital Medicine". The journal has an impact factor of 15,36.
The evidence base is clear. Many internet- and mobile-based interventions are similarly effective as, for example, "face-to-face" treatments in psychotherapy. Accordingly, the question behind the study is logical as well as reasonable: "If we have different therapies available and they are all similarly effective, we naturally take the one with the lowest cost. IMIs seem to generate fewer costs, but this has not yet been scientifically proven," Kählke explains. On this basis, the PhD student evaluated nearly 4,044 articles and compared 36 included, health economic evaluations for their cost-effectiveness and efficacy. The goal of the study was to present the current evidence base, examine it for methodological quality, and exclude confounding factors. "There were very many poor studies that did not use the correct economic methodology. That's why our review was narrowly focused," Kählke said.
This involved evaluating all analyses of interventions that addressed mental health problems, except addictions and dependencies. "We wanted to be able to say at the end which IMIs were cost-effective and which ones we could recommend. That would then have a direct impact on practice and applicability." The evaluations showed that most studies examined interventions to reduce depressive symptoms and anxiety. Often, however, these were accompanied by a therapist. Only about one-third of the studies were unaccompanied. "There is a tendency for unaccompanied IMIs to be cost-effective. However, there are currently too few studies, so we cannot yet make a clear recommendation on applicability," Kählke explains. However, she sees good potential uses for the unaccompanied interventions in the future: "We would like to recommend it, but we need a better evidence base to do so. The advantage is that IMIs are very scalable. They can be offered to many individuals at no additional cost. Despite insufficient evidence, there is an opportunity to make a recommendation on an individual basis. If unaccompanied IMI is effective and cost-effective, then it should be used in practice."
Therapists may now fear for their professional future. But Kählke vehemently disagrees. "It's not about replacing therapists, but about covering the gap in care that has arisen due to too few specialists, as well as bridging waiting times until the start of therapy in a sensible way. Internet- and mobile-based interventions lend themselves to this as measures." Kählke also sees the major advantage of IMIs in the many barriers to seeking help that still exist for those affected: "IMIs can always be done; all that is needed is an internet connection. Nobody reduces you because of your illness. We need to guarantee early care for people. Depending on the extent of the problem, we can also adjust the intensity of intervention (prevention, therapy and aftercare) in a stepped system (stepped-care). In this way, a large number of people can be better helped. That is an important factor," explains the health scientist.
Kählke sees significant progress in the social development with regard to mental health problems in recent years: "The topic is now being addressed more openly. This is also due to the fact that prominent people have dealt with the topic in a more open-minded way and have come out of the closet," explains the researcher. As a result, professional and competent help is now being sought more frequently. "The problem at the moment, however, is that we have too few offers. That's why we conducted our study on IMIs."
Despite the progress made in recent years, Kählke would like to see more attention paid to those affected and a rethink in society: "We have to try to change norms so that the stigmatization of mental illnesses stops. If I break an arm, I go to the doctor. Exactly the same thinking must be anchored in people's minds when it comes to mental illnesses."
To the publication "Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems" in the journal "Digital Medicine"
To the homepage of the Assistant Professorship of Psychology and Digital Mental Health Care
Contact:
Fanny Kaehlke
Assistant Professorship of Psychology and Digital Mental Health Care
Georg-Brauchle-Ring 60/62
80992 München
phone: 089 289 24977
e-mail: fanny.kaehlke(at)tum.de
Text: Bastian Daneyko
Photos: "Digital Medicine"/private