Using the Internet to enhance the treatment of depression


Professor David Castle, Chair of Psychiatry, St. Vincent’s Hospital, The University of Melbourne, Level 2, 46 Nicholson Street (Mail: PO Box 2900), Fitzroy, Vic. 3065, Australia.


Objective: Deficiencies in Australia’s mental health systems persist despite over a decade of mental health reform. Recent developments in e-health provide the opportunity to facilitate health reform and improve services. This paper presents preliminary findings from the implementation of a comprehensive e-health system, called RecoveryRoad, which was designed to augment the routine clinical treatment of depression.

Methods: Depressed patients (n = 144) were referred to RecoveryRoad from a public hospital and public and private clinics in Perth, Western Australia. Online features included secure e-consultations, progress monitoring questionnaires, psychoeducation and evidence-based therapy. Treating clinicians had online access to patients’ progress monitoring outcomes and e-consultations. There were two types of adherence reminders: automated email reminders and personalized case management delivered by email and telephone.

Results: Adherence to the system was high (from 53% to 84%, depending on the modality of reminder), and self-reported medication adherence was over 90%. Average depression severity declined from severe to mild by the eighth session, a large effect (d = 1.0). Both clinicians and patients were generally satisfied with the programme and reported that it improved clinician–patient relationships. Clinicians also reported that it helped patients to better manage depression.

Conclusions: Preliminary findings support the feasibility of comprehensive e-health systems in enhancing the delivery of mental health care.