E–Mental Health Self-Management for Psychotic Disorders: State of the Art and Future Perspectives

• Published in: Psychiatric services (Washington, D.C.) Vol. 65; no. 1; pp. 33 - 49
• Main Authors: van der Krieke, Lian, Wunderink, Lex, Emerencia, Ando C, de Jonge, Peter, Sytema, Sjoerd
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01.01.2014
• Subjects: Biological and medical sciences; Humans; Medical sciences; Mental Health Services - standards; Mental Health Services - trends; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotic Disorders - therapy; Self Care - standards; Self Care - trends; Social psychiatry. Ethnopsychiatry; Telemedicine - standards; Telemedicine - trends; Social environment; Human; Psychosis; Mental health; Self management; Review; Public health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.201300050

Online therapies, Web-based self-management systems, and Internet forums are rapidly becoming part of the mental health services repertoire, but can they be effective for individuals with psychotic disorders? This literature review indicates that people with psychotic disorders are able and willing to use e-health services. In fact, e-health interventions for this population are at least as effective as standard, non–technology-based care. Their greatest benefit, the authors said, may be to reduce health care costs for service providers as well as service users. ObjectiveThe aim of this review was to investigate to what extent information technology may support self-management among service users with psychotic disorders. The investigation aimed to answer the following questions: What types of e–mental health self-management interventions have been developed and evaluated? What is the current evidence on clinical outcome and cost-effectiveness of the identified interventions? To what extent are e–mental health self-management interventions oriented toward the service user?MethodsA systematic review of references through July 2012 derived from MEDLINE, PsycINFO, AMED, CINAHL, and the Library, Information Science and Technology database was performed. Studies of e–mental health self-management interventions for persons with psychotic disorders were selected independently by three reviewers.ResultsTwenty-eight studies met the inclusion criteria. E–mental health self-management interventions included psychoeducation, medication management, communication and shared decision making, management of daily functioning, lifestyle management, peer support, and real-time self-monitoring by daily measurements (experience sampling monitoring). Summary effect sizes were large for medication management (.92) and small for psychoeducation (.37) and communication and shared decision making (.21). For all other studies, individual effect sizes were calculated. The only economic analysis conducted reported more short-term costs for the e–mental health intervention.ConclusionsPeople with psychotic disorders were able and willing to use e–mental health services. Results suggest that e–mental health services are at least as effective as usual care or nontechnological approaches. Larger effects were found for medication management e–mental health services. No studies reported a negative effect. Results must be interpreted cautiously, because they are based on a small number of studies.