Open Access Research article

Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects

Robin Kenter13*, Lisanne Warmerdam13, Christine Brouwer-Dudokdewit2, Pim Cuijpers13 and Annemieke van Straten13

Author Affiliations

1 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands

2 De BOSgroep, Badhoevedorp, The Netherlands

3 The EMGO institute for Health and Care research, VU University, Amsterdam, The Netherlands

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BMC Psychiatry 2013, 13:43  doi:10.1186/1471-244X-13-43

Published: 31 January 2013



Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center.


We studied all 104 consecutive patients aged 18–65 years with elevated symptoms of depression, anxiety and/or burnout who registered at the center during the first six months after implementation. They were offered a five week guided online treatment. At baseline, five weeks and twelve weeks we measured depressive (BDI-II), anxiety (HADS-A) and burnout symptoms (MBI).


A total of 55 patients (53%) agreed to start with the online treatment. Patients who accepted the online treatment were more often female, younger and lower educated than those who refused. There were no baseline differences in clinical symptoms between the groups. There were large between group effect sizes after five weeks for online treatment for depression (d = 0.94) and anxiety (d = 1.07), but not for burnout (d = −.07). At twelve weeks, when both groups had started regular face-to-face treatments, we no longer found significant differences between the groups, except for anxiety (d = 0.69).


The results of this study show that the majority of patients prefer online guided online treatment instead of waiting for face-to-face treatment. Furthermore, online PST increases speed of recovery and can therefore be offered as a first step of treatment in mental healthcare.

E-mental health; Implementation; Mental healthcare; Depression; Anxiety; Burnout