JMIR Publications

ABSTRACT

Background:

Since 2020, psychotherapists in Germany may prescribe digital health applications for mental disorders (DHA-MD). DHA-MD were supposed to foster digitalization and improve access to mental health services. Yet, prescriptions of DHA-MD are less frequent than had been expected.

Objective:

We investigated which characteristics of psychotherapists predicted perceived need for and prescribing of DHA-MD among German psychotherapists.

Methods:

This was a cross-sectional survey in Germany. We contacted psychotherapists between January and July 2024 via professional associations, training institutes, or the social media platform X. We sent questionnaires to 1000 psychotherapy practices randomly selected from the registry of the Association of Statutory Health Insurance Physicians. We assessed characteristics of the psychotherapists, asked them to rate the perceived need for DHA-MD on an 11-point scale, and documented their prescribing behavior. Linear and logistic regression analyses were performed to predict perceived need and prescribing, respectively.

Results:

A total of 321 psychotherapists participated. Perceived need was estimated as low (M=2.1). Thirty-one percent of psychotherapists prescribed a DHA-MD to at least one patient in a regular quarter. A psychodynamic (b=-1.63, p<.001) or systemic psychotherapy approach (b=-1.48, p=<.01) and higher age (b=-0.03, p<.01) negatively predicted the perceived need, while being a psychiatrist (b=0.73, p=.02) and a psychotherapeutic and psychopharmacological treatment focus (b=1.31, p=.04) positively predicted the perceived need. For prescribing, odds were lower for psychotherapists with a psychodynamic approach (OR=0.30, 95% CI [0.13, 0.68]), and higher for psychotherapists with more than a half service mandate (OR=2.34, 95% CI [1.12, 4.88]), and a psychotherapeutic and psychopharmacological treatment focus (OR=9.53, 95% CI [1.37, 66.37]).

Conclusions:

We found that professional group, psychotherapy approach, age, size of service mandate, and treatment focus predicted perceived need and prescribing of DHA-MD among psychotherapists. Our findings may inform stakeholders and decision-makers in healthcare and politics about where DHA-MD have already been implemented in the landscape of mental health services. Clinical Trial: Not applicable.