JMIR Publications

ABSTRACT

Background:

Major depressive disorder (MDD) and anxiety disorders are among the most prevalent mental health conditions worldwide, leading to substantial disability, reduced quality of life, and increased health care costs. Limited access to psychiatric services, particularly in rural or resource-restricted settings, remains a major barrier to effective treatment. Telepsychiatry, involving real-time video interventions between psychiatrists and patients, offers a promising alternative to overcome such barriers by improving accessibility and treatment continuity. However, empirical data comparing online and face-to-face psychiatric interventions among adults with MDD in Türkiye are limited.

Objective:

This study aimed to compare the clinical effectiveness of online and face-to-face psychiatric interventions in patients diagnosed with major depressive disorder. The primary objectives were to assess depressive and anxiety symptoms, treatment attendance, and symptom patterns across follow-up visits.

Methods:

A total of 120 patients with MDD were assigned to either online (n=60) or face-to-face (n=60) psychiatric follow-up according to patient preference at the Department of Psychiatry, Ankara University Faculty of Medicine. Participants were evaluated at baseline and during the 1st, 2nd, 4th, and 6th follow-up sessions over 6 months. Standardized assessment tools included the DSM-5 Level 1 Cross-Cutting Symptom Measure, DSM-5 Level 2 Depression Scale, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Suicide Probability Scale. All participants received standard psychiatric care, including pharmacological treatment when clinically indicated, in accordance with current clinical guidelines. Data were analyzed using chi-square, Student t, Mann-Whitney U, and Spearman correlation tests, with statistical significance set at P<.05.

Results:

Descriptively, both groups had lower HAM-D and HAM-A scores at the 6th follow-up session than at baseline. In between-group analyses, the online group had lower mean HAM-D scores at the 4th (P=.045) and 6th follow-up sessions (P=.02). No statistically significant between-group differences were found in HAM-A scores at any assessed time point (P>.05). On the DSM-5 Level 2 Depression Scale, the online group had lower mean T-scores at the 4th (P=.007) and 6th follow-up sessions (P=.003). DSM-5 Level 1 Cross-Cutting Symptom Measure findings descriptively indicated reduced depression and anxiety symptom burden at follow-up, although elevated self-reported mania scores were observed in a small proportion of participants. No significant group differences were found across the Suicide Probability Scale subscales (P>.05). Attendance at scheduled follow-up sessions was significantly higher in the online group at the 1st (P=.04), 3rd (P=.003), 4th (P=.03), and 5th follow-up sessions (P=.03).

Conclusions:

Online psychiatric interventions showed clinical outcomes comparable to those of face-to-face interventions in patients with MDD and were associated with higher attendance at several follow-up visits. These findings support telepsychiatry as a feasible, accessible, and sustainable approach for the follow-up of patients with MDD in clinical practice.