What we found 

In this study, the research team examined data from a survey of 714 people, including Brightside Health members (51.5%) and the general public (48.5%). The majority (71%) of respondents were receiving mental health treatment at the time of the survey, and 78% of respondents reported either preferring online therapy versus in-person treatment or having no preference.  

The research also uncovered barriers and misconceptions regarding treatment. For example, when asked “how long do you expect to be in therapy?” the majority of respondents perceived lengthy treatment cycles. The most commonly endorsed duration was ‘indefinitely’ (35%), followed by ‘six to 12 months’ (14.2%). Very few (8.1%) thought therapy typically lasts one to three months. 

Respondents also reported a perception that psychotherapy was costly and difficult to find. For those currently in treatment (71%), the majority (67.5%) were using only pharmacotherapy, a minority (7.9%) were engaged only in psychotherapy, and 24.6% were engaged in both psychotherapy and pharmacotherapy. For those strictly engaged in pharmacotherapy, the majority (76%) would definitely consider psychotherapy, but it was perceived as too costly and/or difficult to find the right therapist, followed by taking too much time. 

In general, those surveyed reported favorable perceptions of both psychotherapy and psychiatric medication. 

The survey also explored how respondents chose their therapist. In response to a question about factors to consider when assessing therapist compatibility, the most frequently endorsed factors within the entire sample were: personal connection (67.7%), areas of expertise (62.7%), their commitment to me getting better (55%), type of therapist (52.7%), and warmth (50.3%). Cost was endorsed by 44.2%, whether they take insurance was endorsed by 46.2%, and expertise with evidence-based therapies was endorsed by 35.9% of the whole sample.

Why this matters

Though one in five U.S. adults suffered from mental illness in 2020 alone, estimates suggest that only half of people who need mental health services receive them. We must improve our understanding of barriers to care, yet few surveys have sought patient input as consumers of therapy services. Our research suggests consumer perceptions may be one of those barriers to care. 

To our knowledge, there are no surveys of consumer preferences from an existing and/or potential purely telehealth-utilizing sample. This study meaningfully adds to the literature by investigating perceptions of psychotherapy of both the general public and patients receiving telehealth. The results suggest generally favorable perceptions, as well as gaps in public education that can more effectively be addressed – such as awareness of the typical duration, as treatment can be effective in as little as a few sessions . Practitioners and those marketing their services might consider debunking some of these falsely held beliefs in their marketing campaigns.

Our team will continue to explore barriers to receiving care through peer-reviewed research. For now, this latest research is available in the open-access journal JMIR Formative Research, found here. 

Additional published studies from Brightside Health:

• Journal of Clinical Psychopharmacology – Early Response to Antidepressant Medications in Adults With Major Depressive Disorder
• Cureus – A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis
• BMC Psychiatry – Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression
• Frontiers in Psychiatry – Do older adults benefit from telepsychiatric care: Comparison to younger adults
• JMIR Formative Research – Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study
• Journal of Clinical Psychopharmacology – Does Bupropion Increase Anxiety? A Naturalistic Study Over 12 Weeks
• Frontiers in Psychiatry – Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression
• Psychotherapy Research – The utility of completing adjuvant video lessons based on the unified protocol during psychotherapy: A retrospective study using a telehealth platform in routine clinical care
• Journal of Affective Disorders – Symptom clustering of major depression in a national telehealth sample

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What we found 

In this retrospective study, our research team examined data from 7,278 Brightside Health patients receiving psychotherapy for depression and/or anxiety. 

During treatment, licensed therapists provided teletherapy which was supplemented by 10 optional video lessons that provide psychoeducation related to the Unified Protocol evidence-based intervention.  For patients who completed the video lessons, therapists reviewed the content of the lessons and then provided the UP intervention during their video therapy sessions. Patients were also sent “practice questions” via text message after completing each of the videos that helped them to apply the content of the UP videos to their daily lives. 

Generally, across the entire sample, symptom severity decreased as the number of UP video lessons completed increased. Patients who completed at least 7/10 UP lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any.

Why this matters

These findings add to a growing body of literature supporting the utility of digital tools and web-based approaches in treating anxiety and depression. They also suggest that videos which teach the  UP skills are valuable as a supplement to tele-psychotherapy and can be helpful in reducing symptoms of anxiety and depression. These highly accessible solutions make it easier to utilize evidence-based mental healthcare. 

Additional published studies from Brightside Health:

• Journal of Clinical Psychopharmacology – Early Response to Antidepressant Medications in Adults With Major Depressive Disorder
• Cureus – A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis
• BMC Psychiatry – Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression
• Frontiers in Psychiatry – Do older adults benefit from telepsychiatric care: Comparison to younger adults
• JMIR Formative Research – Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study
• Journal of Clinical Psychopharmacology – Does Bupropion Increase Anxiety? A Naturalistic Study Over 12 Weeks
• Frontiers in Psychiatry – Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression

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What we found

In this naturalistic study, the research team examined archival data from 8,457 Brightside Health patients. Propensity matching was used to create SSRI and bupropion groups using 17 covariates. These samples were then compared using repeated measures analysis of variance on Generalized Anxiety Disorder Scale 7 (GAD-7) scores at start of treatment, six weeks, and 12 weeks. There were no differences in anxiety outcomes between the group prescribed SSRIs and the group prescribed bupropion across 12 weeks of treatment. 

Why this matters

The study suggests the long-held belief that bupropion increases anxiety is unfounded, and that bupropion is just as effective a treatment as SSRIs for anxiety symptoms in patients with comorbid major depressive disorder. Given that bupropion has advantages in tolerability over other antidepressants — it is less likely to cause weight gain or sexual dysfunction, is not sedating and is less likely to induce mania—the results suggest it should be considered more often by clinicians. 

Additional published studies from Brightside Health:

• Journal of Clinical Pharmacology: Early Response to Antidepressant Medications in Adults With Major Depressive Disorder
• Cureus: A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis
• BMC Psychiatry: Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression
• Frontiers in Psychiatry: Do older adults benefit from telepsychiatric care: Comparison to younger adults 
• JMIR Formative Research: Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study

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What we found

In this study, the research team looked at archival data from 12,908 Brightside Health patients to examine whether early response after two weeks of antidepressant therapy could predict remission at 14 weeks. The researchers found that those who responded early to treatment (defined by a 30% drop in Patient Health Questionnaire 9 score at week 4) were 3.2 times more likely to experience remission than the group without early response when controlling for other variables.

The study adds to a body of evidence that early signal in response to antidepressant treatment is a significant predictor of later treatment outcomes.

The results further suggest that waiting until after eight weeks to switch antidepressant medication may be a mistake. Switching medications before four to eight weeks has typically not been recommended, based on the idea that antidepressant response is often delayed.
The study also examined which medications are effective when no early response is observed. The results suggest that among patients with a lack of response by week four, those prescribed a norepinephrine and dopamine reuptake inhibitor may achieve superior outcomes.

Why this matters

This is the largest naturalistic study of early response to antidepressants to date. This paper meaningfully adds to the body of convincing evidence that early improvement is a significant predictor of later treatment response.

It also raises the question of whether the common practice of delaying a medication switch until 6 to 12 weeks of treatment in nonresponders is a mistake. A more rapidly iterative approach to antidepressant selection and treatment may be called for to save patients time and increase their odds of long-term remission.

What’s next

Brightside Health’s research team will continue to explore how the field of mental health can use data science to predict treatment outcomes. This latest research is available in the open-access Journal of Clinical Pharmacology, found here.

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At Brightside Health, we’re committed to conducting ongoing research that helps us identify the most effective mental health treatments for a broad spectrum of conditions. Our most recent peer-reviewed study, published in JMIR Formative Research, focuses on how our virtual care model and approach is able to reduce suicidal ideation among patients who receive treatment. The paper was co-authored by our Clinical Team, led by co-founder and Chief Medical Officer Dr. Mimi Winsberg. In this blog post, we’ll break down what we studied and why it matters.

What we uncovered

In this study, our Clinical Team looked at how a telepsychiatric care platform can reduce suicidal ideation over time through a combination of therapy and prescription medication. Suicidal ideation refers to thinking about, considering, or planning suicide. Historically, telehealth solutions have not been well-equipped to treat those with suicidal ideation, which underscores the significance of today’s publication.

We examined results from over 8,500 U.S.-based adults who either received at least 12 weeks of treatment, or engaged on the platform without receiving care. Among participants, those receiving care through Brightside Health’s program (telehealth with decision support) were 4.3 times more likely to experience remission than the control group.

As part of this research, we also analyzed how baseline symptoms and patient demographics, such as age, sex, and education level, were predictive of suicidal ideation. We found that younger age and lower levels of education were more predictive of suicidal ideation prior to treatment. Females and those with advanced education beyond high school were 1.4 times more likely to remit with treatment than males and those without advanced education.

While treatment was the biggest predictor of remission, other factors that contributed to remission included:

• Older age
• Being Caucasian
• Lower depression severity at baseline

Why this matters

For Brightside Health members, this demonstrates that the Brightside telehealth platform can be effective in addressing and reducing suicidal ideation, in addition to underlying symptoms of depression.

For the mental healthcare industry, this study suggests that providers and payers can feel confident in using the Brightside telehealth platform to treat patients with more severe mental health conditions, including suicidal ideation.

What’s next

More innovation is needed to care for those with suicidal ideation over telehealth, including predicting and identifying who needs treatment most, as well as the implementation of evidence-based solutions to manage and treat those with active suicidal ideation.

Brightside Health will continue to research the impact of telehealth treatment across the spectrum of mental health conditions. For now, this latest research is available in the open-access journal JMIR Formative Research and can be found here.

Resources

If you are in emotional distress or thinking about hurting yourself in any way please make use of these resources:
Visit: If you are having a medical or mental health emergency, call 911 or go to your local emergency department
Text: The Crisis Text Line provides 24-hour free and confidential help. Text ‘HOME’ to 741-741 to connect with a counselor immediately
Call: You can call the 988 Suicide & Crisis Lifeline by dialing 988 to talk with a live counselor 24 hours per day

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