New horizons for e-mental health research and practice

The past decade has seen a phenomenal growth in e-mental health research and practice. Much of this work has been concerned with evaluating online prevention, education and treatment services, particularly for the high-prevalence disorders. Given the considerable advantages afforded by the Internet, including improved access by consumers and the automation of data collection and processing, this growth is likely to continue. These advantages can also facilitate developments in a much broader range of domains, many of which currently depend on traditional methodologies. The possible impact of e-mental health strategies on several of these is described below.

Epidemiological and post-disaster surveys

Implementation of e-mental health methodologies may herald a new approach to conducting surveys that measure the prevalence of mental disorders and the impact of disasters (Kessler et al., 2008). Traditionally, such surveys are expensive, time consuming and labour intensive. More frequent epidemiological surveys and rapidly initiated post-disaster surveys, enabled by e-mental health technologies, offer important opportunities to provide service and policy planners with data about the nature and magnitude of need. Advances in automated online and telephone-administered diagnostic assessments, combined with careful targeting of respondents using social marketing techniques, will increase the feasibility of such surveys. Combined with data on disability, the data from these automated surveys could inform about the need for generic or targeted mental health interventions for different cohorts. Follow-up surveys could also provide a feasible and acceptable mechanism for evaluating the clinical and cost effectiveness of such interventions.

Models of classification and cross-cultural treatment research

The research techniques of e-mental health may facilitate the process of examining, revising and extending models of psychiatric classification. Research through e-mental health could provide an additional means for evaluating and testing proposed criteria sets for disorders, again by virtue of access to large and otherwise difficult to access populations, including those with rare disorders.

Because internet-administered research is less affected by geographic boundaries, new e-mental health research methodologies may also provide scope for exploring the applicability of models of psychopathology across different cultural and ethnic groups. This research can also extend to testing the transportability of psychological treatments across cultures and ages (Choi et al., 2012; Dear et al., 2012; Zou et al., 2012). Such research will inform about the universality and specificity of psychiatric syndromes associated with different cultures, which may provide insights into how models and treatment need to be modified across cultures.

Models of change in psychotherapy

Research through e-mental health can also contribute to our understanding about the mechanisms of change during treatment. Despite many decades of research and practice, models of change during psychopathology, and questions about what makes psychotherapy work, remain largely unanswered (Kazdin, 2009). It has recently been proposed that e-mental health research provides a framework and advantages that may help to answer such questions (Kazdin and Blasé, 2011).

Combining the advantages of internet treatments with emerging mobile technologies, including ecological momentary assessments, provides considerable scope for testing and informing these questions. Such research has already commenced and the very large samples and resulting data sets are likely to yield valuable insights into the process of therapeutic change. The size of such data sets may require new statistical models and software to aid interpretation, but these will offer an unprecedented opportunity for identifying moderators and mediators of change during therapy.

Future e-mental health methodologies offer enormous research and clinical opportunities beyond those to which they have currently been applied. The possible applications described here represent but a few of the likely developments over the next decade. The astonishing rate of development of this field means that the legal and regulatory systems relevant to e-mental health research and practice will be likely to continue to lag behind developments in the field. Thus, the onus will continue on researchers and professional bodies, who can react more quickly than regulatory bodies, to identify emerging ethical issues and pro-actively update standards of e-mental health research and practice. This has already begun (Abbott et al., 2008; Australian Psychological Society, 2012; Royal Australian and New Zealand College of Psychiatrists, 2009) but given the specialised nature of this field, including rapidly evolving changes in IT safety and security, rofessional organisations may find it useful to combine resources when preparing such standards and guidelines. Despite the challenges, the e-mental health field will continue to offer considerable potential for enhancing existing mental health services while also increasing our understanding of mental illness and the processes underlying recovery.