Symptom Trajectories and Attendance in Face-to-Face and Online Psychiatric Follow-Up for Major Depressive Disorder and Anxiety Symptoms: Prospective Observational Cohort Study
- 1Department of Psychiatry Afyonkarahisar State Hospital Afyonkarahisar Türkiye
- 2Department of Psychiatry Faculty of Medicine Ankara University Ankara Türkiye
Abstract
Background: Major depressive disorder is a leading cause of disability, and access to specialist psychiatric follow-up remains limited in many settings. Telepsychiatry may reduce logistical barriers to care, but data on video-based follow-up under routine outpatient conditions in Türkiye are scarce, and comparisons of delivery modalities are frequently limited by baseline imbalance between self-selected groups.
Objective: The aim of the study is to describe symptom trajectories and attendance over 6 months of routine psychiatric follow-up delivered either face-to-face or online and to examine whether outcomes differed between modalities after adjustment for baseline severity.
Methods: In this prospective, nonrandomized observational cohort study, 120 adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) major depressive disorder were followed for 6 months at a university hospital psychiatry department in Ankara, Türkiye (September 2021 to May 2022). Participants entered face-to-face (n=60) or online (n=60) follow-up according to their own preference. Seven sessions were scheduled at approximately 4-week intervals; the Hamilton Depression Rating Scale (HAM-D; primary outcome), the Hamilton Anxiety Rating Scale, and DSM-5 Level 1 and Level 2 measures were administered at baseline and at sessions 1, 2, 4, and 6. Attendance was recorded at all sessions. Between-group comparisons used analysis of covariance adjusted for the corresponding baseline score and for prespecified covariates. Linear mixed models incorporating a group-by-time interaction were fitted to all available observations, and multiple imputation (m=20) was performed as a sensitivity analysis.
Results: Depressive symptoms decreased substantially in both groups: mean HAM-D fell from 26.6 to 5.0 in the face-to-face group (81.2% reduction; Cohen d=4.86; P<.001; n=43) and from 24.1 to 3.3 in the online group (86.3% reduction; Cohen d=6.06; P<.001; n=49). Response rates were 41 of 43 (95.3%) and 48 of 49 (98%; P=.60), and remission rates were 32 of 43 (74.4%) and 43 of 49 (87.8%; P=.11). Unadjusted between-group differences at sessions 4 and 6 did not persist after adjustment for baseline severity (session 4: –0.47, 95% CI –1.71 to 0.77; P=.46; session 6: –0.79, 95% CI –2.22 to 0.65; P=.28), and the group-by-time interaction was not significant (χ23=1.9; P=.59). Anxiety scores did not differ at any time point. Findings were unchanged under multiple imputation, and prescribing patterns were comparable. Attendance across all 7 scheduled sessions was higher in the online group overall (373/420, 88.8% vs 319/420, 76%; P<.001), with differences at sessions 2 through 5.
Conclusions: Both modalities were followed by large reductions in depressive symptoms, and between-group differences did not persist after adjustment for baseline severity. The study was not designed as an equivalence trial and cannot establish equivalence. The most consistent difference favoring online follow-up was attendance, although its reasons could not be determined. These findings characterize online psychiatric follow-up as a feasible means of maintaining continuity of routine care rather than as a more effective one.
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BibTeX
@article{akalın2026symptom,
title = {{Symptom Trajectories and Attendance in Face-to-Face and Online Psychiatric Follow-Up for Major Depressive Disorder and Anxiety Symptoms: Prospective Observational Cohort Study}},
author = {Doğan Akalın and Vesile Şentürk Cankorur},
journal = {JMIR Formative Research},
year = {2026},
month = oct,
doi = {10.2196/97656},
url = {https://doi.org/10.2196/97656},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Symptom Trajectories and Attendance in Face-to-Face and Online Psychiatric Follow-Up for Major Depressive Disorder and Anxiety Symptoms: Prospective Observational Cohort Study
AU - Doğan Akalın
AU - Vesile Şentürk Cankorur
PY - 2026
DA - 2026/10/19
JO - JMIR Formative Research
DO - 10.2196/97656
UR - https://doi.org/10.2196/97656
AB - Background: Major depressive disorder is a leading cause of disability, and access to specialist psychiatric follow-up remains limited in many settings. Telepsychiatry may reduce logistical barriers to care, but data on video-based follow-up under routine outpatient conditions in Türkiye are scarce, and comparisons of delivery modalities are frequently limited by baseline imbalance between self-selected groups. Objective: The aim of the study is to describe symptom trajectories and attendance over 6 months of routine psychiatric follow-up delivered either face-to-face or online and to examine whether outcomes differed between modalities after adjustment for baseline severity. Methods: In this prospective, nonrandomized observational cohort study, 120 adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) major depressive disorder were followed for 6 months at a university hospital psychiatry department in Ankara, Türkiye (September 2021 to May 2022). Participants entered face-to-face (n=60) or online (n=60) follow-up according to their own preference. Seven sessions were scheduled at approximately 4-week intervals; the Hamilton Depression Rating Scale (HAM-D; primary outcome), the Hamilton Anxiety Rating Scale, and DSM-5 Level 1 and Level 2 measures were administered at baseline and at sessions 1, 2, 4, and 6. Attendance was recorded at all sessions. Between-group comparisons used analysis of covariance adjusted for the corresponding baseline score and for prespecified covariates. Linear mixed models incorporating a group-by-time interaction were fitted to all available observations, and multiple imputation (m=20) was performed as a sensitivity analysis. Results: Depressive symptoms decreased substantially in both groups: mean HAM-D fell from 26.6 to 5.0 in the face-to-face group (81.2% reduction; Cohen d=4.86; P<.001; n=43) and from 24.1 to 3.3 in the online group (86.3% reduction; Cohen d=6.06; P<.001; n=49). Response rates were 41 of 43 (95.3%) and 48 of 49 (98%; P=.60), and remission rates were 32 of 43 (74.4%) and 43 of 49 (87.8%; P=.11). Unadjusted between-group differences at sessions 4 and 6 did not persist after adjustment for baseline severity (session 4: –0.47, 95% CI –1.71 to 0.77; P=.46; session 6: –0.79, 95% CI –2.22 to 0.65; P=.28), and the group-by-time interaction was not significant (χ23=1.9; P=.59). Anxiety scores did not differ at any time point. Findings were unchanged under multiple imputation, and prescribing patterns were comparable. Attendance across all 7 scheduled sessions was higher in the online group overall (373/420, 88.8% vs 319/420, 76%; P<.001), with differences at sessions 2 through 5. Conclusions: Both modalities were followed by large reductions in depressive symptoms, and between-group differences did not persist after adjustment for baseline severity. The study was not designed as an equivalence trial and cannot establish equivalence. The most consistent difference favoring online follow-up was attendance, although its reasons could not be determined. These findings characterize online psychiatric follow-up as a feasible means of maintaining continuity of routine care rather than as a more effective one.
SN - 2561-326X
ER -