# A pre-treatment comparison of referral pathways to guided ICBT for depression and anxiety disorders - A naturalistic study in routine clinical care

## TL;DR

This study compares patients who self-refer to guided ICBT for depression and anxiety with those referred by GPs, finding differences in socioeconomic factors.

## Contribution

The study provides new insights into how referral pathways influence the socioeconomic profile of patients accessing guided ICBT.

## Key findings

- Self-referred patients reported higher socioeconomic resources compared to GP-referred patients.
- No differences were found in pre-treatment symptom levels or basic demographics between referral groups.
- Referral pathways showed significant differences in education, employment, income, and healthcare utilization.

## Abstract

Self-referral to therapist-guided internet-delivered cognitive behavioral therapy (guided ICBT) is increasingly being implemented in specialized mental healthcare settings to reduce barriers to care. Little is known about the characteristics of patients who access treatment through this pathway compared to the traditional referral pathway from general practitioner (GP). This study aims to compare demographic characteristics, socioeconomic and social factors between GP- and self-referred patients receiving guided ICBT for depression and anxiety disorders.

Naturalistic cross-sectional study comparing pre-treatment characteristics between GP- and self-referred patients in a specialized routine care ICBT clinic.

The study included 460 patients, 305 GP-referred, 155 self-referred. We found statistically significant differences between referral pathways in the socioeconomic factors; educational level (P < .001), employment status (P = .002), source of income (P = .004), social support (P = .029), types of healthcare utilization 6 months prior to treatment (P < .001) and information source about the treatment (P < .001). We found no difference in pre-treatment symptom level or basic demographics. Multiple logistic regression reduced the number of findings.

Different referral pathways potentially attract distinct patient populations, with self-referred patients being more likely to report greater socioeconomic resources than GP-referred. GP-referral remains crucial for individuals who may need more structured guidance to navigate healthcare systems. To promote equitable access, referral strategies should be tailored to reach those less likely to self-refer. Offering two pathways may support broader access to specialized mental healthcare. Future studies should further explore these identified statistical differences to optimize referral systems and ensure equitable access to mental healthcare for all in need.