Predictors of functional impairment at assessment and functional improvement after treatment at a national digital mental health service.

"Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: N. Titov and B. Dear are authors and developers of the treatment courses used at the MindSpot Clinic but derive no personal or financial benefit from them. All other authors declare they have no competing interests."

"Funding Investigator-initiated."

"This study was designed as a prospective uncontrolled observational cohort study and is reported according to STROBE guidelines (). It includes all patients who registered for assessment, or enrolled in a transdiagnostic treatment course at the MindSpot Clinic from 1st January 2019 to 31st December 2019. As a naturalistic study, we aimed to follow the observed service flow through the pathway during that period, which resulted in three ‘pathway’ groups and one outcome group (). The ‘assessment’ group comprised all who started the online assessment to enter the service and did not enrol in treatment. The ‘enrolment’ group completed the assessment and elected to enrol in a treatment course, while the ‘completion’ group is a subset of the ‘enrolment’ group who completed the treatment, defined as reading four of the five lessons of the course. The outcome group was labelled the ‘improvement’ group, a subset of the treatment completion group reporting a 50 % reduction in DOR, as described below. A similar grouping model examining factors predicting treatment uptake, completion and symptom outcome has been previously reported (). Ethical approval for the collection and use of the data was obtained from the Macquarie University Human Research Ethics Committee (5201200912) and registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12613000407796). All included patients consented to their non-identifiable, aggregated data being used for research purposes.Fig. 1Participant flow from assessment through to treatment completion.Fig. 1"