To the Editor: The Internet is an increasing popular means of communicating for physicians and their patients. Psychiatry and psychotherapy seem to be two of the most promising medical fields in which to carry on diagnostic and therapeutic activities in virtual reality (1). We designed and implemented a noncommercial virtual psychiatric clinic (http://www.psychpark.net/clinic). Web visitors can ask questions about psychiatric problems by e-mail, then our professionals e-mail the answers back. Then clients can ask further questions. Our service is free of charge for clients. There are more than 80 volunteer professionals in our clinic, including psychiatrists, psychologists, social workers, occupational therapists, and psychiatric nurses.

The characteristics of the 66 clients in our virtual clinic were compared with 42 clients on their first visits to a psychiatric outpatient clinic located in downtown Taipei. There were significant differences between them. The clients of our virtual clinic were significantly younger than the outpatients (mean age=28.9 years, SD=6.1, versus 35.8 years, SD=14.3, respectively) (t=2.93, df=49.4, p=0.005, two-tailed), more had a college education (N=44, 66.7%, versus N=12, 28.6%; Pearson’s χ²=35.4, df=5, p=0.001, two-tailed), and more had never previously visited a psychiatric clinic (N=29, 43.9%, versus N=6, 14.3%; p=0.001, Fisher’s exact test, two-tailed). Among clients who had visited real psychiatric clinics, there were significant differences in the types of previous diagnoses between the two groups (Pearson’s χ²=12.33, df=4, p=0.02, two-tailed). The most common diagnosis of clients of the virtual clinic was anxiety disorder (panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder) (N=36, 54.5%); the most common diagnosis for the clients of the real clinic was mood disorder (depression or bipolar disorder) (N=20, 47.6%).

In a study by Milton et al. of an Internet anxiety disorder program (2), all patients were young, well-educated, male, and of high socioeconomic status—all characteristics of Internet users. He suggested that anxiety plays a part in the different ways in which they sought help, and such patients could be predisposed to using computers to obtain information or to obtain access to resources to understand their problems (2). Our study results were compatible with those of Milton et al. Our web clients were also young and highly educated, they had more anxiety-related disorders, and most of them had not visited a real psychiatric clinic before. Clients who might have had trouble expressing their feelings in face-to-face sessions were able to discuss them freely through e-mail (3). The convenience and privacy of virtual psychiatric clinics may increase some patients’ motivation to seek help from mental professionals. Although, to our knowledge, there are no articles comparing the efficacy of web-based treatment and real clinics, the Internet is a way to educate and reach potential patients. Understanding the characteristics of web clients may improve further online services to meet the needs of different health care consumers.