Meru Health Inc, Palo Alto, CA, United States.
Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, United States.
JMIR Mhealth Uhealth. 2019 Aug 26;7(8):e14284. doi: 10.2196/14284.
Depression is one of the most common mental health disorders and severely impacts one's physical, psychological, and social functioning. To address access barriers to care, we developed Ascend-a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. A previous feasibility study with 102 adults with elevated depression reported that Ascend is associated with a postintervention reduction in depression symptoms.
We aimed to examine whether Ascend is associated with a reduction in symptoms of anxiety, and importantly, whether reductions in symptoms of depression and anxiety are maintained up to 12-months postintervention.
We assessed whether the previously reported, end-of-treatment improvements seen in the 102 adults with elevated symptoms of depression extended up to 12 months posttreatment for depression symptoms (measured by the Patient Health Questionnaire-9 [PHQ-9]) and up to 6 months posttreatment for anxiety symptoms (added to the intervention later and measured using the Generalized Anxiety Disorder-7 [GAD-7] scale). We used linear mixed effects models with Tukey contrasts to compare time points and reported intention-to-treat statistics with a sensitivity analysis.
The intervention was associated with reductions in symptoms of depression that were maintained 12 months after the program (6.67-point reduction in PHQ-9 score, 95% CI 5.59-7.75; P<.001; Hedges g=1.14, 95% CI 0.78-1.49). A total of 60% of the participants with PHQ-9 scores above the cutoff for major depression at baseline (PHQ≥10) reported clinically significant improvement at the 12-month follow-up (at least 50% reduction in PHQ-9 score and postprogram score <10). Participants also reported reductions in symptoms of anxiety that were maintained for at least 6 months after the program (4.26-point reduction in GAD-7 score, 95% CI 3.14-5.38; P<.001; Hedges g=0.91, 95% CI 0.54-1.28).
There is limited evidence on whether outcomes associated with smartphone-based interventions for common mental health problems are maintained posttreatment. Participants who enrolled in Ascend experienced clinically significant reductions in symptoms of depression and anxiety that were maintained for up to 1 year and 6 months after the intervention, respectively. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and anxiety.
抑郁症是最常见的精神健康障碍之一，严重影响人们的身体、心理和社会功能。为了解决获得护理的障碍，我们开发了 Ascend，这是一种基于几种针对抑郁和焦虑的循证心理治疗的智能手机提供的、治疗师支持的、为期 8 周的干预措施。之前对 102 名抑郁症状升高的成年人进行的一项可行性研究报告称，Ascend 与干预后的抑郁症状减轻有关。
我们旨在研究 Ascend 是否与焦虑症状的减轻有关，重要的是，抑郁和焦虑症状的减轻是否在干预后长达 12 个月内保持。
我们评估了之前报告的、在 102 名抑郁症状升高的成年人中看到的治疗结束时的改善是否在治疗后长达 12 个月（通过患者健康问卷-9 [PHQ-9] 测量）和治疗后长达 6 个月（后来添加到干预中并使用广泛性焦虑障碍-7 [GAD-7] 量表测量）时仍保持抑郁症状。我们使用具有 Tukey 对比的线性混合效应模型来比较时间点，并报告意向治疗统计数据和敏感性分析。
该干预措施与抑郁症状的减轻有关，这种减轻在计划后 12 个月内得以维持（PHQ-9 评分降低 6.67 分，95%CI 5.59-7.75；P<.001；Hedges g=1.14，95%CI 0.78-1.49）。基线时 PHQ-9 得分高于临界值（PHQ≥10）的参与者中，有 60%报告在 12 个月随访时出现临床显著改善（PHQ-9 得分至少降低 50%，且干预后得分<10）。参与者还报告了焦虑症状的减轻，至少在计划后 6 个月内保持（GAD-7 评分降低 4.26 分，95%CI 3.14-5.38；P<.001；Hedges g=0.91，95%CI 0.54-1.28）。
关于基于智能手机的常见心理健康问题干预措施相关的结果是否在治疗后仍能维持，证据有限。参加 Ascend 的参与者经历了抑郁和焦虑症状的临床显著减轻，分别在干预后长达 1 年和 6 个月内得以维持。需要进行未来的随机试验来测试 Ascend 是否可以作为治疗抑郁和焦虑的可扩展解决方案。
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