Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois.
Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.
JAMA Psychiatry. 2020 Sep 1;77(9):906-914. doi: 10.1001/jamapsychiatry.2020.1011.
Depression and anxiety are common and disabling. Primary care is the de facto site for treating these mental health problems but is typically underresourced to meet the burden of these demands.
To evaluate the efficacy of a mobile intervention platform, IntelliCare, for addressing depression and anxiety among primary care patients.
DESIGN, SETTING, AND PARTICIPANTS: Two-arm randomized clinical trial at internal medicine clinics at the University of Arkansas for Medical Sciences. Adult primary care patients (N = 146) who screened positive for depression on the Patient Health Questionnaire-8 (PHQ; score ≥ 10) or anxiety on the Generalized Anxiety Disorder-7 (GAD-7; score ≥ 8) were recruited between July 17, 2018, and December 14, 2018.
The coach-supported platform composed of a suite of apps, was delivered over 8 weeks. Wait list control participants received treatment as usual for 8 weeks, then the mobile platform.
Primary outcomes were changes in depression (PHQ-9) and anxiety (GAD-7) during the intervention period. Secondary outcomes were differences in the proportion of patients who achieved recovery (PHQ-9/GAD-7 <5 or 50% improvement from baseline), sustainment of intervention effects during 2-month follow-up, and app use during the intervention period.
One hundred forty-six patients were included (119 of 146 were women [81.5%]; mean [SD] age, 42.3 [13.8] years). Of the 146 patients, 122 (83.6%) were diagnosed as having depression and 131 (89.7%) were diagnosed as having anxiety. A greater proportion of intervention vs wait list control participants achieved recovery from depression (n = 38 of 64 [59%] vs n = 18 of 58 [31%]; odds ratio, 3.25; 95% CI, 1.54-6.86) and anxiety (n = 37 of 65 [57%] vs n = 25 of 66 [38%]; odds ratio, 2.17; 95% CI, 1.08-4.36). Sustained effects were observed for depression (slope, 0.01; 95% CI, -0.09 to 0.10; P = .92) and anxiety scores (slope, 0.02; 95% CI, -0.08 to 0.12; P = .67) during follow-up. App use was high, with a median of 93 and 98 sessions among participants with depression and anxiety, respectively.
In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients. Findings also support designing digital mental health interventions as platforms containing simple, brief apps that can be bundled by users to meet their needs.
ClinicalTrials.gov Identifier: NCT03500536.
抑郁和焦虑是常见且使人丧失能力的疾病。初级保健是治疗这些心理健康问题的事实上的场所，但通常资源不足，无法满足这些需求的负担。
评估移动干预平台 IntelliCare 在解决初级保健患者的抑郁和焦虑问题方面的疗效。
设计、地点和参与者：在阿肯色大学医学科学分校内科诊所进行的双臂随机临床试验。在 2018 年 7 月 17 日至 2018 年 12 月 14 日期间，筛选出 PHQ-8（得分≥10）或 GAD-7（得分≥8）阳性的成年初级保健患者（N=146），这些患者患有抑郁或焦虑。
由一套应用程序组成的教练支持平台在 8 周内提供。等待名单对照组在 8 周内接受常规治疗，然后使用移动平台。
主要结果是干预期间抑郁（PHQ-9）和焦虑（GAD-7）的变化。次要结果是达到康复的患者比例（PHQ-9/GAD-7<5 或与基线相比有 50%的改善）、在 2 个月随访期间干预效果的维持以及干预期间应用程序的使用方面的差异。
共纳入 146 例患者（146 例中有 119 例为女性[81.5%]；平均[SD]年龄，42.3[13.8]岁）。在 146 例患者中，122 例（83.6%）被诊断为患有抑郁症，131 例（89.7%）被诊断为患有焦虑症。与等待名单对照组相比，更多的干预组参与者从抑郁中康复（n=64[59%]与 n=58[31%]；比值比，3.25；95%CI，1.54-6.86）和焦虑（n=65[57%]与 n=66[38%]；比值比，2.17；95%CI，1.08-4.36）。在随访期间，抑郁（斜率，0.01；95%CI，-0.09 至 0.10；P=0.92）和焦虑评分（斜率，0.02；95%CI，-0.08 至 0.12；P=0.67）的效果持续存在。应用程序的使用频率很高，患有抑郁症和焦虑症的参与者的中位数分别为 93 和 98 次。
在这项试验中，移动干预应用程序对初级保健患者的抑郁和焦虑有效。研究结果还支持将数字心理健康干预设计为包含简单、简短应用程序的平台，用户可以根据自己的需求对其进行组合。
ClinicalTrials.gov 标识符：NCT03500536。
