Montgomery Robert M, Boucher Eliane M, Honomichl Ryan D, Powell Tyler A, Guyton Sharelle L, Bernecker Samantha L, Stoeckl Sarah Elizabeth, Parks Acacia C
Happify Health, New York, NY, United States.
JMIR Cardio. 2021 Nov 19;5(2):e32351. doi: 10.2196/32351.
The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions.
The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2).
Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks' exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time.
Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well.
This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD.
美国心脏协会已确定心理健康不佳是患有心血管疾病（CVD）风险因素（如高血压、高胆固醇和糖尿病）的人群进行健康行为改变的关键障碍。数字心理健康干预措施，如通过互联网提供给电脑或智能手机的干预措施，可能为改善这一人群的身心健康提供一种可扩展的解决方案。Happify就是这样一种干预措施，并且已证明在改善普通人群和慢性病患者的心理健康方面具有疗效证据。
本分析针对自我报告有CVD风险因素（包括高血压和胆固醇、糖尿病和心脏病）的Happify用户的真实世界数据，旨在研究这些用户是否会随着时间的推移报告主观幸福感和焦虑感有所改善（假设1），以及与未按推荐使用相比，按推荐使用Happify是否会随着时间的推移与主观幸福感和焦虑感的显著更大改善相关联（假设2）。
数据来自报告上述CVD风险因素的现有Happify用户。样本包括1803名至少接触Happify 6周（从42天到182天）的用户，他们在此期间在应用程序内完成了至少一项活动和两项评估。主观幸福感用Happify量表进行评估，这是一种对积极情绪和生活满意度的9项测量方法，焦虑感用广泛性焦虑症2（GAD - 2）进行评估。为了评估假设1，使用混合效应线性回归模型评估两个结果随时间的变化，并控制人口统计学和使用情况。对于假设2，在模型中添加了一个交互项，以评估按推荐使用是否与随时间的更大改善相关联。
两个假设均得到支持。对于Happify量表和GAD - 2，最初没有交互项的多变量模型显示了从基线开始的时间效应，并且时间与推荐使用之间的交互项的添加也具有显著性。
对真实世界数据的这一分析提供了初步证据，表明自我报告有包括高血压或胆固醇、糖尿病和心脏病等CVD风险因素的Happify用户随着时间的推移幸福感和焦虑感有所改善；并且与完成活动较少的用户相比，按推荐使用Happify的用户在心理健康的这些方面有更大改善。这些发现将先前的研究扩展到了一个心理健康尤为关键的新人群：有患CVD风险的人群，先前的研究表明按推荐参与Happify与身体健康用户以及慢性病患者的幸福感改善相关。
