Modern Health, San Francisco, California, United States of America.
Clinical Excellence Research Center, Stanford School of Medicine, Palo Alto, California, United States of America.
PLoS One. 2022 Aug 18;17(8):e0272162. doi: 10.1371/journal.pone.0272162. eCollection 2022.
The COVID-19 pandemic created an unprecedented need for mental health services that can be remotely delivered. Digital mental health services that offer personalized care recommendations hold promise to efficiently expand service, but evidence of the effectiveness of digitally delivered mental health care in real-world settings remains limited.
A retrospective cohort of adults (N = 1,852) receiving care through a digital mental health platform with elevated depressive symptoms during the COVID-19 pandemic was analyzed to estimate changes in subjective well-being and clinical improvement in depressive symptoms (using the World Health Organization-Five [WHO-5] Well-Being Index), as well as compare the relative effectiveness and cost of different care utilization patterns.
The average improvement in WHO-5 score was 10.1 points (CI: 9.3-10.9, p<0.001) at follow-up, which constituted a medium effect size (d = 0.73). The odds of clinical improvement in depressive symptoms were significantly greater among those who utilized telecoaching (aOR = 2.45, 95%CI: 1.91-3.15, p < .001), teletherapy (aOR = 2.01, 95%CI: 1.57-2.57, p < .001), and both services (aOR = 2.28, 95%CI: 1.67-3.11, p < .001) compared to those who only utilized assessments, adjusting for baseline WHO-5 score, age, sex, and number of days between baseline and follow-up assessments. The average estimated cost of care for telecoaching was $124 per individual, which was significantly less than teletherapy ($413) or both services ($559).
Digitally delivered care with a therapist and/or coach was effective in improving subjective well-being and clinical improvement in depressive symptoms. Although clinical outcomes were similar across utilization patterns, the cost of care was lowest among those utilizing telecoaching.
COVID-19 大流行导致对远程提供的精神卫生服务的需求空前增长。提供个性化护理建议的数字精神卫生服务有望高效扩大服务范围，但在现实环境中，数字交付的精神卫生保健的有效性证据仍然有限。
对在 COVID-19 大流行期间通过数字精神卫生平台接受治疗且抑郁症状升高的成年人（N=1852）进行回顾性队列分析，以评估主观幸福感的变化和抑郁症状的临床改善（使用世界卫生组织-五（WHO-5）福祉指数），并比较不同利用模式的相对效果和成本。
在随访时，WHO-5 评分的平均改善为 10.1 分（CI：9.3-10.9，p<0.001），这构成了中等效应量（d=0.73）。与仅接受评估的患者相比，利用远程咨询（aOR=2.45，95%CI：1.91-3.15，p<0.001）、远程治疗（aOR=2.01，95%CI：1.57-2.57，p<0.001）和两种服务（aOR=2.28，95%CI：1.67-3.11，p<0.001）的患者，出现抑郁症状临床改善的可能性显著更高，调整了基线 WHO-5 评分、年龄、性别和从基线到随访评估的天数。远程咨询的平均估计护理费用为每人 124 美元，显著低于远程治疗（413 美元）或两种服务（559 美元）。
有治疗师和/或教练参与的数字交付护理在改善主观幸福感和抑郁症状的临床改善方面是有效的。尽管利用模式的临床结果相似，但利用远程咨询的护理成本最低。
