Dzubur Eldin, Yu Jessica, Hoffman Julia, Painter Stefanie, James Roberta, Shah Bimal
Teladoc Health, Purchase, NY, United States.
Duke University Medical School, Durham, NC, United States.
JMIR Form Res. 2023 Oct 3;7:e36596. doi: 10.2196/36596.
Evidence-based digital health programs have shown efficacy in being primary tools to improve emotional and mental health, as well as offering supplementary support to individuals undergoing psychotherapy for anxiety, depression, and other mental health disorders. However, information is lacking about the dose response to digital mental health interventions.
The objective of the study was to examine the effect of time in program and program usage on symptom change among individuals enrolled in a real-world comprehensive digital mental health program (myStrength) who are experiencing severe anxiety or depression.
Eligible participants (N=18,626) were adults aged 18 years and older who were enrolled in myStrength for at least four weeks as part of their employee wellness benefit program, who completed baseline, the 2-week, 2-month, and 6-month surveys querying symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7]) and depression (Patient Health Questionnaire-9 [PHQ-9]). Linear growth curve models were used to analyze the effect of average weekly program usage on subsequent GAD-7 and PHQ-9 scores for participants with scores indicating severe anxiety (GAD-7≥15) or depression (PHQ-9≥15). All models were adjusted for baseline score and demographics.
Participants in the study (N=1519) were 77.4% female (1176/1519), had a mean age of 45 years (SD 14 years), and had an average enrollment time of 3 months. At baseline, participants reported an average of 9.39 (SD 6.04) on the GAD-7 and 11.0 (SD 6.6) on the PHQ-9. Those who reported 6-month results had an average of 8.18 (SD 6.15) on the GAD-7 and 9.18 (SD 6.79) on the PHQ-9. Participants with severe scores (n=506) experienced a significant improvement of 2.97 (SE 0.35) and 3.97 (SE 0.46) at each time point for anxiety and depression, respectively (t=-8.53 and t=-8.69, respectively; Ps<.001). Those with severe baseline scores also saw a reduction of 0.27 (SE 0.08) and 0.25 (SE 0.09) points in anxiety and depression, respectively, for each additional program activity per week (t=-3.47 and t=-2.66, respectively; Ps<.05).
For participants with severe baseline scores, the study found a clinically significant reduction of approximately 9 points for anxiety and 12 points for depression after 6 months of enrollment, suggesting that interventions targeting mental health must maintain active, ongoing engagement when symptoms are present and be available as a continuous resource to maximize clinical impact, specifically in those experiencing severe anxiety or depression. Moreover, a dosing effect was shown, indicating improvement in outcomes among participants who engaged with the program every other day for both anxiety and depression. This suggests that digital mental health programs that provide both interesting and evidence-based activities could be more successful in further improving mental health outcomes.
基于证据的数字健康项目已被证明是改善情绪和心理健康的主要工具，同时也能为接受焦虑、抑郁及其他心理健康障碍心理治疗的个体提供辅助支持。然而，关于数字心理健康干预的剂量反应信息却很匮乏。
本研究旨在探讨参与现实世界中综合数字心理健康项目（myStrength）的、患有严重焦虑或抑郁的个体，项目参与时长和项目使用情况对症状变化的影响。
符合条件的参与者（N = 18626）为18岁及以上的成年人，他们作为员工健康福利项目的一部分，注册myStrength至少四周，完成了基线调查、2周、2个月和6个月的调查，这些调查询问了焦虑症状（广泛性焦虑障碍量表-7 [GAD-7]）和抑郁症状（患者健康问卷-9 [PHQ-9]）。线性增长曲线模型用于分析平均每周项目使用情况对GAD-7和PHQ-9得分的影响，这些参与者的得分表明患有严重焦虑（GAD-7≥15）或抑郁（PHQ-9≥15）。所有模型均对基线得分和人口统计学因素进行了调整。
本研究中的参与者（N = 1519）女性占77.4%（1176/1519），平均年龄为45岁（标准差14岁），平均注册时长为3个月。在基线时，参与者在GAD-7上的平均得分为9.39（标准差6.04），在PHQ-9上的平均得分为11.0（标准差6.6）。报告6个月结果的参与者在GAD-7上的平均得分为8.18（标准差6.15），在PHQ-9上的平均得分为9.18（标准差6.79）。得分严重的参与者（n = 506）在焦虑和抑郁的每个时间点分别有显著改善，改善值分别为2.97（标准误0.35）和3.97（标准误0.46）（t值分别为-8.53和-8.69；P值均<0.001）。基线得分严重的参与者，每周每增加一次项目活动，焦虑和抑郁得分分别降低0.27（标准误0.08）和0.25（标准误0.09）分（t值分别为-3.47和-2.66；P值均<0.05）。
对于基线得分严重的参与者，研究发现注册6个月后，焦虑症状临床上显著降低约9分，抑郁症状显著降低约12分，这表明针对心理健康的干预措施在症状出现时必须保持积极、持续的参与，并作为一种持续可用的资源，以最大化临床效果，特别是对于那些患有严重焦虑或抑郁的人。此外，研究显示了剂量效应，表明每隔一天参与该项目的参与者在焦虑和抑郁方面的结果都有所改善。这表明提供有趣且基于证据的活动的数字心理健康项目在进一步改善心理健康结果方面可能会更成功。
