Heinz Michael V, Lekkas Damien, Abreu Veronica, Lee Camilla, Marsch Lisa A, Jacobson Nicholas C
Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Npj Ment Health Res. 2024 Sep 30;3(1):43. doi: 10.1038/s44184-024-00086-7.
Depression and anxiety frequently co-occur with opioid use disorder (OUD) yet are often overlooked in standard OUD treatments. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a mobile application designed to address these symptoms in individuals receiving medications for OUD (MOUD). A randomized controlled trial recruited N = 63 adults with OUD who received MOUD and screened positive for moderate depression or generalized anxiety. Participants were randomized to an app-based digital intervention or treatment-as-usual for 4 weeks, and completed follow-ups at 4 and 8 weeks. Primary outcomes were self-reported severity measures for depression and generalized anxiety, and urine drug screens (UDS). Secondary outcomes included self-reported OUD severity, craving intensity, and digital biomarkers derived from passive smartphone sensors. The application was well-received (median app rating = 4/5 stars). The intervention group showed significant reductions in depressive and generalized anxiety symptoms post-intervention and at 8 weeks follow-up (d > 0.70), with large (d = 0.78) and moderate (d = 0.38) effect sizes, respectively, compared to controls. Both groups exhibited substantial decreases in self-reported severity of opioid use symptoms (d > 2.50). UDS suggested similar between-group adherence to MOUD, with a marginal decrease in opioid (MOP) use in the intervention group and increase in controls, yielding medium between group effect sizes (d = 0.44). Passive sensor data suggested significant increases in social connectedness in the intervention group, evidenced by a significant rise in incoming and outgoing calls and text connections. Initial evidence supports the feasibility and acceptability of a digital intervention for treating anxiety and depressive symptoms in persons receiving MOUD. While underpowered to confidently determine statistical significance beyond directionality, the intervention showed promise in reducing depressive and anxiety symptoms, suggesting its potential as a cost-effective and scalable adjunctive therapy alongside standard OUD treatment. Due to the preliminary nature of this pilot study, further research with sample sizes permitting greater statistical power is needed to confirm findings and explore long-term effects.
抑郁症和焦虑症经常与阿片类药物使用障碍（OUD）同时出现，但在标准的OUD治疗中常常被忽视。本研究评估了一款移动应用程序的可行性、可接受性和初步有效性，该应用程序旨在解决接受OUD药物治疗（MOUD）的个体的这些症状。一项随机对照试验招募了N = 63名患有OUD且接受MOUD治疗并筛查出中度抑郁症或广泛性焦虑症呈阳性的成年人。参与者被随机分配到基于应用程序的数字干预组或常规治疗组，为期4周，并在4周和8周时完成随访。主要结局是自我报告的抑郁和广泛性焦虑严重程度测量指标以及尿液药物筛查（UDS）。次要结局包括自我报告的OUD严重程度、渴望强度以及从被动智能手机传感器得出的数字生物标志物。该应用程序受到好评（应用程序评分中位数 = 4/5星）。干预组在干预后和8周随访时抑郁和广泛性焦虑症状显著减轻（d > 0.70），与对照组相比，效应大小分别为大（d = 0.78）和中（d = 0.38）。两组自我报告的阿片类药物使用症状严重程度均大幅下降（d > 2.50）。UDS表明两组在MOUD治疗的依从性方面相似，干预组阿片类药物（MOP）使用略有下降，而对照组有所增加，组间效应大小为中等（d = 0.44）。被动传感器数据表明干预组的社交联系显著增加，来电和短信联系显著增多证明了这一点。初步证据支持了数字干预治疗接受MOUD治疗者焦虑和抑郁症状的可行性和可接受性。虽然样本量不足以自信地确定超出方向性的统计显著性，但该干预在减轻抑郁和焦虑症状方面显示出前景，表明其作为标准OUD治疗之外具有成本效益且可扩展的辅助治疗的潜力。由于这项初步研究的性质，需要进行进一步研究，样本量要足够大以获得更大的统计效力，以证实研究结果并探索长期效果。
