Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 5, 2019
Open Peer Review Period: Apr 8, 2019 - May 19, 2019
Date Accepted: Jul 24, 2019
(closed for review but you can still tweet)
One-year outcomes of a therapist-supported, smartphone-based intervention for elevated symptoms of depression and anxiety
ABSTRACT
Background:
Depression is one of the most common mental health disorders and severely impacts physical, psychological and social functioning. To address access barriers to care, we developed Ascend - a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety.
Objective:
A feasibility study reported that Ascend is associated with a post-intervention reduction in depression symptoms among 102 adults with elevated depression. Here, we examined whether Ascend is also associated with a reduction in symptoms of anxiety, and critically, whether reductions in symptoms of depression and anxiety are maintained up to 12 months post-intervention.
Methods:
We examined whether the previously-reported, end-of-treatment improvements among 102 adults with elevated symptoms of depression extended up to 12 months post-treatment for depression symptoms (measured by the Patient Health Questionnaire [PHQ-9]), and up to 6 months post-treatment for anxiety symptoms (added to the intervention later, and measured by the Generalized Anxiety Disorder scale [GAD-7]). We used linear mixed effects models with Tukey contrasts to compare time-points, and report intention-to-treat statistics with a sensitivity analysis.
Results:
The intervention was associated with reductions in symptoms of depression that were maintained 12 months after the program (6.67 reduction in PHQ-9, 95% CI 5.59 to 7.75, P < 0.001; Hedges’ g = 1.14 [0.78 to 1.49]). 60% of participants with PHQ-9 scores above the cut-off for major depression at baseline (PHQ ≥ 10) reported clinically significant improvement at 12-month follow-up (at least 50% reduction in PHQ-9 score and post-program score < 10). Participants also reported reductions in symptoms of anxiety that were maintained for at least 6 months after the program (4.26 reduction in GAD-7, 95% CI 3.14 to 5.38, P < 0.001; Hedges’ g = 0.91 [0.54 to 1.28]).
Conclusions:
There is limited evidence regarding whether outcomes associated with smartphone-based interventions for common mental health problems are maintained post-treatment. Participants enrolled in Ascend experienced clinically significant reductions in symptoms of depression and anxiety that were maintained for up to one year after the intervention. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and/or anxiety.
Citation
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