JMIR Publications

ABSTRACT

Background:

Chronic conditions account for 75% or more of health care costs, and the impact of chronic illness is expected to further grow over time. The burden of chronic illness can be amplified by depression, which is problematic because in the context of chronic illness, depression is substantially more common than in the general population. There exist interventions that can target depression in chronic conditions already, but they can be difficult to access, as they are often offered in person, with associated expenses and other barriers, and they are rarely integrated to contain multiple existing, evidence-based intervention approaches. Happify, which draws from multiple theoretical traditions to target well-being and is offered in a digital format, has already been established as an efficacious means of improving well-being in both distressed and non-distressed users.

Objective:

To test Happify’s effectiveness in users with a chronic condition, as compared with users reporting no chronic condition.

Methods:

Data were drawn from 821 users of Happify who had received a minimum of 8 weeks exposure to Happify. Respondents were asked if they had any of the following chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed-effects linear regression model was fit for subjective well-being.

Results:

At baseline, users with a chronic condition also had lower scores on the composite subjective well-being scale (M = 38.34, SD = 17.40) than users without (M = 43.65, SD = 19.13). However, there was no significant difference between change trajectories for users with or without a chronic condition; they experienced the same amount of improvement as users without a chronic condition. Additionally, there was an effect for time from baseline (b = 0.071, SE = 0.010, P < .01) and number of activities completed (b = 0.03, SE = 0.009, P < .01), as well as a two-way interaction between number of activities completed and time from baseline (b = 0.0002, SE = 0.00006, P < .01) such that completing more activities and doing so over increasingly longer time periods interacted to produce improved well-being scores.

Conclusions:

The current data support the conclusion that users with a chronic condition experienced significant improvement over time, and that despite reporting lower subjective well-being on the whole, their change trajectory while using Happify does not differ from those without a chronic condition. Users who completed more activities over a longer time period showed the greatest amount of improvement, consistent with past research. In short, the presence of a chronic condition did not prevent users from benefitting when they use Happify.