JMIR Publications

ABSTRACT

Background:

Even though one in five Americans experience some form of mental illness in a given year, 80% have shown to discontinue psychotherapy prematurely. The traditional psychotherapy service delivery model consisting of isolated clinical sessions lacks the capability to keep patients engaged outside clinical sessions. Newer digital mental health platforms can address the clinical need for a robust tool that tracks mental wellbeing as well as improved engagement in patients with depressive symptoms.

Objective:

The primary goals of this feasibility study were to (1) assess the compliance to a digital mental health platform protocol among providers and their patients, and (2) examine the usability and fidelity of the mobile application through structured participant feedback.

Methods:

A sample of thirty participants were recruited for a 5-week study from a community-based mental health clinic in Baltimore, Maryland, USA. Inclusion criteria consisted of being 18 years or older, having access to a smartphone, and having at least mild-to-moderate depression and/or anxiety as measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Eligible participants were randomized into one of two study arms: (1) the intervention arm or (2) the waitlist control arm. Participants in the intervention arm were asked to download the Rose application and were prompted to complete clinical assessments (PHQ-9 and GAD-7) every other week, daily mood and anxiety Likert scales, and daily journal entries. The participants in the waitlist arm served as controls for the study and completed the clinical assessments only. Both arms engaged in weekly psychotherapy sessions, with participant in-app input informing the psychotherapy process of the intervention arm, while those in the waitlist control arm continued their standard care. Outcomes of interest included adherence to completion of in-app assessments and usability of Rose mobile app assessed through the modified Mobile Application Rating Scale (mMARS).

Results:

Over the study period, a sample of thirty participants used the Rose app 2,834 times to complete clinical assessments. On average, 69% (95% CI: 61.14%-77.41%) of participants completed mood and anxiety daily check-ins and journal entries five days per week. 97% of participants completed all PHQ-9 and GAD-7 in-app scales over the study. 73% of participants found the mobile app to be engaging and in-line with their needs and approximately 70% of the participants reported the app functionality and quality of information to be excellent. Additionally, more than two-thirds of the participants felt that their knowledge and awareness of depression and anxiety management improved through using the app.

Conclusions:

Steady compliance and high application ratings showcase the utility of the Rose mobile mental health application in augmenting the psychotherapy process for patients with mood disorders and improving mental health knowledge. Future studies are needed to further examine the impact of Rose on treatment outcomes. Clinical Trial: ClinicalTrials.gov Identifier: NCT04200170