JMIR Publications

ABSTRACT

Background:

Anxiety is an extremely prevalent condition, but has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. Growing concerns about the burden of anxiety have only been exacerbated by the Coronavirus (COVID-19) pandemic due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities

Objective:

This study aimed to examine differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and collaborative) within an on-demand mental health system. We also explored the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety

Methods:

We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018 and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement.

Results:

761/1611 (47.0%) experienced a decrease in anxiety symptoms as measured by a change from positive to negative GAD-2 screen. Among members who still screened positive (n=865; 53%) at follow up, a total of 192 members (11.9%) experienced a clinically significant reduction in score on the full GAD-7 (i.e. a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app only”). Higher GAD-7 intake score was also associated with decreased odds of improvement.

Conclusions:

This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in collaborative care (teletherapy and text-based coaching) have the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and exploring explanations and solutions for lower utilization members.