JMIR Publications

ABSTRACT

Background:

Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although there are a growing number of randomized trials establishing the efficacy of digital interventions for common mental health problems, less is known about the real world impact of these tools. AbleTo Digital+, a commercially available mental health application for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in real world contexts.

Objective:

The primary objective of this study was to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs, as well as to evaluate Digital+ module completion and use of 1:1 coaching.

Methods:

In this retrospective cohort study, we analyzed previously collected and permanently de-identified data from a consecutive cohort of 1,896 adults who initiated use in one of the three Digital+ eight-module programs (Depression, Generalized Anxiety, or Social Anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Social Phobia Inventory (SPIN) respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging were also evaluated.

Results:

Large effects were observed among Depression (d=1.5), Generalized Anxiety (d=1.2), and Social Anxiety (d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (B=-1.2; P<.001), generalized anxiety (B=-1.1; P<.001), and social anxiety (B=-2.4; P<.0001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD=2.7) modules. The average total length of app use was 7.5 weeks (SD=11.9). Approximately two-thirds of users engaged in 1:1 coaching calls (66.8%) or in-app text messaging (66.10%). Participants who completed at least four modules participated in significantly more coaching calls per module (mean=1.1; SD=0.7)than users who completed fewer than four modules (mean=1.0; SD=1.2; t=-2.1, P=.03).

Conclusions:

This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms over the course of the program.