JMIR Publications

ABSTRACT

Background:

The American Heart Association has identified poor mental health in particular as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention, and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and amidst users with chronic conditions.

Objective:

The objective of this analysis of real-world user data was to examine changes in both subjective well-being and anxiety over time in Happify users with self-reported cardiovascular disease risk factors, including high blood pressure and cholesterol, diabetes, and heart disease.

Methods:

Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate our first hypothesis, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For the second hypothesis, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time.

Results:

Users completed an average of 2.9 activities per week, and 35% (636/1803) met criteria for the recommended use. For both the Happify scale and the GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, supporting the first hypothesis. The addition of the interaction term between time and recommended use, was significant as well for both outcomes, supporting the second hypothesis.

Conclusions:

This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time, and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who used less. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing cardiovascular disease.