JMIR Publications

ABSTRACT

Background:

Despite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire (PHQ-9) and/or General Anxiety Disorder (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, the current study utilized the health-related quality of life (HRQoL) tool from the Center for Disease Control and Prevention (CDC) “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical individuals and individuals with symptoms not meeting clinical thresholds.

Objective:

The purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL.

Methods:

Two hundred and eighty-eight members completed the 4-item HRQoL measure at baseline and one-month following use of the Ginger on-demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively.

Results:

Members completed on average 1.92 coaching sessions (SD = 2.16) and 0.91 clinical sessions (SD = 1.37) during the assessment month. Paired samples t-tests revealed significant reductions in the average number of unhealthy mental health days between baseline (M = 16.0 days) and one month later (M = 13.2 days), and in the average number of days adversely impacted (M = 10.9, M = 8.19 at baseline and follow-up, respectively). Both subclinical members and members with clinically anxious and/or depressive symptoms demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days. Finally, member-engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days.

Conclusions:

To our knowledge, this study is one of the first to utilize the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed.