JMIR Publications

ABSTRACT

Background:

Depression is a common psychiatric condition, with an estimated lifetime prevalence for Major Depression of 16.6% among the U.S. adult population, and is effectively treated through psychotherapy. The widespread availability of personal devices such as smartphones have led to an increase in technology-mediated psychotherapy; however, little is known about whether and for whom this type of therapy is beneficial and whether having synchronous video-based sessions provides additional benefit to clients above and beyond messaging-based therapy.

Objective:

This study examined outcomes associated with the use of a digital platform (Talkspace) providing technology-mediated psychotherapy. We examined how long clients engaged in therapy and client depression score trajectories over 16 weeks. We explored the association of client characteristics, therapist characteristics, and type of service plan with time-to-disengagement and trajectories of change in depression scores.

Methods:

This naturalistic observational study harnessed data collected routinely by the platform between January 2016 and January 2018 and examines psychotherapy outcomes among a large representative sample of adult clients with clinically significant depression. Treatment disengagement was defined as a lack of client-initiated communication for more than four weeks. Clients completed the Patient Health Questionnaire-8 item (PHQ-8) at intake and every 3 weeks via an in-app survey. Cox regression was used to examine time until and predictors of disengagement. Change in depression scores and predictors of change over time were examined with mixed effects regressions.

Results:

The study included 5,890 clients and 1271 therapists. Client scores on the PHQ-8 declined over time, with the average client improving from a score of 15 to below the clinical cutoff of 10 by week 6. By this same time point, 37% of clients had disengaged from the therapy. When combined into a final Cox regression model, those more likely to disengage were clients aged 18-25 versus 50 years or older (OR 0.82, 95% CI 0.74-0.9; P < .001), had higher education (OR 1.14, 95% CI 1.06-1.22; P < .001), had been in therapy before (OR 1.09, 95% CI 1.02-1.17; P =.01), and were living with a partner but unmarried versus single (OR 1.14, 95% CI 1.02-1.27; P = .02). Having a therapist with more than 10 years of experience was related to lower odds of disengagement (OR 0.87, 95% CI 0.8-0.94; P = .01). When combined into a final regression model predicting improvement in depression scores over time, clients showing more improvement were those with an Associate’s degree or higher (linear est = -0.07, p = .002) and with higher intake PHQ-8 scores (est = 3.73, P < .001). There were no differences based on plan type.

Conclusions:

Our findings add to the growing literature showing the benefit of technology-mediated psychotherapy in a relatively brief period of time (16 weeks).