JMIR Publications

ABSTRACT

Background:

Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using Cognitive Behavioral Therapy (CBT) have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outcomes. However, there is a limited understanding of the association between digital platform components and clinical outcomes.

Objective:

This study investigated the contribution of specific digital engagement tools to mental health conditions. We hypothesized that participation in coaching sessions and breathing exercises would be associated with a reduction in depression and anxiety correspondingly.

Methods:

Depression and general anxiety symptoms were evaluated in real-world data cohorts using the digital health platform for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed two cohorts of people: (1) users who started with moderate levels of depression and completed at least two depression assessments (n=519) and (2) users who started with moderate levels of anxiety and completed at least two anxiety assessments (n=474). Levels of depression (PHQ-9) and anxiety (GAD-7) were tracked throughout the first 16 weeks. A piecewise mixed effects model was applied to model the trajectories of the PHQ-9 and the GAD-7 mean scores in two segments (1-6 weeks and 7-16 weeks). Finally, simple slope analysis was used for the interpretation of the interactions probing the moderators: coaching session and breathing exercise in both depression and anxiety cohorts.

Results:

Analysis revealed significant decrease in depression symptoms (B=-0.34, CI 95% -0.52- -0.16, p=<0.001) during the period of weeks 1-6 of app usage which was maintained during the period of 7-16 weeks. Coach interaction significantly moderated the reduction in depression symptoms during the period of weeks 1-6 (B=-0.03, 95% CI -0.05- -0.001, p=0.02). A significant decrease in anxiety symptoms (B=-0.42, 95% CI -0.51- -0.33, p=<0.001) was revealed during the period of 1-6 weeks which was maintained during the period of 7-16 weeks. Breathing exercise significantly moderated the reduction in anxiety symptoms during the period of 1-6 weeks (B= -0.07, 95% CI -0.14- -0.01, p=0.02).

Conclusions:

This study demonstrated general improvement followed by a period of stability of depression and anxiety symptoms associated with CBT-based digital intervention. Interestingly, engagement with a coaching session but not breathing exercise was associated with reduction in depression symptoms. Moreover, breathing exercise but not engagement with a coaching session was associated with a reduction of anxiety symptoms. These findings emphasize the importance of utilizing a personalized approach to behavioral health during digital health interventions.