JMIR Publications

ABSTRACT

Background:

One out of two adults with Attention deficit hyperactivity disorder (ADHD) struggle with major depressive (MDD) and/or anxiety disorders (GAD). The co-occurrence of these disorders affects treatment adherence and, therefore, clinical outcomes. The presence of depressive and/or anxiety symptoms can mask symptoms of ADHD and forestall its diagnosis in adult populations, while they can also create a barrier to utilization of the available treatment options. These confounding factors have created a treatment dilemma that needs to get the attention of the research community.

Objective:

The objective of this study is to investigate the (i) feasibility and acceptance of a digital mental health program, (ii) participants’ engagement and retention levels during the study and the potential efficacy with respect to anxiety and depression symptoms for a population with ADHD. Our main hypothesis is that a digital, data-driven and personalized intervention for adults with coexisting ADHD and depressive and/or anxiety symptoms would show high engagement and adherence levels which would be accompanied by a substantial decrease in depressive and anxiety symptoms, along with an overall increase in the quality of life and life satisfaction levels.

Methods:

This real-world data single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive and/or anxiety symptoms that joined a 16-week digital, data-driven, mental health support program. This intervention is based on a combination of evidence-based approaches, such as cognitive behavioral therapy, mindfulness and Positive Psychology techniques. The targeted symptomatology was evaluated using the PHQ-9, GAD-7 and BAARS-IV questionnaires. Quality of life aspects were evaluated using the Satisfaction with Life Scale (SWLS) and the Life Satisfaction Questionnaire (LISAT-11) and user feedback surveys were used to assess user experience and acceptability.

Results:

The overall retention during the study was 96% (29/30), followed by very high engagement levels, as depicted by the 69 minutes spent in the app, 5 emotion logs and 11.5 Mental Health Actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive and 46.3% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half of the participants (17/30 and 18/30 in each case). This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P<.003; r=0.8) in SWLS and LISAT-11 scores. The overall participant satisfaction level was 4.3/5.

Conclusions:

The findings support the feasibility, acceptability and value of the examined digital program for adults with ADHD symptomatology to support the coexisting depressive and/or anxiety symptoms. However, controlled trials with larger sample size and more diverse participant profiles are required in order to provide further evidence of clinical efficacy.