JMIR Publications

ABSTRACT

Background:

Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge.

Objective:

We sought to examine predictors of engagement in digital mental health services offered as part of an employer-based mental health benefit that utilizes a technology-enabled care platform.

Methods:

Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions.

Results:

In total 950 individuals enrolled in the study, with 38% using any digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both digital and 1:1 modalities made up about one quarter the sample (N=235, 24.7%). Those using only coaching or therapy (N=170, 17.9%) and those using only digital mental health resources (N=126, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% more mHealth digital mental health resource interactions while use of any teletherapy session was associated with 79.5% more digital mental health resources interactions (both P<0.001).

Conclusions:

Our key finding was that use of coaching and/or teletherapy was associated with increased self-guided digital mental health resource utilization. Higher digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with one modality in the platform, they may be more likely to begin engaging with others, becoming ‘super users’ of all resources.