JMIR Publications

ABSTRACT

Background:

Perceived stress in the United States has drastically increased since the COVID-19 pandemic and is associated with negative mental health outcomes such as depression and anxiety. Digital mental health (DMH) interventions are efficacious tools to address negative mental health outcomes and have helped reduce psychological symptom severity such as anxiety, depression, and perceived stress compared to waitlist controls. Although DMH tools have been studied in controlled settings, less is known about the real-world evidence of such interventions.

Objective:

1) Characterize patterns in baseline perceived stress and changes in perceived stress among Headspace members with moderate and severe baseline perceived stress; and 2) examine associations between engagement with Headspace content and changes in perceived stress (evaluate if there is a dose-response relationship).

Methods:

We evaluated two timepoints of real-world perceived stress and engagement data from Headspace app members with baseline moderate and severe perceived stress. Perceived stress was measured using the Perceived Stress Scale (PSS-10) and engagement using active days and active minutes engaged with Headspace as well as number of user sessions. Descriptive statistics were computed for all variables. Correlations examined relationships between PSS-10 baseline and follow-up scores, PSS-10 percent change, days between PSS-10, active days, active days/week, active minutes, active minutes/day, sessions, and sessions/week. T-tests investigated the differences in baseline PSS-10, follow-up PSS-10, PSS-10 percent change, active days, active days/week, active minutes, active minutes/day, sessions, and sessions/week between: 1) those who did and did not improve PSS-10 scores (yes vs. no improvement); and 2) those who improved ≥30% vs. those with <30% improvement.

Results:

Overall 21,088 Headspace members were included in these analyses. On average, members saw a 23.52% decrease in PSS-10 scores from baseline to follow-up. On average members had 2.42±1.76 active days/week, 25.89±33.40 active minutes/day, and completed 7.11±8.34 sessions/week. T-tests suggest that members who improved PSS-10 scores from baseline to follow-up had significantly higher baseline PSS-10 scores (d=0.56), more active days/week (d=0.33), and more sessions/week (d=0.27) than those who did not improve PSS-10 scores (all P<0.001). Additional t-tests suggest that members with ≥30% PSS-10 improvement had significantly higher baseline PSS-10 scores (d=0.35), more active days/week (d=0.36), and more sessions/week (d=0.31) than those with >30% PSS-10 improvement (all P<0.001).

Conclusions:

Findings suggest that real-world use of Headspace is associated with decreased perceived stress. Furthermore, data suggest that more engagement, specifically weekly active days and sessions, is associated with greater likelihood of stress reduction.