JMIR Publications

ABSTRACT

Background:

Background:

Mood and anxiety disorders are prevalent mental health diagnoses. Numerous studies have shown that measurement-based care (MBC), which is used to monitor patient symptoms, functioning, and progress in treatment, as well as help guide clinical decisions and collaborate on treatment goals, can improve outcomes in patients with these disorders. Including digital information on patients’ electronic communications and social media activity is an innovative approach to augmenting MBC. Recent data indicate interest and willingness from both mental health clinicians and patients for sharing this type of digital information in treatment sessions. However, the clinical benefit of systematically doing this has been minimally evaluated.

Objective:

Objective:

To develop an electronic dashboard for tracking patients’ digital social activity and a protocol for a pragmatic randomized trial to test the feasibility and efficacy of using the dashboard in real-world clinical care of patients with depression and/or anxiety disorders.

Methods:

Method: We developed a personalized electronic dashboard which tracks patients’ electronic communications and social media activity, visualizes data on these interactions in key graphics and figures, and provides a tool that can be readily integrated into routine clinical care for use by clinicians and patients during treatment sessions. We then designed a randomized trial to evaluate the feasibility and effectiveness of using the electronic dashboard in real-world care compared to treatment as usual (TAU). The trial will include patients 12 years and older with a mood and/or anxiety disorder who are receiving treatment in outpatient psychiatry clinics in the Johns Hopkins Health System and the Kennedy Krieger Institute. The primary outcome includes changes in patient-rated depressive symptoms. Secondary outcomes include changes in patient-rated anxiety symptoms and overall functioning. Exploratory analyses will examine the impact of the intervention on measures of therapeutic alliance and the detection of clinically actionable targets.

Results:

Results:

We successfully developed an electronic dashboard for tracking patients’ electronic communications and social media activity, and we implemented a protocol for evaluating the feasibility and efficacy of using the dashboard in routine care for mood and/or anxiety disorders. The protocol was approved by the Johns Hopkins University School of Medicine Institutional Review Board, and the study is currently underway. Here, we discuss the technological, ethical and pragmatic challenges in developing the dashboard and testing it in a real-world setting. The lessons learned in implementing the study inform on-going discussions about the value of gathering collateral information on patients’ digital social activity and how to do it in a way that is acceptable and clinically effective.

Conclusions:

Conclusions:

The integration of an electronic dashboard and monitoring digital social activity into mental health care treatment is novel. This study examines the feasibility and effectiveness of the dashboard as well as challenges in implementing this protocol. Data from this study will provide guidance on the use of systematically incorporating electronic communication into clinical care. Clinical Trial: clinical trial: NCT03925038