JMIR Publications

ABSTRACT

Background:

Gender minority populations experience increased risk of depression relative to cisgender counterparts and report significant access barriers to mental health services. While digital mental health (DMH) technologies may address barriers, it remains unclear how gender minority consumers engage with DMH services and if DMH improves their clinical outcomes.

Objective:

This naturalistic study explored 15-week clinical outcomes of cisgender and gender minority clients of a large DMH provider.

Methods:

The analytic sample included Talkspace clients (N=20,156) with a baseline PHQ-8 score ≥10. Participants completed at least two PHQ-8 assessments over 15 weeks of treatment. Changes in depression symptoms by gender were examined via multilevel linear models. Differences in secondary clinical outcomes were examined via Chi-square and Fisher’s exact tests.

Results:

Compared to cisgender men, rates of change in PHQ-8 scores were significantly slower for gender diverse participants (b=0.60, P≤.001), nonbinary participants (b=0.81, P≤.001), and transgender women (b=0.87, P=.007), but not for cisgender women (P=.98) or transgender men (P=.38). There were significant differences by gender in treatment response from weeks 3 to 12 (P≤.02), remission at weeks 3, 6, 9, and 15 (P≤.047), and clinically significant symptom reduction at each timepoint (P≤.03). There were no significant differences in deterioration by gender from weeks 3 to 15 (P>.05).

Conclusions:

While clinical outcomes improved over time, some gender minority populations experienced slower improvements compared to cisgender participants. Future research may explore strategies to adapt DMH interventions to better meet the needs of diverse gender identities. Clinical Trial: N/A