JMIR Publications

ABSTRACT

Background:

Background:

Depression and anxiety are highly prevalent and burdensome, yet many individuals, especially those with subclinical symptoms, remain underserved by traditional care models. While digital mental health interventions (DMHIs) have improved access, few integrate high-frequency measurement-based care (MBC) or evaluate outcomes across the full spectrum of symptom severity in real-world settings.

Objective:

Objectives: The purpose of this study was to examine the effects of participation in a commercial MBC DMHI, Rula Health, on changes in depression and anxiety over time in both subclinical and clinical patients. We aimed to: (1) explore the trajectories of anxiety and depression symptoms, and (2) examine the impact of demographics and primary diagnosis on depression and anxiety trajectories.

Methods:

Methods:

We retrospectively analyzed longitudinal symptom data from adults receiving therapy through Rula Health, a MBC-based DMHI. Depression and anxiety symptoms were measured before each visit over 12 therapy visits. Linear mixed-effects models were used to evaluate symptom trajectories and identify moderators of treatment response, including demographics characteristics and primary diagnosis.

Results:

Results:

A total of 365,741 adults (mean age 37; 66% female; 60% White) with 2,685,1032 therapy visits were included in the sample. Baseline depression and anxiety scores averaged 9.41 and 9.45, respectively, decreasing to 6.37 and 6.50 within 12 visits. Linear mixed effects model results showed that depression (b=-0.72., p<0.0001) and anxiety (b=-0.72, p<0.0001) symptoms decreased significantly over the first 5 visits, and to a lesser degree over visits 6-12 (depression: b=-0.02, p<0.0001; anxiety: b=-0.0078, p=0.0044). Demographic characteristics including age, gender, race, ethnicity, and diagnosis were significant moderators of visit 1-5 and visit 6-12 slopes.

Conclusions:

Conclusion: Rula Health is one of the only commercial DMHIs to demonstrate significant improvements in depression and anxiety across both subclinical and clinical populations using real-world data at scale. Symptom reductions were most rapid in the first five visits, with continued improvements through session 12, especially among historically underserved groups. These findings highlight Rula Health’s ability to deliver early, sustained, and equitable outcomes through a MBC model.