Coached Mobile App Platform for the Treatment of Depression and Anxiety Among Primary Care Patients: A Randomized Clinical Trial
Open accessAbstract
Importance: Depression and anxiety are common and disabling. Primary care is the de facto site for treating these mental health problems but is typically underresourced to meet the burden of these demands. Objective: To evaluate the efficacy of a mobile intervention platform, IntelliCare, for addressing depression and anxiety among primary care patients. Design, Setting, and Participants: Two-arm randomized clinical trial at internal medicine clinics at the University of Arkansas for Medical Sciences. Adult primary care patients (N = 146) who screened positive for depression on the Patient Health Questionnaire-8 (PHQ; score ≥ 10) or anxiety on the Generalized Anxiety Disorder-7 (GAD-7; score ≥ 8) were recruited between July 17, 2018, and December 14, 2018. Interventions: The coach-supported platform composed of a suite of apps, was delivered over 8 weeks. Wait list control participants received treatment as usual for 8 weeks, then the mobile platform. Main Outcomes and Measures: Primary outcomes were changes in depression (PHQ-9) and anxiety (GAD-7) during the intervention period. Secondary outcomes were differences in the proportion of patients who achieved recovery (PHQ-9/GAD-7 <5 or 50% improvement from baseline), sustainment of intervention effects during 2-month follow-up, and app use during the intervention period. Results: One hundred forty-six patients were included (119 of 146 were women [81.5%]; mean [SD] age, 42.3 [13.8] years). Of the 146 patients, 122 (83.6%) were diagnosed as having depression and 131 (89.7%) were diagnosed as having anxiety. A greater proportion of intervention vs wait list control participants achieved recovery from depression (n = 38 of 64 [59%] vs n = 18 of 58 [31%]; odds ratio, 3.25; 95% CI, 1.54-6.86) and anxiety (n = 37 of 65 [57%] vs n = 25 of 66 [38%]; odds ratio, 2.17; 95% CI, 1.08-4.36). Sustained effects were observed for depression (slope, 0.01; 95% CI, -0.09 to 0.10; P = .92) and anxiety scores (slope, 0.02; 95% CI, -0.08 to 0.12; P = .67) during follow-up. App use was high, with a median of 93 and 98 sessions among participants with depression and anxiety, respectively. Conclusions and Relevance: In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients. Findings also support designing digital mental health interventions as platforms containing simple, brief apps that can be bundled by users to meet their needs. Trial Registration: ClinicalTrials.gov Identifier: NCT03500536.
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Some DMHIs can lead to greater reductions in anxiety compared with usual care.
“and can lead to greater reductions in anxiety compared with usual care [8]”
From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [8]
Some trials have shown strong patient engagement in health care settings.
“Although some trials have shown strong patient engagement in health care settings (59), others have had high dropout rates (60, 61).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [59]
Patient engagement has been a challenge for some digital mental health treatments.
“Patient engagement has been a challenge for some DMHTs. Although some trials have shown strong patient engagement in health care settings (59), others have had high dropout rates (60, 61).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [59]
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- Authors
- Graham, A. K., Greene, C. J., Kwasny, M. J., Kaiser, S. M., Lieponis, P., Powell, T., & Mohr, D. C.
- Affiliations
- Northwestern University (US)
- University of Arkansas for Medical Sciences (US)
- Actualize Therapy, Inc, Chicago, Illinois
- Corresponding author
- Mohr, David C.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2020-09-01
- Volume
- 77
- Issue
- 9
- Pages
- 906
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC7240649
- OpenAlex
- W3027708473
- Cited by
- 162
- References
- 43
- Citations by year
- 2026: 22 · 2025: 41 · 2024: 20 · 2023: 28 · 2022: 17 · 2021: 31 · 2020: 3
- FWCI
- 17.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (U54TR001629, UL1TR001422)
- National Institute of Mental Health (P50MH119029, R44MH114725)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116925)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, anxiety, mobile health intervention, primary care, recovery from depression, sustained treatment effects, app use, PHQ-9, GAD-7, internal medicine clinic, digital mental health, waitlist control
- MeSH terms
- Internet-Based Intervention, Adult, Anxiety Disorders, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Education as Topic, Primary Health Care, Psychotherapy, Telephone, Telemedicine, Text Messaging, Mobile Applications
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