Cited by 162Digital Mental Health InterventionsMobile Health and mHealth ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Coached Mobile App Platform for the Treatment of Depression and Anxiety Among Primary Care Patients: A Randomized Clinical Trial

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Graham, Andrea K., Greene, Carolyn J., Kwasny, Mary J., Kaiser, Susan M., Lieponis, Paul, Powell, Thomas, Mohr, David C.·2020·JAMA Psychiatry

DOI 10.1001/jamapsychiatry.2020.1011PMC PMC7240649

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Abstract

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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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.
ORCID: Graham, Andrea K.
Greene, Carolyn J.
Kwasny, Mary J.
Kaiser, Susan M.
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)
DOI: 10.1001/jamapsychiatry.2020.1011
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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Coached Mobile App Platform for the Treatment of Depression and Anxiety Among Primary Care Patients: A Randomized Clinical Trial

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