Comparison of the Effects of Coaching and Receipt of App Recommendations on Depression, Anxiety, and Engagement in the IntelliCare Platform: Factorial Randomized Controlled Trial
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Abstract
Background: IntelliCare is a modular platform that includes 12 simple apps targeting specific psychological strategies for common mental health problems. Objective: This study aimed to examine the effect of 2 methods of maintaining engagement with the IntelliCare platform, coaching, and receipt of weekly recommendations to try different apps on depression, anxiety, and app use. Methods: A total of 301 participants with depression or anxiety were randomized to 1 of 4 treatments lasting 8 weeks and were followed for 6 months posttreatment. The trial used a 2X2 factorial design (coached vs self-guided treatment and weekly app recommendations vs no recommendations) to compare engagement metrics. Results: The median time to last use of any app during treatment was 56 days (interquartile range 54-57), with 253 participants (84.0%, 253/301) continuing to use the apps over a median of 92 days posttreatment. Receipt of weekly recommendations resulted in a significantly higher number of app use sessions during treatment (overall median=216; P=.04) but only marginal effects for time to last use (P=.06) and number of app downloads (P=.08). Coaching resulted in significantly more app downloads (P<.001), but there were no significant effects for time to last download or number of app sessions (P=.36) or time to last download (P=.08). Participants showed significant reductions in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) across all treatment arms (P s<.001). Coached treatment led to larger GAD-7 reductions than those observed for self-guided treatment (P=.03), but the effects for the PHQ-9 did not reach significance (P=.06). Significant interaction was observed between receiving recommendations and time for the PHQ-9 (P=.04), but there were no significant effects for GAD-7 (P=.58). Conclusions: IntelliCare produced strong engagement with apps across all treatment arms. Coaching was associated with stronger anxiety outcomes, and receipt of recommendations enhanced depression outcomes. Trial Registration: ClinicalTrials.gov NCT02801877; https://clinicaltrials.gov/ct2/show/NCT02801877
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People can benefit from fully automated, unguided digital mental health treatments.
“People can benefit from fully automated, unguided DMHTs (36); however, at a population level, they show small benefits, likely because dropout rates are higher in unguided than guided interventions (37, 38).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [36]
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- Authors
- Mohr, D. C., Schueller, S. M., Tomasino, K. N., Kaiser, S. M., Alam, N., Karr, C., Vergara, J. L., Gray, E. L., Kwasny, M. J., & Lattie, E. G.
- Affiliations
- Northwestern University (US)
- University of California, Irvine (US)
- Centers for New Horizons (US)
- Corresponding author
- Mohr, David C
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2019-08-28
- Volume
- 21
- Issue
- 8
- Pages
- e13609
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC6737883
- OpenAlex
- W2963665532
- Cited by
- 116
- References
- 40
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 16 · 2023: 23 · 2022: 14 · 2021: 19 · 2020: 12 · 2019: 3
- FWCI
- 13.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001422)
- National Institute of Mental Health (K08MH112878, P50MH119029, R01MH100482)
- 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
- mental health apps, depression, anxiety, coaching, app engagement, app recommendations, self-guided treatment, digital mental health interventions, app downloads, PHQ-9, GAD-7
- MeSH terms
- Mentoring, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Research Design, Mobile Applications
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