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Original Investigation
May 20, 2020

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

Author Affiliations
  • 1Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois
  • 2Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
  • 3Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
  • 4Department of Preventive Medicine, Northwestern University, Chicago, Illinois
  • 5Actualize Therapy, Inc, Chicago, Illinois
  • 6Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock
JAMA Psychiatry. Published online May 20, 2020. doi:10.1001/jamapsychiatry.2020.1011
Key Points

Question  Is a mobile intervention platform composed of a suite of simple-to-use apps, supported by brief coaching, efficacious for treating depression and anxiety among primary care patients?

Findings  In this randomized clinical trial of 146 patients with depression and anxiety, a mobile platform achieved greater reductions in depression and anxiety and higher odds of recovery compared with treatment-as-usual wait list control individuals, and effects were sustained at follow-up. Engagement with apps was high throughout the intervention period.

Meaning  Results support the efficacy of a platform approach to mobile intervention using apps designed to fit into the fabric of users’ lives for treating patients with depression and anxiety in primary care.

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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