Primary care patients customized a selection of apps based on individual wants and needs

A suite of simple smartphone apps that users can bundle and customize to align with their clinical needs was effective in managing depression and anxiety in primary care patients, new randomized clinical trial data showed.

“Digital mental health interventions (DHMIs) have been championed as a solution to access barriers and high dropout rates for psychotherapy among primary care patients. However, engagement has proven challenging,” wrote study first author Andrea Graham, PhD, a researcher with the Center for Behavioral Intervention Technologies at Northwestern University in Chicago, and colleagues, in JAMA Psychiatry. “Our findings may be because the platform approach matches how people use apps: participants could use or ignore apps as preferred, and the novelty of receiving new apps is likely engaging…Findings support the movement of DMHIs from single apps for depression or anxiety to platform approaches containing multiple brief apps that patients can bundle to meet their needs and fit into the fabric of their lives.”

DMHIs can be cost-effective and can potentially improve the capacity of health care settings to address mental health problems, the study authors noted. However, implementation in primary care has often failed, in part because of the apps’ inability to fully engage patients.

Digital interventions delivered through standard computers are primarily based on evidence-based therapies, rely heavily on psychoeducation, and usually require 30-45 minutes per week for 6 or more weeks in order to achieve results. In contrast, Graham and colleagues wrote, smartphone apps are single-purpose and are designed to be used over shorter periods of time. Even so, previous data showed smartphone app adherence falling over the first 2 weeks of use.

“App-based DMHIs may have greater success if they accommodate… 2 major challenges for delivering mental health interventions,” Graham and colleagues wrote. “First, the many effective behavioral strategies may appeal differentially to different people. Second, people do not tend to use mental health apps for long periods.”

At the center of the recent study was IntelliCare, a platform designed to address those challenges by offering a suite of smartphone apps providing educational material and weekly symptom assessments. Over 8 weeks, study participants received access to 5 clinically focused apps within the IntelliCare platform, with trained coaches recommending new apps to try based on patient preferences and set recommendation protocols.

A total of 146 patients were included in the study (119 of 146 women [81.5%]; mean [SD] age, 42.3 [13.8] years). Of those patients, 122 (83.6%) were diagnosed with depression and 131 (89.7%) were diagnosed with anxiety.

A greater proportion of intervention versus waitlist control participants were determined to have recovered from depression (n=38 of 64 [59%] versus n=18 of 58 [31%]; OR 3.25; 95% CI 1.54-6.86) and anxiety (n=37 of 65 [57%] versus n=25 of 66 [38%]; OR 2.17; 95% CI 1.08-4.36).

The findings showed IntelliCare achieved significant success both in terms of engagement and actual clinical metrics. Sustained effects emerged at follow-up for depression (slope 0.01; 95% CI −0.09 to 0.10; P=0.92) and anxiety (slope 0.02; 95% CI −0.08 to 0.12; P=0.67). Median overall app use was high, with 93 and 98 sessions occurring, respectively, among people with depression and anxiety. Further, respective effect sizes in the trial of 0.78 and 0.64 for depression and anxiety approximated those found by analyses of the effects of psychotherapy (0.69 and 0.84, respectively).

According to the study authors, the results may have suggested that the IntelliCare platform and the apps it contains are better suited to the tendencies of modern primary care patients.

“Our findings may be because the platform approach matches how people use apps: participants could use or ignore apps as preferred, and the novelty of receiving new apps is likely engaging,” Graham and colleagues wrote. “The sample also comprised a group rarely represented in technology research: in contrast to past research, which has tended to attract those drawn to technology, participants were from a diverse, traditionally underserved community seeking help for depression and anxiety. Thus, findings suggest this service appealed to patients more generally and underscore the importance of designing DMHIs to match patients’ app use preferences.”

The study team identified several limitations in data, including a follow-up period that was insufficient to replicate previous studies and the fact that the self-reported data on which the study relied could mean findings are not generalizable to mental health clinics and other settings where more thorough assessments might occur.

Future studies will be needed, Graham and colleagues wrote, particularly into the effects of customizable app combinations as opposed to a more static presentation.

“Taken together, the relative high engagement suggests that platform approaches, such as IntelliCare, may be more acceptable to patients and likely produce better outcomes than disorder-focused single apps; however, this remains to be tested in a trial,” Graham and colleagues wrote.

  1. A suite of smartphone apps helped improve depression and anxiety in primary care patients.

  2. Customizable apps allowed patients to tailor their experience — which could increase adherence.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this article disclosed any relevant financial relationship with industry.

Cat ID: 146

Topic ID: 87,146,730,192,146,925