Evaluation of an On-Demand Mental Health System for Depression Symptoms: Retrospective Observational Study (Preprint)

BACKGROUND Depression is an extremely prevalent issue in the United States, with an estimated 7% of adults experiencing at least one major depressive episode in 2017. Although psychotherapy and medication management are effective treatments for depression, significant barriers in accessing care persist. Virtual care can potentially address some of these obstacles. OBJECTIVE We conducted a preliminary investigation of utilization characteristics and effectiveness of an on-demand health system for reducing depression symptoms. METHODS Data were analyzed from 1662 users of an on-demand mental health system that includes behavioral health coaching, clinical services (therapy and psychiatry), and self-guided content and assessments primarily via a mobile app platform. Measures included engagement characterized by mobile app data, member satisfaction scores collected via in-app surveys, and depression symptoms via the Patient Health Questionnaire-2 (PHQ-2) at baseline and 8-12 week follow-up. Descriptive statistics are reported for measures, and pre/post-PHQ-2 data were analyzed using the McNemar test. A chi-square test was used to test the association between the proportion of individuals with an improvement in PHQ-2 result and care modality (coaching, therapy, and psychiatry, or hybrid). RESULTS During the study period, 65.5% of individuals (1089/1662) engaged only in coaching services, 27.6% of individuals (459/1662) were engaged in both coaching and clinical services, 3.3% of individuals (54/1662) engaged only in clinical services, and 3.7% of individuals (61/1662) only used the app. Of the 1662 individuals who completed the PHQ-2 survey, 772 (46.5%) were considered a positive screen at intake, and 890 (53.6%) were considered a negative screen at intake. At follow-up, 477 (28.7%) of individuals screened positive, and 1185 (71.3%) screened negative. A McNemar test showed that there was a statistically significant decrease in the proportion of users experiencing depressed mood and anhedonia more than half the time at follow-up (<i>P</i><.001). A chi-square test showed there was no significant association between care modality and the proportion of individuals with an improvement in PHQ-2 score. CONCLUSIONS This study provides preliminary insights into which aspects of an on-demand mental health system members are utilizing and levels of engagement and satisfaction over an 8-12 week window. Additionally, there is some signal that this system may be useful for reducing depression symptoms in users over this period. Additional research is required, given the study limitations, and future research directions are discussed.

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Evaluation of an On-Demand Mental Health System for Depression Symptoms: Retrospective Observational Study

Journal of Medical Internet Research ◽

10.2196/17902 ◽

2020 ◽

Vol 22 (6) ◽

pp. e17902

Author(s):

Sarah Kunkle ◽

Manny Yip ◽

Watson Ξ ◽

Justin Hunt

Keyword(s):

Mental Health ◽

Health System ◽

Mental Health System ◽

Mobile App ◽

Depression Symptoms ◽

Clinical Services ◽

Chi Square ◽

On Demand ◽

Chi Square Test

Background Depression is an extremely prevalent issue in the United States, with an estimated 7% of adults experiencing at least one major depressive episode in 2017. Although psychotherapy and medication management are effective treatments for depression, significant barriers in accessing care persist. Virtual care can potentially address some of these obstacles. Objective We conducted a preliminary investigation of utilization characteristics and effectiveness of an on-demand health system for reducing depression symptoms. Methods Data were analyzed from 1662 users of an on-demand mental health system that includes behavioral health coaching, clinical services (therapy and psychiatry), and self-guided content and assessments primarily via a mobile app platform. Measures included engagement characterized by mobile app data, member satisfaction scores collected via in-app surveys, and depression symptoms via the Patient Health Questionnaire-2 (PHQ-2) at baseline and 8-12 week follow-up. Descriptive statistics are reported for measures, and pre/post-PHQ-2 data were analyzed using the McNemar test. A chi-square test was used to test the association between the proportion of individuals with an improvement in PHQ-2 result and care modality (coaching, therapy, and psychiatry, or hybrid). Results During the study period, 65.5% of individuals (1089/1662) engaged only in coaching services, 27.6% of individuals (459/1662) were engaged in both coaching and clinical services, 3.3% of individuals (54/1662) engaged only in clinical services, and 3.7% of individuals (61/1662) only used the app. Of the 1662 individuals who completed the PHQ-2 survey, 772 (46.5%) were considered a positive screen at intake, and 890 (53.6%) were considered a negative screen at intake. At follow-up, 477 (28.7%) of individuals screened positive, and 1185 (71.3%) screened negative. A McNemar test showed that there was a statistically significant decrease in the proportion of users experiencing depressed mood and anhedonia more than half the time at follow-up (P<.001). A chi-square test showed there was no significant association between care modality and the proportion of individuals with an improvement in PHQ-2 score. Conclusions This study provides preliminary insights into which aspects of an on-demand mental health system members are utilizing and levels of engagement and satisfaction over an 8-12 week window. Additionally, there is some signal that this system may be useful for reducing depression symptoms in users over this period. Additional research is required, given the study limitations, and future research directions are discussed.

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A New Digital Mental Health System Infrastructure for Diagnosis of Psychiatric Disorders and Patient Follow-Up by Text Analysis in Turkish

IFMBE Proceedings - CMBEBIH 2019 ◽

10.1007/978-3-030-17971-7_59 ◽

2019 ◽

pp. 395-402

Author(s):

Zeynep Orhan ◽

Mine Mercan ◽

Merve Kevser Gökgöl

Keyword(s):

Mental Health ◽

Health System ◽

Psychiatric Disorders ◽

Text Analysis ◽

Mental Health System

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Chronicity of Symptoms in Combat Veterans with PTSD Treated by the VA Mental Health System

Psychological Reports ◽

10.2466/pr0.1994.75.2.843 ◽

1994 ◽

Vol 75 (2) ◽

pp. 843-848 ◽

Cited By ~ 8

Author(s):

B. Christopher Frueh ◽

Robert F. Mirabella ◽

Keith Chobot ◽

Mark D. Fossey

Keyword(s):

Mental Health ◽

Health System ◽

Mental Health System ◽

Combat Veterans ◽

Self Report ◽

Time In Treatment ◽

Show Evidence ◽

Mississippi Scale ◽

Two Stages

Self-report questionnaire data, collected at two stages of treatment, are presented for a group of 40 combat veterans with PTSD treated within the VA mental health system. Patients completed the Beck Depression Inventory, Mississippi Scale, and Dissociative Experiences Scale prior to treatment at a PTSD outpatient clinic and at midtreatment follow-up. Patients' symptom reports at follow-up were not correlated with length of time in treatment. Further, results suggest that patients' self-reported symptoms on these measures do not show evidence of improvement after entry into the VA mental health system. Explanations for this apparent chronicity of symptoms are discussed.

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Association between virtual care modality, utilization, and anxiety outcomes: retrospective observational study (Preprint)

10.2196/preprints.24662 ◽

2020 ◽

Author(s):

Sarah Kunkle ◽

Manny Yip ◽

Justin Hunt ◽

Watson Ξ ◽

Dana Udall ◽

...

Keyword(s):

Mental Health ◽

Observational Study ◽

Health System ◽

Mental Health System ◽

Anxiety Symptoms ◽

Retrospective Observational Study ◽

Public Health Perspective ◽

On Demand ◽

Clinically Significant ◽

Health System Data

BACKGROUND Anxiety is an extremely prevalent condition, but has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. Growing concerns about the burden of anxiety have only been exacerbated by the Coronavirus (COVID-19) pandemic due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities OBJECTIVE This study aimed to examine differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and collaborative) within an on-demand mental health system. We also explored the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety METHODS We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018 and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. RESULTS 761/1611 (47.0%) experienced a decrease in anxiety symptoms as measured by a change from positive to negative GAD-2 screen. Among members who still screened positive (n=865; 53%) at follow up, a total of 192 members (11.9%) experienced a clinically significant reduction in score on the full GAD-7 (i.e. a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app only”). Higher GAD-7 intake score was also associated with decreased odds of improvement. CONCLUSIONS This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in collaborative care (teletherapy and text-based coaching) have the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and exploring explanations and solutions for lower utilization members.

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