The effect of depression and anxiety symptom severity on clinical outcomes and app use in digital mental health treatments: Meta-regression of three trials

• Published in: Behaviour research and therapy Vol. 147; p. 103972
• Main Authors: Mohr, David C., Kwasny, Mary J., Meyerhoff, Jonah, Graham, Andrea K., Lattie, Emily G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2021; Elsevier Science Ltd
• Subjects: Anxiety; Anxiety - therapy; Anxiety Disorders - therapy; Clinical outcomes; Clinical trials; Depression; Depression - therapy; Educational attainment; eHealth; Health care; Health care industry; Humans; Mental depression; Mental Health; Mental health services; mHealth; Mobile Applications; Severity; Symptoms; Treatment methods; Treatment outcomes; mHealth; Depression; Anxiety; eHealth
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2021.103972

A large number of trials have consistently shown that guided digital mental health treatments (DMHTs) are effective for depression and anxiety. As DMHTs are adopted by healthcare organizations, payers, and employers, they are often considered most appropriate for people with mild-to-moderate levels of symptom severity. Thus, the aim of this study was to examine the effects of symptom severity on depression and anxiety outcomes and app use across three trials of a guided DMHT, IntelliCare. Participants were categorized into mild, moderate, moderately severe, and severe symptom severity groups on depression and anxiety. All symptom severity groups showed significant reductions in depression and anxiety in a clear ordinal pattern, with the mild symptom severity group showing the smallest changes and the severe symptom group showing the largest improvements. Those with the lowest levels of educational attainment showed the largest symptom improvement. Baseline symptom severity was not significantly related to app use. App use was significantly related to depression and anxiety outcomes. These findings suggest that depression and anxiety symptom severity is not useful in determining who should be referred to a guided DMHT. •IntelliCare, a guided digital mental health treatment for depression and anxiety, was effective across three trials at all levels of baseline symptom severity.•There was no evidence that baseline symptom severity, or comorbidity of depression and anxiety affected app use.•Symptom severity alone is not useful in determining who should be referred to a guided digital mental health treatment for depression or anxiety.