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

Educational Objective
To evaluate the efficacy of a mobile intervention platform, IntelliCare, for addressing depression and anxiety among primary care patients.
1 Credit CME
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.


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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Article Information

Corresponding Author: David C. Mohr, PhD, Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, 750 N Lake Shore Dr, 10th Floor, Chicago, IL 60611 (d-mohr@northwestern.edu).

Accepted for Publication: March 9, 2020.

Published Online: May 20, 2020. doi:10.1001/jamapsychiatry.2020.1011

Author Contributions: Drs Mohr and Kwasny had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Greene, Lieponis, Mohr.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Graham, Greene, Kaiser, Mohr.

Critical revision of the manuscript for important intellectual content: Graham, Greene, Kwasny, Lieponis, Powell, Mohr.

Statistical analysis: Kwasny, Powell, Mohr.

Obtained funding: Greene, Mohr.

Administrative, technical, or material support: Graham, Greene, Kaiser, Lieponis, Mohr.

Supervision: Graham, Greene, Mohr.

Conflict of Interest Disclosures: Dr Mohr has an ownership interest in Adaptive Health Inc, which has a license from Northwestern University to commercialize IntelliCare. Drs Graham and Kwasny and Ms Kaiser have received consulting fees from Actualize Therapy LLC. Dr Graham reported grants from the National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study and from the National Institute of Mental Health outside the submitted work. Dr Greene reported grants from Actualize Therapy during the conduct of the study. Dr Powell reported grants from the National Institutes of Health Small Business Innovation Research during the conduct of the study. Dr Mohr reported grants from the National Institute of Mental Health during the conduct of the study; personal fees from Apple Inc; and other support from Actualize Therapy Inc and Otsuka Pharmaceuticals outside the submitted work; in addition, Dr Mohr had a patent to US Patent 15/654,245, 2018 pending. No other disclosures were reported.

Funding/Support: This work was supported by grants from the National Institutes of Health (R44 MH114725 and K01 DK116925) as well as by the Translational Research Institute (U54 TR001629) through the National Center for Advancing Translational Sciences of the National Institutes of Health.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3.

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