Digital intervention helped improve depression outcomes in primary care

A digital behavioral program appeared effective at treating depression symptoms in primary care, a recent study found.

Patients at 22 primary care clinics in South Carolina who had at least moderate symptoms of depression on the Patient Health Questionnaire-9 (PHQ-9) were randomly assigned to a digital behavioral intervention called Moodivate, to Moodivate with clinician access to information on patients' usage in the electronic health record (EHR), or to usual care for depression. Additional inclusion criteria were English proficiency, willingness to use a mobile app for treating depressed mood, ownership of a smartphone, email or text messaging access, and a scheduled primary care appointment in the next four weeks. The trial's primary outcome was change in depression symptoms on the Beck Depression Inventory-II (BDI-II) over 12 weeks, while secondary outcomes included clinically significant improvement in depression symptoms, defined as a 10-point decrease in BDI-II score, and depression remission, defined as a score of 13 or lower. The results were published April 14 by JAMA Internal Medicine.

Of the 649 participants included in the trial's final analysis, 76% were female and the mean age was 44.68 years. Mean BDI-II score at baseline was 32.87, and 524 patients (81%) said they had been taking a medication for mental or emotional health for a mean of 4.26 years. Two hundred sixteen had been randomized to the Moodivate group, 221 to the Moodivate plus EHR group, and 212 to usual care. Those who received Moodivate, with and without EHR integration, had significantly improved depression symptoms over 12 weeks versus usual care (least-squares mean change from baseline, −10.34 for Moodivate, −9.88 for Moodivate with EHR, and −5.94 for usual care). Patients assigned to the Moodivate groups had 2.5 to 3.0 times higher odds of a clinically significant improvement in depression symptoms than those assigned to usual care (odds ratios [ORs], 2.98 [97.5% CI, 1.69 to 5.27] and 2.53 [97.5% CI, 1.45 to 4.41] for Moodivate and Moodivate plus EHR, respectively; P<0.001 for both comparisons), as well as higher odds of depression remission (ORs, 2.27 [97.5% CI, 1.16 to 4.44] and 2.63 [97.5% CI, 1.38 to 5.04]; P=0.006 and P<0.001, respectively). Weekly retention for Moodivate ranged from 68% to 100% in the first month, with 33% of patients continuing to use the app after 12 weeks. Of the 99 clinicians who treated patients in the Moodivate plus EHR group, 14% used the related EHR functionality.

Among other limitations, depression symptoms were self-reported, the study took place in only one state, and the smartphone requirement and other inclusion criteria may have biased the results, the authors noted. “Study findings support that a digital behavioral activation intervention effectively improved depression in adults with at least moderate symptoms of depression in the primary care setting, even without high [primary care clinician] engagement,” they wrote. “Although Moodivate needs further testing in other clinical settings and at scale, this self-guided digital behavioral activation intervention may provide an accessible and valuable depression treatment option.”