Comparison of the Effects of Coaching and Receipt of App Recommendations on Depression, Anxiety, and Engagement in the IntelliCare Platform: Factorial Randomized Controlled Trial

David C Mohr, Stephen M Schueller, Kathryn Noth Tomasino, Susan M Kaiser, Nameyeh Alam, Chris Karr, Jessica L Vergara, Elizabeth L Gray, Mary J Kwasny, Emily G Lattie, David C Mohr, Stephen M Schueller, Kathryn Noth Tomasino, Susan M Kaiser, Nameyeh Alam, Chris Karr, Jessica L Vergara, Elizabeth L Gray, Mary J Kwasny, Emily G Lattie

Abstract

Background: IntelliCare is a modular platform that includes 12 simple apps targeting specific psychological strategies for common mental health problems.

Objective: This study aimed to examine the effect of 2 methods of maintaining engagement with the IntelliCare platform, coaching, and receipt of weekly recommendations to try different apps on depression, anxiety, and app use.

Methods: A total of 301 participants with depression or anxiety were randomized to 1 of 4 treatments lasting 8 weeks and were followed for 6 months posttreatment. The trial used a 2X2 factorial design (coached vs self-guided treatment and weekly app recommendations vs no recommendations) to compare engagement metrics.

Results: The median time to last use of any app during treatment was 56 days (interquartile range 54-57), with 253 participants (84.0%, 253/301) continuing to use the apps over a median of 92 days posttreatment. Receipt of weekly recommendations resulted in a significantly higher number of app use sessions during treatment (overall median=216; P=.04) but only marginal effects for time to last use (P=.06) and number of app downloads (P=.08). Coaching resulted in significantly more app downloads (P<.001), but there were no significant effects for time to last download or number of app sessions (P=.36) or time to last download (P=.08). Participants showed significant reductions in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) across all treatment arms (P s<.001). Coached treatment led to larger GAD-7 reductions than those observed for self-guided treatment (P=.03), but the effects for the PHQ-9 did not reach significance (P=.06). Significant interaction was observed between receiving recommendations and time for the PHQ-9 (P=.04), but there were no significant effects for GAD-7 (P=.58).

Conclusions: IntelliCare produced strong engagement with apps across all treatment arms. Coaching was associated with stronger anxiety outcomes, and receipt of recommendations enhanced depression outcomes.

Trial registration: ClinicalTrials.gov NCT02801877; https://ichgcp.net/clinical-trials-registry/NCT02801877.

Keywords: anxiety; clinical trial; depression; mHealth.

Conflict of interest statement

Conflicts of Interest: DM has accepted honoraria from Apple Inc and has an ownership interest in Actualize Therapy, which has a license from Northwestern University for IntelliCare. EL has received consulting fees from Actualize Therapy. SS serves as a scientific advisor to Joyable, Inc, and has received stock options in Joyable. The other authors have no conflicts of interest to declare.

©David C Mohr, Stephen M Schueller, Kathryn Noth Tomasino, Susan M Kaiser, Nameyeh Alam, Chris Karr, Jessica L Vergara, Elizabeth L Gray, Mary J Kwasny, Emily G Lattie. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.08.2019.

Figures

Figure 1
Figure 1
Flow of participants through the trial.
Figure 2
Figure 2
Survival analysis: time to last app launch by treatment cell. Recs: recommendations.

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