Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study

Abstract

Background: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows.

Objective: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction.

Methods: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews.

Results: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change.

Conclusions: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies.

Trial registration: ClinicalTrials.gov NCT04061642; https://ichgcp.net/clinical-trials-registry/NCT04061642.

Keywords: artificial intelligence; clinical decision support system; feasibility; major depressive disorder; mobile phone; usability.

Conflict of interest statement

Conflicts of Interest: DB, CA, RF, SI, KP, and MC are shareholders and employees, directors, or founders of Aifred Health. DK and JM are employed by Aifred Health. MTS is employed by Aifred Health and is an options holder. GG, CP, KFH, GS, EL, JB, JW, TP, DS, BD, KW, and CR have been or are employed or financially compensated by Aifred Health. SVP, KH, and JFK are members of Aifred Health’s scientific advisory board and have received payments or options. WS, KL, and SR are members of the data safety monitoring board. HM has received honoraria, sponsorship, or grants for participation in speaker bureaus, consultation, advisory board meetings, and clinical research from Acadia, Amgen, HLS Therapeutics, Janssen-Ortho, Mylan, Otsuka-Lundbeck, Perdue, Pfizer, Shire, and SyneuRx International. After the study but during manuscript preparation, SR became a shareholder of Aifred Health; this was disclosed to their site and to other members of the DSMB; SR reports owning shares in Aifred Health.

©Christina Popescu, Grace Golden, David Benrimoh, Myriam Tanguay-Sela, Dominique Slowey, Eryn Lundrigan, Jérôme Williams, Bennet Desormeau, Divyesh Kardani, Tamara Perez, Colleen Rollins, Sonia Israel, Kelly Perlman, Caitrin Armstrong, Jacob Baxter, Kate Whitmore, Marie-Jeanne Fradette, Kaelan Felcarek-Hope, Ghassen Soufi, Robert Fratila, Joseph Mehltretter, Karl Looper, Warren Steiner, Soham Rej, Jordan F Karp, Katherine Heller, Sagar V Parikh, Rebecca McGuire-Snieckus, Manuela Ferrari, Howard Margolese, Gustavo Turecki. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.10.2021.

Figures

Figure 1

Consolidated Standards of Reporting Trials study flow chart of participant recruitment and completion. CDSS: clinical decision support system.

Figure 2

Patient appointment times. A total of 14 patients completed the study; however, 1 patient’s appointment time could not be counted at baseline because of their physician opening the clinical decision support system erroneously. CDSS: clinical decision support system.

Figure 3

Frequency of PHQ-9 completion by patients in the first 12 weeks of the study versus the total number sent in the clinical decision support systems (1 per week, per active patient). PHQ-9: Patient Health Questionnaire-9.

Figure 4

Frequency of GAD-7 questionnaires completed by patients in the first 12 weeks of the study versus the total number sent in the clinical decision support systems (1 per week, per active patient). GAD-7: General Anxiety Disorder-7.

Figure 5

Percent of PHQ-9 completion by patients in the clinical decision support systems during the first 12 weeks of the study. PHQ-9: Patient Health Questionnaire-9.

Figure 6

Percent of GAD-7 questionnaires completed by patients in the clinical decision support systems during the first 12 weeks of the study. GAD-7: General Anxiety Disorder-7.