The Association between Engagement and Treatment Response among Members Accessing Virtual Mental Health Services: A Real-World Observational Study (Preprint)

BACKGROUND There has been a care delivery bottleneck for mental health care as the demand for care has outpaced the availability of mental health professionals. As a result, many health systems have shifted to teletherapy as a scalable approach to increasing accessibility to care. Within these care models, a variety of treatment modalities (e.g., self-guided content, coaching, teletherapy) are used to deliver support for anxiety and depression. However, more research is needed to better understand differences in treatment response for depression and anxiety. OBJECTIVE The purpose of the current study was to examine the association between levels of engagement with different treatment modalities and symptom score changes in members seeking out services in a virtual care model. METHODS We conducted an observational study of 4,219 members who accessed Ginger, an on-demand mental health service, between September 2020 and September 2021. Using a mobile app platform, members could access on-demand, text-based behavioral health coaching, teletherapy and telepsychiatry, and self-guided content. The current study focused on members who had clinically elevated depression and/or anxiety at intake. Logistic regressions were performed to assess the association between levels of engagement across modalities and treatment response in depression and anxiety, using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7), respectively. RESULTS Of the 4,219 members, 56.2% demonstrated a partial response and 38.5% demonstrated a full response in depression symptoms; 54.6% demonstrated a partial response and 40.0% demonstrated a full response in anxiety symptoms. Engagement with professional care (i.e., text-based coaching, clinical therapy, hybrid of coaching and clinical care) showed significantly increased odds of partial and full response compared to those who engaged only with self-guided content. Members who engaged with a hybrid of care had the highest odds of improvement; the odds of showing a partial and a full response in depressive symptoms were respectively, 2.97 times higher (CI: 2.35-3.75; p < .001) and 2.54 times higher (CI: 1.99-3.26; p < .001) compared to members who engaged only with self-guided content. Similarly, the odds of showing a partial and a full response in anxiety symptoms were respectively, 2.93 times higher (CI: 2.32-3.71; p < 0.001) and 2.66 times higher (CI: 2.08-3.41, p < .001). CONCLUSIONS Engagement with Ginger services was associated with improvements in depression and anxiety. Members who engaged with coaching or clinical care had significantly increased odds of improvement compared to those who only engaged with self-guided content. There were no significant differences in predicted probabilities of partial or full response to treatment between engagement with text-based coaching and virtual clinical care. Results support the utility of digital behavioral health interventions and further highlight text-based coaching protocols as an accessible and suitable option when considering virtual care for treating anxiety and depressive symptoms.