Wednesday, October 18, 2017

App Improves Mental Health Service Delivery to Pregnant Women With Symptoms of Depression

A smartphone application that tracks mood changes and alerts providers if symptoms worsen appears to improve service delivery and patient engagement among pregnant women with perinatal depression symptoms, according to a report in Psychiatric Services in Advance.  

The findings suggest such an app “is a feasible option to improve mental health service delivery via monitoring at-risk patients between visits,” wrote Liisa Hantsoo, Ph.D., and colleagues at the University of Pennsylvania Perleman School of Medicine. “[T]his app also facilitated patient-provider contact when needed rather than relying on the patient to decide to send an electronic message to her provider through a [patient portal].”

Hantsoo and colleagues recruited pregnant women (aged 18 and older; 32 weeks gestation or less) with depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) during a routine prenatal appointment at a clinic within an academic medical center serving a predominantly low-income and racial-ethnic minority population. To be included in this trial, the women had to own a smartphone with an iOS or Android operating system and speak English.

Seventy-two participants were randomly assigned to either a mobile app allowing access to a standard patient portal used for all patients at the health center that enabled email-like communication with providers (n=24) or to the patient portal with the addition of a mood tracking and alert (MTA) app (n=48). The MTA app alerted providers when participant mood symptoms worsened, prompting the provider to contact the participant. 

The researchers assisted the study participants with downloading the app(s), provided written materials explaining the apps, and administered a baseline interview, where care engagement and satisfaction were assessed. After eight weeks, care engagement and satisfaction were reassessed, and service delivery data on patient-provider contacts during the eight-week period were extracted from the electronic health record of each participant. Within the MTA group, depressive and anxiety symptoms were assessed after eight weeks.

Compared with the patient portal group, the MTA group had significantly more telephone encounters with providers that mentioned mental health. Within the MTA group, 17 women (41%) received a phone call from a provider that was triggered by an alert from the app. These women had a significantly higher rate of referral to a mental health provider compared with women who did not receive an MTA app–triggered contact. As gestational age increased, MTA users rated their ability to manage their own health significantly better than women in the control group.

The mean daily mood score was significantly positively correlated with the number of calls that a participant in the MTA group received in weeks 1 to 4. Participants who received an MTA-triggered call had consistently higher PHQ-9 and Generalized Anxiety Disorder (GAD-7) scores across the eight weeks compared with those who did not receive an MTA-triggered call. Among MTA users, PHQ-9, GAD-7, and self-reported daily mood scores significantly improved over eight weeks.

For related information, see the Psychiatric News PsychoPharm article, “FDA Clears First Prescription-Based ‘Digital Therapeutic’.”

(Image: shironosov/


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