In our coaching with clinical care (combined) analyses, we considered both a member’s coaching and clinical utilization level to calculate an overall utilization level. ©Sarah Kunkle, Manny Yip, Justin Hunt, Watson Ξ, Dana Udall, Patricia Arean, Andrew Nierenberg, John A Naslund. We assessed the association between level of engagement and improvement within each modality, and we adjusted for baseline anxiety score with the reference group denoted as the “app-only” group (ie, those not engaged with a coach or clinician) as this is the lowest intensity intervention of all options. J Affect Disord 2018 Mar 15;229:443-449. For those users who had reported gender (560/1611, 34.5%), 371 (66.3%) were female and 187 (33.3%) were male. A Hosmer-Lemeshow test failed to reject the null hypothesis, indicating goodness of fit, X2 (8, N=470)=7.11, P=.53. This aligns with existing literature that finds that most forms of treatment are better than nothing, further highlighting the need to get even low-intensity treatments to individuals who need help. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities [6]. Leave this field blank . These results are shown graphically as probability of anxiety improvement by care modality and levels of intake severity in Figure 1. A total of 1611 individuals initially screened GAD-2 positive for anxiety symptoms, completed a full GAD-7, completed a follow-up screen, and were included in this analysis. John Wiley & Sons 2000:143-164. The authors would like to acknowledge Alexis Hahn and Erica Hayes for their literature review input and support. SK authored this manuscript. Arean, Andrew Yip M, <4 weeks of coaching, or the average days between interactions is ˃14 days, and <2 clinical sessions. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. Psychometric properties and clinical utility of brief measures of depression, anxiety, and general distress: The PHQ-2, GAD-2, and K-6. However, there are certain situations in which the duration of treatment is modified (either extended or shortened) based on member-specific circumstances (clinical presentation, covered sessions, the goodness of fit between clinician and member, and life circumstances), which is consistent with recommendations from the literature [17,32]. AN and PA are paid scientific advisors. Is JMIR Formative Research in PubMed yet? Finally, Table 6 reports outputs for the model examining the association between utilization and anxiety symptom improvement for individuals engaged in both coaching and clinical services. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. The impact of COVID-19 has been felt worldwide, yet we are still unsure about its full impact. Coaches work to get members on a weekly schedule. Table 2 shows descriptive characteristics of Ginger platform users, categorized by individuals who experienced a change in GAD screen (ie, from a positive screen to a negative follow-up screen) and those who did not (positive follow-up screen). Data for this study were processed using Looker (Looker Data Sciences Inc), a business intelligence and data analytics platform. JMIR Dermatology (JDerm) is a new sister journal of JMIR (the leading open-access journal in health informatics), focusing on technologies, medical devices, apps, engineering, informatics applications for patient education in dermatology, including preventative interventions (e.g. Future directions include more detailed classifications of utilization patterns and exploring explanations and solutions for lower utilization members. Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care: A Randomized Clinical Trial. J Nerv Ment Dis 2006 Feb;194(2):91-97 [, Fisher PL, Durham RC. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members. Of these 1611 individuals, 756 (46.9%) experienced a decrease in anxiety symptoms as measured by a change from a positive to a negative GAD-2 screen. Based on our inclusion criteria, 4369 individuals were eligible for this study. Anxiety and Depression Association of America. A Hosmer-Lemeshow test failed to reject the null hypothesis, indicating goodness of fit, X2 (8, N=349)=6.44, P=.50. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. The first clinical session is generally considered an “information gathering” intake session. 33496679 Similarly, in the United States, anxiety disorders are the most common mental health condition, but a large portion of those affected (36.9%) are estimated to go untreated [5]. If we include the commonly accepted definition of a 5-point reduction in score, an additional 11.9% (192/1617) of the cohort would be classified as “improved.” Finally, we lack a control group to understand what would have happened in the absence of Ginger and to attribute causality, although we are able to understand these associations relative to defined reference groups. Update: This is an archived post. Eur Heart J Suppl 2015 Jul 10;17(suppl D):D2-D8. In addition to demographics, Table 2 also reports care modality, levels of utilization, satisfaction scores, and clinical [Patient Health Questionnaire (PHQ) and GAD] intake scores for those who screened negative at follow-up and those who screened positive at follow-up. National Board for Health and Wellness Coaching. We categorized utilization levels based on Ginger clinical protocols, external guidelines, and supporting literature. Ginger administers the survey every 2 weeks to users who screen positive and every 3 months for users who screen negative to monitor symptom response and assess if additional care is warranted. Recent studies focused on text-based coaching interventions have shown significant improvements in mental health outcomes equivalent to treatment as usual, namely, in-person and telephone counseling [16,17]. URL: Toussaint A, Hüsing P, Gumz A, Wingenfeld K, Härter M, Schramm E, et al. 4 2020: v.4(1) 2020 Jan: v.4(2) 2020 Feb: v.4(3) 2020 Mar: v.4(4) 2020 Apr: v.4(5) 2020 May: v.4(6) 2020 Jun: v.4(7) 2020 Jul: v.4(8) 2020 Aug: v.4(9) 2020 Sep: v.4(10) 2020 Oct: v.4(11) 2020 Nov: v.4(12) 2020 Dec: Vol. Ginger uses the 2-item and 7-item Generalized Anxiety Disorder questionnaires (GAD-2 and GAD-7) to assess and track anxiety, both of which have been validated and shown to have good operating characteristics for all anxiety disorders [24]. Centers for Disease Control and Prevention. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. [. A meta-analysis of randomized controlled trials. Background: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. Prior to 4 weeks of engagement, members are unlikely to achieve a meaningful reduction in symptoms. These are members who have completed a coaching or clinical session but received minimal therapeutic intervention based on their length of engagement. Centers for Disease Control and Prevention. We can build upon our understanding of these associations by increasing the collection of demographic data to enhance our understanding of member utilization patterns and user personas, and by adding content analysis of coaching messages. Another potential limitation is that we had to rely on GAD-2 rather than GAD-7 to assess anxiety symptom improvement. 2020. Characteristics and predictors of full and partial recovery from generalized anxiety disorder in primary care patients. Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions. A positive screen was defined as a response score for either question of 2 or greater (ie, a response of “more than half the days” or “nearly every day”). [, Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. JMIR Publications, JMIR Rehabilitation and Assistive Technologies, Formative Evaluation of Digital Health Interventions, Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study, Skip recent articles and go to articles open for peer-review section, Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study, Global Collaborative Social Network (Share4Rare) to Promote Citizen Science in Rare Disease Research: Platform Development Study, The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study, System Architecture for "Support Through Mobile Messaging and Digital Health Technology for Diabetes" (SuMMiT-D): Design and Performance in Pilot and Randomized Controlled Feasibility Studies, Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder, Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input, Development and Evaluation of Research Methods, Instruments and Tools, Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods, Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App–Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study, A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study, e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study, eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study, Monitoring Peer-to-Peer, Social Media Communication by Military Personnel About Dietary Supplements Used for Weight Loss and Sports Performance: A Pilot Content Analysis of 11 Years of Posts on the Reddit Platform, Skip partnership section and go to footer section, define and understand populations in need of an intervention or public health program, create programs that are specific to the needs of those populations, ensure programs are acceptable and feasible to users before launching, improve the relationship between users and agencies/research groups, demonstrate the feasibility, use, satisfaction with, or problems with a program before large-scale summative evaluation (looking at health outcomes). 2016 Aug. April 02, 2021, Copyright © This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. Compared to the minimal-utilization reference group (those who only attended 1 therapy session), those in the low, medium, and high utilization categories had increased odds of improvement, with odds ratios increasing ordinally with each category. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. A study by the World Health Organization (WHO) found that only a fifth (20.6%) of participants with an anxiety disorder sought help from health care services, and of those individuals who sought help, 23.2% received no treatment at all [1]. As Ginger members achieve improvements in their GAD scores, they could be moved to a lower level of intervention to ensure therapists are working at the “top of their license” and the system is efficiently using scarce clinical resources. Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Given the current environment with COVID-19, the ability to reach people in need with virtual care is critical. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) have the greatest odds of anxiety improvement. aOdds ratio obtained by exponentiation of the regression coefficients. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. We performed chi-square tests for categorical variables, t tests for continuous variables, and Mood median tests for medians to assess differences in characteristics between those who improved versus those who did not. Med 2014 Jan 22;44(11):2363-2374. Our first set of models assesses the association between care modality and improvement. Compared to the low-utilization group, there were significantly increased odds of improvement for the high utilization group but not for the low- and medium-utilization group. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. URL: Kunkle S, Yip M, Ξ W, Hunt J. available at, Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Conclusions: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Papers with focus on games in health or gamification aspects of apps and theoretical issues/commentary on gaming are now primarily published in / transferred to JMIR … The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants’ needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app-only”). Methods: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. ≥4 weeks of coaching, and average days between interactions is ≤14 days, and ≥2 clinical sessions. All Clarivate Analytics websites use cookies to improve your online experience. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. Furthermore, our results cannot generalize to individuals who do not have access to this system. J Med Internet Res 2020 Jun 18;22(6) [, Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. We calculated utilization based on product user behavior data, including the number of coaching sessions and messages, number of clinical (therapy and psychiatry) appointments completed, and length of time engaged. Show/hide abstract. ≥4 weeks of coaching, and average days between interactions is ≤14 days. Our data further meet the assumptions of logistic regression, including independent observations and little or no multicollinearity among the independent variables [33]. Data from the Centers for Disease Control and Prevention (CDC) show an increasing percentage of adults experiencing symptoms of anxiety disorder since early April; approximately 35% of adults reported symptoms of anxiety in July 2020 compared to 8.2% in January 2019 to June 2019 [8]. Evaluation of an On-Demand Mental Health System for Depression Symptoms: Retrospective Observational Study. Community Health 2020 Apr 08;8(1):176-187. Higher GAD-7 intake scores were also associated with decreased odds of improvement. Gender and age data were missing for a large portion of the sample, as this is optional information provided in employer eligibility files. Log In; Automatic login IP; PUBLISHERS' AREA DISCOVER ISSN SERVICES SEARCH OPEN ACCESS RESOURCES KEEPERS REGISTRY ISSN INTERNATIONAL CENTER. A Hosmer-Lemeshow test failed to reject the null hypothesis, indicating goodness of fit, X2 (8, N=1080)=9.14, P=.33. Table 4 reports outputs for the model examining the association between utilization and anxiety symptom improvement for the text-based coaching-only cohort. Study participants have access to the Ginger system as part of their employer or health plan benefits. Arean P, For all figures, shapes represent the expected mean probability of improvement by modality and intake severity; lines represent the corresponding 95% confidence interval. Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. This is also consistent with most evidence-based protocols of 8-12 sessions, as these sessions are not always completed at a weekly cadence [17]. JMIR Formative Research Vols. Members generally begin receiving active intervention during their second session. March 19, 2021 Kunkle, Manny January, 1Ginger, San Francisco, CA, United States, 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States, 3Massachusetts General Hospital, Boston, MA, United States, 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States. Given the binary nature of our dependent outcome variable (“improved” vs “did not improve”), we used logistic regression modeling, a common statistical method for quantifying the relationship between various factors and a binary clinical outcome (ie, dependent variable). Can smartphone mental health interventions reduce symptoms of anxiety? JMIR Mhealth Uhealth 2019 Jan 23;7(1):e10948 [. One of the gaps in our current knowledge relates to the long-term mental and physical impact of the infection on affected individuals. Med Care 2008 Mar;46(3):266-274. Anxiety and Depression Household Pulse Survey. [, Andrews G, Basu A, Cuijpers P, Craske M, McEvoy P, English C, et al.
Bain Budapest Echec,
Mauritania Sierra Leone,
+ 12autresmeilleurs Dînersl'huitrier Pie, La Table 38 Autres,
Vivement Dimanche En Direct,
Turquie Lettonie Match,
Rt France Direct,
Cinq Toques En Savoie,
Faux Test De Grossesse Positif,
Les As De La Jungle Jeux Vidéo,
International Smoke Yelp,
Greece Srl Vs Kosovo Srl,
Coloriage Vaiana Cochon,
Ourson Guimauve Chocolat Noir,