(PS10-47) Differences in Engagement and Treatment Outcomes During a Mindfulness App Clinical Trial: Moderation by Gender, Sexual Orientation, Race/ethnicity, Educational Attainment

Abstract Text:

Background: Mindfulness apps have demonstrated efficacy in improving mental health and can overcome key treatment barriers (e.g., cost, stigma). While promising to increase access to mental health treatment, little is known about who is more or less likely to benefit from this treatment modality, especially those from underserved populations, who disproportionately experience heightened mental health problems and exposure to stigma.

Aim: Using data from a non-randomized clinical trial of a mindfulness app (AmDTx), this secondary analysis examined whether marginalized status on social and personal factors (gender identity, sexual orientation, race/ethnicity, educational attainment) is associated with differences in app engagement and trajectories of change in treatment outcomes.

Method: Adults aged 18-66 waiting for mental health treatment (N = 185; Mage = 34) received access to AmDTx and self-reported outcomes at 2, 4, 8, and 12 weeks. Controlling for age, regression models evaluated for differences in app engagement (adoption [attempted meditation], number of activities completed, total meditation hours) and study attrition (number of study assessments completed) by gender, sexual orientation, race/ethnicity, and educational attainment. Multilevel models evaluated the social and personal factors as moderators of self-reported treatment outcomes over time, controlling for age, inpatient hospitalization history, medication use, and baseline scores. The sample was 65.4% women and 7.0% non-binary; 36.2% sexual minority; 36.2% racial/ethnic diverse; and 36.2% with below college education.

Results: There were no differences in adoption or attrition. Women, sexual minorities, White individuals, and people with below college education were more likely to complete more exercises and meditate more, compared to their counterparts. Changes in treatment outcomes differed by sexual orientation, gender, and education. While heterosexual individuals reported improvements on all outcomes, sexual minorities experienced some but relatively diminished improvements on disability, and no change in depression, anxiety, or stress over time. Gender differences were only found for disability: men showed the most improvement, followed by women, whereas non-binary people did not show changes in disability over time. People with below college education (vs. college or above) had greater reductions in depression and anxiety symptoms, while there were no differences for disability or stress. No racial/ethnic differences were found for change in any outcomes.

Conclusions: The efficacy of mindfulness apps may differ by demographic characteristics. Despite greater app engagement, gender and sexual orientation groups do not benefit equally, perhaps due to chronic, recurring stressors (e.g., minority stress) and structural determinants that are harder to address with meditation practices. However, mindfulness apps may be especially promising for treatment-seeking people with lower educational attainment. Future work is needed to evaluate the capacity of mindfulness apps to be more gender-, trauma-, or culturally-informed, explore further influences of intersectionality, and promote identity-affirmative care.