5 - (SYM 29) Sociodemographic and Clinical Predictors of Mhealth App Usage Among Treatment-seeking Psychiatric Outpatients

Background: Digital mental health interventions (DMHIs) have demonstrated modest effects for improving depression, anxiety, and psychiatric distress. However, dropout rates in clinical trial studies are high. In real-world setting, fewer than 4% of those downloading a mental health app continue to use it after two weeks. Identifying individuals most likely to engage with DMHIs and strategies to increase engagement are critical, yet little is known about the factors that drive engagement in naturalistic settings. The current study investigated differences in engagement based on sociodemographic and clinical characteristics among adults provided with a DMHI while waiting for outpatient psychiatric care.  

Methods: Participants were 1,223 adults (74% White, 68% women, M_age: 36.8 years) waiting for outpatient psychiatric services and randomized to receive a subscription to a mindfulness-based mHealth app (Headspace) or a CBT-based mHealth app (SilverCloud). Usage data from the assigned apps (e.g., times opened, minutes used, etc.) were gathered through a study-specific application. Participants were not required to download or use the apps as part of their participation in the broader study and were not compensated for app use.

Results: Most participants (73%) used their assigned DMHI at least once, with a median use time of 91 total minutes over a median of 7 unique use days. Participants were more likely to try Silvercloud, but used Headspace for significantly more time (total minutes) and unique days. While there were no racial/ethnic differences based on downloading the apps, White participants used their apps for more days than Asian or Black participants. Individuals with only a GED or high school education were significantly less likely to download their app than participants with some college or Bachelor’s degree and above. App usage progressively increased with age, with individuals in their 50s and 60s reporting the most usage (with slightly less usage among those ages 70 and above). Severity of symptoms for depression, anxiety, sleep, and suicidality were not meaningfully associated with app usage, nor was gender.

Conclusions: While most participants tried out their assigned applications, the amount of time spent using DMHIs were quite limited. Several demographic features emerged as distinguishing factors with respect to engagement—identifying barriers to engagement for underserved groups and matching DMHI features to user needs may allow for greater uptake and benefit from DMHIs.