Digital engagement approach lowers healthcare worker anxiety, depression

A digital engagement strategy that included text messaging, mobile mental health assessments, and connection to care improved depression and anxiety among healthcare workers, according to recent research published in JAMA Network Open.

Healthcare workers in the United States are experiencing a slew of mental health issues exacerbated by the COVID-19 pandemic. Centers for Disease Control and Prevention (CDC) data reveals that healthcare workers reported an increase of 1.2 days of poor mental health per month from 3.3 days in 2018 to 4.5 days in 2022. The percentage of those who reported burnout very often also increased from 11.6 percent to 19 percent during the same period.

Researchers from the Perelman School of Medicine at the University of Pennsylvania tested the efficacy of a digital engagement strategy that encouraged the use of a mental health platform in reducing depression and anxiety among healthcare workers.

The study involved two groups: the intervention arm, which received monthly automated reminder text messages on the availability of the COBALT mental health platform and mobile mental health assessments, and the control group, which had access to the platform but no proactive outreach. The COBALT platform offers various mental health resources, such as podcasts, articles, and worksheets, pathways to schedule one-on-one mental healthcare sessions, and group sessions focused on specific issues.

Of the 10,000 healthcare workers invited to participate, 1,275 were included in the study, with 642 randomized to the intervention group and 633 to the usual care group. Most participants had minimal or mild anxiety at baseline.

Researchers used the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) score to measure anxiety.

The mean GAD-7 score for the control group was 5.79 at baseline and decreased to 5.54 at six months, which was insignificant. On the other hand, the mean GAD-7 score in the intervention group was 5.99 at baseline, which significantly decreased to 5.00 at six months.

In subgroup analyses, researchers observed significant decreases in anxiety at the six- and nine-month periods for female and Black participants and those with minimal or mild baseline anxiety scores.

The mean PHQ-9 score was 5.59 at baseline for the control group and 5.29 at six months, compared to 5.91 at baseline for the intervention group, which significantly decreased to 4.65 at six months.

The improvements in depression and anxiety were also sustained nine months after the start of the intervention.

“What we found shows that touching base with people, letting them know that help is available and easy to access, goes a long way toward maximizing digital mental health interventions and platforms, which leads to important, tangible results,” said study lead author Anish Agarwal, MD, an assistant professor of emergency medicine and deputy director of the Center for Insights to Outcomes at Penn, in a press release. “Mental health platforms continue to grow and evolve, but, to this point, there hasn’t been enough research about them and how to optimize their use, particularly among health care workers. Work like ours is important as health systems across the country seek to better assist their staff with the challenges they face.”

Preserving the mental health of healthcare workers is critical as mental health struggles are depleting an already beleaguered workforce.

A spring 2023 survey revealed that a third of 500 healthcare workers plan to leave their jobs next year; 14 percent of respondents said they planned to leave the industry entirely within the following year.

Additionally, 55 percent of respondents said they felt anxious, and 35 percent said they felt depressed multiple times a week.

Further, a survey of 18,000 academic physicians between October 2019 and July 2021 showed that 5,177 reported moderate or greater intention to leave their jobs. Almost 40 percent (37.9 percent) of the sample experienced burnout.