mHealth-augmented care linked to robust improvements in depression symptom severity among patients with chronic pain: an exploratory, retrospective-cohort study (Preprint)

Abstract

BACKGROUND Depression and chronic pain are commonly comorbid, mutually reinforcing, and debilitating. Emerging approaches to mobile behavioral healthcare (mHealth) promise to improve outcomes for patients with comorbid depression and chronic pain by integrating with existing care models to bolster support and continuity between clinical visits; however, the evidence base supporting the use of mHealth to augment care for this patient population is limited. OBJECTIVE To develop an evidence base that sets the stage for future research, we aimed to explore the associations between changes in depression severity and various integrated care models, with and without mHealth augmentation, among patients with comorbid depression and non-malignant chronic pain. METHODS Our team leveraged retrospective, real-world data from N=3837 patients with comorbid depression and non-malignant chronic pain who received integrated care at a subspecialty pain clinic. For some patients (N=972), integrated care was augmented by the mHealth app NeuroFlow, which provides remote measurement-based care, digital assessments, and evidence-based behavioral self-help content. We evaluated changes in depression severity between treatment cohorts via longitudinal analyses of both clinician- and mHealth-administered PHQ9 assessments. RESULTS mHealth-augmented integrated care led to significantly greater proportions of patients reaching clinical benchmarks for reduction (86% vs 76%), response (82% vs 73%), and remission (75% vs 69%) compared to integrated care alone. Furthermore, hierarchical regression modeling revealed that patients who received mHealth-augmented psychiatric collaborative care (CoCM) experienced the greatest sustained reductions in on-average depression severity compared to other cohorts, irrespective of clinical benchmarks. Additionally, patients who engaged with an mHealth platform before entering CoCM experienced a 7.2% reduction in average depression severity before starting CoCM treatment. CONCLUSIONS Our findings suggest that mHealth platforms have the potential to improve treatment outcomes for patients with comorbid chronic pain and depression by providing remote measurement-based care, tailored interventions, and improved continuity between appointments. Moreover, our study set the stage for further research, including randomized controlled trials to evaluate causal relationships between mHealth engagement and treatment outcomes in integrated care settings.

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