The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data

Abstract

Background The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD.

The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data

“…The purpose of this analysis was to explore whether older adults would engage with a digital well-being intervention and the extent to which engaging with this intervention led to improvements in subjective well-being and anxiety symptoms. Our results show that approximately one-third of older adults who qualified for our analysis engaged with the program at the recommended level, which is consistent with the rates of engagement reported in other analyses of Happify users that did not include older adults [30].…”

“…Happify is a self-guided wellness program that aims to improve psychological well-being by delivering brief gamified activities adapted from evidence-based activities from various therapeutic approaches. Previous research has shown that completing 2 or more activities via Happify per week led to significant improvements in subjective well-being and anxiety symptoms after 6 weeks [29][30][31], but none of these studies examined the effects of age or focused specifically on older adults. Therefore, in the current retrospective analysis, we analyzed data from real-world Happify users who self-reported being aged ≥65 years to determine whether completion of intervention activities was related to changes in subjective well-being and anxiety symptoms after at least six weeks of use.…”

Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

“…Universal efforts and tailored, culturally appropriate methods will be needed to direct individuals to resources for improving or maintaining CVH, potentially ameliorating the negative impacts of SDOH and psychological health and promoting positive social and psychological assets. 143,149 Ubiquitous health technology can put important CVH information in the hands of traditionally underserved populations. However, contextual factors (SDOH, access to health care and health technology, health literacy, and psychological health) mediate individuals’ access to health technology and information and can affect their ability to maintain or achieve optimal CVH.…”

“…A variety of strategies have been proposed to collect lifestyle data and house it within the EHR system, 142 including the use of brief questionnaires on computers or tablets in the waiting room or through patient portals before a visit. Some investigators and companies have created standalone apps to collect self-reported lifestyle data, 143,144 although these have the disadvantage of not being integrated within the EHR. As technology continues to evolve, wearable devices may offer the ability to replace self-reported data on PA, BP, and sleep with objectively measured data.…”

A New Metric for Promoting Cardiovascular Health: Life’s Essential 8

“…In so doing, consideration of the important (aforementioned) foundational contexts of CVH, SDOH, and the psychological well-being of patients from diverse populations is essential with aim of mitigating the nega-tive impacts of SDOH and promoting positive social and psychological assets. [8][9][10] Relatedly, effective communication with patients in diverse settings regarding CVH requires attention to the SDOH with the goal of promoting CVH equity. The LE8 writing group also provides recommendation for promoting CVH in neighborhoods and communities, going beyond traditional settings and considering the sociocultural context of individuals and families.…”