Improvement of elevated anxiety and depressive symptom severity in children and adolescents with an acute mental health crisis: A study of a novel framework for crisis support at Bend Health Inc. (Preprint)
Authors: Lawrence-Sidebottom Darian , Huffman Landry Goodgame , Huberty Jennifer , Guerra Rachael , Parikh Amit , Roots Monika , Roots Kurt 
Published: May 2023

BACKGROUND

The prevalence of children and adolescents with elevated risk of suicide, self-harm, and harm to others has increased substantially over recent years. Given the limited availability and accessibility of risk intervention resources for children and adolescents, digital mental health interventions (DMHIs) may be an effective strategy to treat those at risk. Bend Health Inc., a pediatric collaborative care DMHI, initiated a comprehensive risk assessment and safety planning policy in October 2022 to address this need.

OBJECTIVE

Using data from members (children and adolescents) participating in Bend Health Inc., the purpose of this study was to 1) describe characteristics of members who have been flagged with elevated risk versus those with no elevated risk, 2) compare symptom severity of members with elevated risk and members with no elevated risk, and 3) assess whether symptom progression over time with a collaborative care DHMI differs by level of risk.

METHODS

Risk of acute mental health crisis was assessed for members (ages two to 17) during every meeting with a practitioner (e.g., coaching and therapy sessions). Approximately every 30 days, members or their caregivers completed the following validated assessments to measure anxiety and depressive symptom severity: Patient-Reported Outcomes Measurement Information System (PROMIS), General Anxiety Disorder 7 (GAD-7), and Patient Health Questionnaire 9 (adolescent version; PHQ-9A). The study purpose was addressed by comparing data from members with elevated risk (elevated risk group: n = 93) to data from members without elevated risk (non-elevated risk group: n = 929).

RESULTS

The elevated risk group tended to be older (12.8 ± 2.9 years) and more predominantly female (64.5%) than the non-elevated risk group (10.9 ± 3.7 years; 51.2% female). At baseline, compared to the non-elevated risk group, the elevated risk group had more severe anxiety (PROMIS scores: t = 3.07, P = .004; GAD-7 scores: t = 1.92, P = .059) and depressive symptoms (PROMIS scores: t = 3.27, P = .002; PHQ-9A scores: t = 2.33, P = .024). Symptom severity significantly improved over months of participation with the collaborative care DMHI (Anxiety: F1,287 = 64.85, P < .001; Depressive: F1,145 = 28.63, P < .001), and the rate of improvement did not differ between the elevated risk and non-elevated risk groups (Anxiety: F1,287 = 1.20, P = .27; Depressive: F1,145 = 0.14, P = .71).

CONCLUSIONS

We demonstrated that participation with a collaborative care DMHI is associated with improvements in mental health outcomes in members with elevated risk. These results provide promising support for the use of pediatric DMHIs to identify and address risk in children and adolescents. Future studies should address the long-term effects of DHMI participation on risk outcomes.