Racial and Ethnic Differences in Mental Health Outcomes for a Digital Mental Health Intervention: Exploratory Observational Study (Preprint)
Authors: Etkins Onisha , Joshi Priyam , Garay Maria , Oyetunde Tolulope , Taymuree Zainab , Vasan Nina 
Published: October 2023

BACKGROUND

Nearly 1 in 5 U.S. adults experience mental illness annually, yet they face challenges in accessing quality care due to health disparities and inequities. Disproportionate mental health care and access is particularly concerning for marginalized racial and ethnic groups given the history of structural inequity in the U.S. Digital mental health interventions utilizing smartphones and mobile apps provide innovative solutions to overcome these challenges. However, it is important to assess the effectiveness of such interventions, particularly in diverse and underserved racial and ethnic subgroups, to ensure equitable and inclusive mental health care.

OBJECTIVE

This study aims to test the impact of a digital mental health platform on measures of depression, anxiety, mental health literacy, empowerment, and help-seeking behaviors in adult populations ages 26-34 and examine subgroup differences by race and ethnicity.

METHODS

The study focused on an asynchronous digital content experience, which was designed and led by therapists, that consisted of 8 sessions of psychoeducational content on specific mental health topics with challenges and digital journaling to promote reflection and skill-building. Participants completed a baseline survey, including sociodemographic information and measures of clinical and non-clinical mental health outcomes, before starting the Pathway. After 30 days, participants completed a follow-up survey to evaluate changes in their mental health outcomes.

RESULTS

At the end of the 30-day intervention period, significant mean changes were observed across five measured domains: depression (mean -4.04, SD 4.79, p < 0.001), anxiety (mean -3.97, SD 4.66, p < 0.001), mental health literacy (mean 2.57, SD 6.38, p< 0.001), empowerment (mean 3.02, SD 6.86, p < 0.001), and general help-seeking(mean 3.62, SD = 7.64, p < 0.001). After the intervention, 41% of participants experienced clinically meaningful decreases in depression and 37.7% in anxiety (≥ 5 points change). Correlations between clinical and non-clinical outcomes were observed, indicating interrelated improvements. There were differences in clinical outcome changes between racial groups in the sample. Notably, there was a higher average decrease for White participants (PHQ-9 -5.19, SD 5.50; GAD-7 -4.92, SD 5.08) and a lower average decrease for Asian participants (PHQ-9 -2.51, SD 4.68; GAD-7 -2.96, SD 4.72), with other racial groups falling in between this range. The differences between White and Asian participants held true after adjusting for confounders as well (PHQ9: β = 2.36(95% CI: 0.50, 4.23), p < 0.05); GAD-7: β = 2.18 (95% CI: 0.38, 3.98), p < 0.05).
However, there were no significant differences between racial groups in non-clinical outcomes.

CONCLUSIONS

This study demonstrates the effectiveness of digital asynchronous psychoeducational content in reducing depression and anxiety symptoms while promoting mental health literacy, help-seeking behaviors, and empowerment among diverse racial groups. Additionally, we found differences by race in the clinical scores, which warrants further attention to how digital mental health care services impact racial groups differently. To foster equitable care, we advocate for a strengths-based approach that centers the voices and lived experiences of systemically marginalized racial groups in the research design of digital mental health interventions, acknowledges structural factors influencing mental wellbeing and reimagines the current healthcare system.

CLINICALTRIAL

Approval for this study (Pro00058739) was granted by Advarra’s Institutional Review Board.