The Association Between Increased Levels of Patient Engagement With an Internet Support Group and Improved Mental Health Outcomes at 6-Month Follow-Up: Post-Hoc Analyses From a Randomized Controlled Trial

被引:20
作者
Geramita, Emily M. [1 ]
Belnap, Bea Herbeck [2 ,3 ]
Abebe, Kaleab Z. [1 ]
Rothenberger, Scott D. [1 ]
Rotondi, Armando J. [3 ,4 ]
Rollman, Bruce L. [3 ]
机构
[1] Univ Pittsburgh, Med Ctr, Div Gen Internal Med, Pittsburgh, PA 15213 USA
[2] Univ Gottingen, Med Ctr, Dept Psychosomat Med & Psychotherapy, Gottingen, Germany
[3] Univ Pittsburgh, Sch Med, Ctr Behav Hlth & Smart Technol, 230 McKee Pl,Suite 600, Pittsburgh, PA 15213 USA
[4] Vet Affairs Pittsburgh Healthcare Syst, Pittsburgh, PA USA
基金
美国国家卫生研究院;
关键词
internet support group; patient engagement; anxiety; depression; PRIMARY-CARE; ANXIETY DISORDERS; DEPRESSION; TECHNOLOGIES; INTERVENTION; COMPUTER; VALIDITY; CANCER;
D O I
10.2196/10402
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: We recently reported that depressed and anxious primary care patients randomized to a moderated internet support group (ISG) plus computerized cognitive behavioral therapy (cCBT) did not experience improvements in depression and anxiety over cCBT alone at 6-month follow-up. Objective: The 1% rule posits that 1% of participants in online communities generate approximately 90% of new user-created content. The aims of this study were to apply the 1% rule to categorize patient engagement with the ISG and identify whether any patient subgroups benefitted from ISG use. Methods: We categorized the 302 patients randomized to the ISG as: superusers (3/302, 1.0%), top contributors (30/302, 9.9%), contributors (108/302, 35.8%), observers (87/302, 28.8%) and those who never logged in (74/302, 24.5%). We then applied linear mixed models to examine associations between engagement and 6-month changes in health-related quality of life (HRQoL; Short Form Health Survey Mental Health Component, SF-12 MCS) and depression and anxiety symptoms (Patient-Reported Outcomes Measurement Information System, PROMIS). Results: At baseline, participant mean age was 42.6 years, 81.1% (245/302) were female, and mean Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and SF-12 MCS scores were 13.4, 12.6, and 31.7, respectively. Of the 75.5% (228/302) who logged in, 61.8 %(141/228) created = 1 post (median 1, interquartile range, IQR 0-5); superusers created 42.3 % (630/1488) of posts (median 246, IQR 78-306), top contributors created 34.6% (515/1488; median 11, IQR 10-18), and contributors created 23.1 % (343/ 1488; median 3, IQR 1-5). Compared to participants who never logged in, the combined superuser + top contributor subgroup (n=33) reported 6-month improvements in anxiety (PROMIS: -11.6 vs -7.8; P=.04) and HRQoL (SF-12 MCS: 16.1 vs 10.1; P=.01) but not in depression. No other subgroup reported significant symptom improvements. Conclusions: Patient engagement with the ISG was more broadly distributed than predicted by the 1% rule. The 11% of participants with the highest engagement levels reported significant improvements in anxiety and HRQoL.
引用
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页数:11
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