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2015 HSR&D/QUERI National Conference Abstract

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1065 — Enhancing Problem Solving Therapy in Primary Care-Mental Health Integration Using SmartPhone Technology

Grubbs KM, COIN-North Little Rock; Greene CJ, Mental Health Informatics Section VHA Mental Health Services (10P4M); Abraham T, COIN-North Little Rock; Pyne JM, COIN-North Little Rock; Fortney JC, COIN- Puget Sound;

Objectives:
Smartphones apps designed for Veterans have the potential to increase engagement in mental healthcare. App development has outpaced research on their clinical utility. This pilot feasibility trial tested an app designed to enhance engagement in evidence-based psychotherapy in Primary Care-Mental Health Integration (PC-MHI).

Methods:
Participants (n = 33) were Veterans enrolled in PC-MHI and diagnosed with an anxiety or depressive disorder. All Veterans received 6-sessions of Problem Solving Therapy (PST) and an iPhone 4S. Veterans were randomized to receive either the Moving Forward app (n = 17) or a paper workbook (n = 16). The app includes all of the educational and skill-building components of PST in a mobile format. Participants were assessed at baseline, six-week and 12-week follow-up. Measures included anxiety, depression, stress, problem solving style, satisfaction, skills usage, and opinions of the app. Qualitative interviews elicited qualitative data from Veterans in the app group.

Results:
Eighty percent of participants were male and the sample had a mean age of 46.6 years (SD = 12.12). Ninety-four percent of participants completed all six sessions of phone therapy. Both groups showed a 1- category reduction (from moderate to mild) in depression, anxiety and stress symptoms from baseline to 6-weeks. These gains were maintained at 12-weeks for depression but not anxiety or stress. There were no significant between group differences in depression, anxiety, skills use or satisfaction at 6- or 12-weeks. However, as compared to the usual care group, a larger percentage of the app group reported skills-practice at 6 weeks (93% versus 75%) and at 12- week follow up (57% versus 30%). Qualitative data highlighted strengths of the app (e.g., immediacy of access to support tools, confidentiality, and ability to share the app) and weaknesses (unavailable on some mobile platforms).

Implications:
This study provides preliminary evidence to support the use of the Moving Forward app in PC-MHI clinics. There were no differences in clinical outcomes between groups, however, improvements in skills-practice engagement and potential long-term outcomes warrant further exploration.

Impacts:
This study contributes valuable data to the emerging field of SmartPhone supported psychotherapy and highlights important questions about future research on technology-based clinical care.