A Novel and Integrated Digitally Supported System of Care for Depression and Anxiety: Findings From an Open Trial

Kate Wolitzky-Taylor; Richard LeBeau; Inna Arnaudova; Nora Barnes-Horowitz; Elizabeth Gong-Guy; Scott Fears; Eliza Congdon; Nelson Freimer; Michelle Craske

doi:10.2196/46200

A Novel and Integrated Digitally Supported System of Care for Depression and Anxiety: Findings From an Open Trial

JMIR Ment Health. 2023 Jul 24:10:e46200. doi: 10.2196/46200.

Authors

Affiliations

¹ Department of Psychiatry and Biobehavioral Sciences, University of California - Los Angeles, Los Angeles, CA, United States.
² Department of Psychology, University of California - Los Angeles, Los Angeles, CA, United States.
³ Greater Los Angeles Veterans Administration, Los Angeles, CA, United States.

PMID: 37486735
PMCID: PMC10407647
DOI: 10.2196/46200

Abstract

Background: The global burden of anxiety and depression has created an urgent need for scalable approaches to increase access to evidence-based mental health care. The Screening and Treatment for Anxiety and Depression (STAND) system of care was developed to meet this need through the use of internet-connected devices for assessment and provision of treatment. STAND triages to level of care (monitoring only, digital therapy with coaches, digital therapy assisted by clinicians in training, and clinical care) and then continuously monitors symptoms to adapt level of care. Triaging and adaptation are based on symptom severity and suicide risk scores obtained from computerized adaptive testing administered remotely.

Objective: This article discusses how the STAND system of care improves upon current clinical paradigms, and presents preliminary data on feasibility, acceptability, and effectiveness of STAND in a sample of US-based university students.

Methods: US-based university students were recruited and enrolled in an open trial of the STAND system of care. Participants were triaged based on initial symptom severity derived from a computerized adaptive test and monitored over 40 weeks on anxiety, depression, and suicide risk to inform treatment adaptation and evaluate preliminary effectiveness.

Results: Nearly 5000 students were screened and 516 received care. Depression and anxiety severity scores improved across all tiers (P<.001 in all cases). Suicide risk severity improved in the highest tier (ie, clinical care; P<.001). Acceptability and feasibility were demonstrated.

Conclusions: STAND is a feasible and acceptable model of care that can reach large numbers of individuals. STAND showed preliminary effectiveness on all primary outcome measures. Current directions to improve STAND are described.

Keywords: CBT; anxiety; care model; care system; cognitive behavioral therapy; college; depression; depressive; digital mental health; eHealth; mHealth; mental health; model of care; online support; postsecondary; psychotherapy; service delivery; stratified models of care; student; student mental health; system of care; university.

©Kate Wolitzky-Taylor, Richard LeBeau, Inna Arnaudova, Nora Barnes-Horowitz, Elizabeth Gong-Guy, Scott Fears, Eliza Congdon, Nelson Freimer, Michelle Craske. Originally published in JMIR Mental Health (https://mental.jmir.org), 24.07.2023.