(PS2-D79) Barriers to Care Among Users of a Digital Therapeutic for Mood and Anxiety

Background: Persistent barriers to accessing effective mental health care interventions such as psychotherapy result in only about half of people in need actually obtaining services. Digital mental health interventions (DMHIs) that have evidence of efficacy and safety offer an additional modality of care access with the potential to improve overall access and meaningful symptom reduction. Research examining the potential impact of DMHI to help those experiencing said barriers to care, however, has been limited. This study sought to: 1) describe endorsed barriers to seeking care; 2) quantify the magnitude of reductions in symptoms of depression, anxiety, and stress after 8 weeks of using the DMHI; and 3) examine the proportion of those without concurrent psychotherapy at baseline who enrolled in new psychotherapy services during the study.

Methods: Barriers to care data was collected as part of an 8-week single-arm trial (n=256) of Woebot-LIFE, a digital therapeutic tool that includes a fully automated relational agent designed to target symptoms of mood and anxiety (NCT05672745). Adult participants were administered the Perceived Barriers to Psychological Treatment, a 27-item measure that asked respondents to rate the degree to which different kinds of problems get in the way of seeking mental health care. Respondents rated each question on a 5-point likert scale from “Not at all Difficult” to “Impossible” that were summarized into 9 separate barrier subscales. For the purposes of this study, dichotomous versions of the subscales were used to indicate any endorsement of a particular barrier.

Results: Just under 80% of enrolled participants reported a barrier to care at baseline, with participation restriction (e.g., fatigue, lack of transportation) (42%), cost (41%), and stigma (40%) being the most frequent barriers endorsed. Those reporting a barrier at baseline had mean Week 8 reductions in depressive symptoms and anxiety symptoms of 3.7 points (SD=5.9) on the Patient Health Questionnaire-8 item scale and 3.9 points (SD=5.6) on the Generalized Anxiety Questionnaire-7 item scale as well as 2.2 points (SD=6.0) on the Perceived Stress Scale. Among those with a reported barrier who did not report being in psychotherapeutic treatment at baseline (n=159, 89%), 12% reported being enrolled by end-of-treatment.

Conclusion: Findings suggest barriers to accessing psychotherapy are prevalent among a sample of adults seeking a DMHI guided by a fully automated relational agent. Participants who endorsed barriers to accessing therapy at baseline had reductions in symptomatology and openness to receive additional mental health treatments by the end of the study. Additional research is needed to confirm the findings of this preliminary investigation.