Abstract 4147453: Use of a Mobile Application and Improved Mental Health for Adults with Coronary Heart Disease: Results from the Mobile4Meds Randomized Clinical Trial

Background: Adherence to cardiovascular medications is critical for avoid morbidity and mortality and may influence mental health. The use of text messaging (TM) or mobile applications (apps) for medication adherence may be supportive for mental health in patients with cardiovascular disease (CVD). Objective: This study sought to compare self-reported mental health (symptoms of depression, anxiety, and post-traumatic stress disorder) in participants of a 3-arm randomized clinical trial (RCT): 1) TM, 2) mobile app, 3) control groups. The primary goal of the parent study was to compare differences in antiplatelet medication based on group assignment. Methods: We analyzed data among Veteran and non-Veteran patients with CVD who were recruited from 4 Veterans Affairs (VA) and 2 non-VA Northern California medical centers from 2018 to 2022. Patients were followed at 3, 6, and 12 months. The variable of interest was change in self-reported mental health status after the mobile health intervention, which was measured from the 5-item mental health questions of the Short Form Survey (SF-20) questionnaire, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder scale (GAD-7), and Posttraumatic Stress Disorder Checklist (PCL) through repeated measures. We used linear mixed models with predictor variables of group (with the control group as reference), time (baseline, 3, 6 months), and group-by-time interactions to detect group differences. Results: The mean age was 66.9 (SD 11), 49.5% female (N=99). Scores from the mental health questions of the SF-20 showed significant main effects of group-by-time interactions for the TM group at 3 and 6 months (B=11.89, standard error [SE]=4.84, p<.05; B=10.91, SE=5.03, p<.05, respectively), compared to the control group. The App group had significant group differences at 3 months (B=11.89, SE=5.29, p<.05); however, effects did not remain at 6 months. No significant group differences were detected from the other questionnaires measuring mental health. Conclusions: The findings of this RCT present the potential for mobile technology to improve mental health status in patients who were recently discharged after a cardiac event from one scale; however, not corroborated by other questionnaires. Further intervention development and measurement in fully powered RCTs can illuminate the impact of technology to improve mental health status, as these patient-reported outcomes remain a major public health priority for individuals with CVD.