Clinically Meaningful Improvement in Depression and Anxiety Among Psychiatry Patients Within a Measurement-Based Care Digital Mental Health Intervention: A Retrospective Analysis of Real-World Data from Rula Health

Depression and anxiety are common, disabling conditions that often require sustained psychiatric care. While digital mental health interventions (DMHIs) offer scalable access, few integrate measurement-based care (MBC) to track outcomes such as minimal clinically important difference (MCID) and remission. The purpose of this study was to evaluate the rate and timing of MCID and remission in depression and anxiety among patients with elevated baseline depression and anxiety scores receiving psychiatry services through Rula Health, a MBC-based DMHI that connects patients with psychiatric care. Symptoms were assessed prior to psychiatric visits over a 24-week period and used to evaluate effect sizes, as well as rates of MCID and remission. Kaplan-Meier and Cox proportional hazards models were used to estimate the timing of MCID and remission, and to identify demographic and clinical factors associated with achieving each outcome. A total of 7124 adults with elevated depression symptoms and 7628 with elevated anxiety symptoms at baseline were included. Depression and anxiety symptoms decreased with large effect sizes (<i>d</i>'s = -1.17 to -1.62). The median survival time to MCID in depression was 12 weeks and remission 22 weeks. The median survival time to MCID in anxiety was 11 weeks and remission 19 weeks. Several demographic and clinical characteristics were associated with time to MCID and remission. MBC-based digital psychiatry services can support sustained, clinically meaningful change. Faster improvement among patients with varying clinical and demographic characteristics highlights Rula Health's ability to address a range of patient needs.