Clinical Digital Health Engagement and Psychological Distress Among Adults

Importance: Digital health technologies are increasingly integrated into clinical care, but their psychological correlates remain unclear. Objective: To examine whether digital health engagement within clinical care systems is associated with psychological distress among US adults. Design, Setting, and Participants: This cross-sectional study using data from the Health Information National Trends Survey (HINTS), a nationally representative survey of noninstitutionalized US adults. Data were analyzed from January 2026 to May 2026. Data from multiple cycles of the HINTS, including HINTS 5 (2017-2020), HINTS 6 (2022), and HINTS 7 (2024), were pooled. The analytic sample included 23 682 individuals. Exposure: Digital health engagement measured using a composite index capturing electronic communication with a health care practitioner, viewing laboratory or test results online, accessing an online medical record or patient portal, use of health or wellness mobile applications, and electronically transmitting health information from a device or application to a health professional. Main Outcomes and Measures: Psychological distress measured using the 4-item Patient Health Questionnaire (PHQ-4), a validated scale ranging from 0 to 12, with higher scores indicating greater psychological distress. Results: The analytic sample included 23 682 individuals. The mean (SD) age was 55 (17) years, digital engagement score was 0.4 (0.3), and the PHQ-4 score was 2.0 (2.8). Overall, 13 855 (59%) of respondents were female; 3940 (17%) were Hispanic, 1161 (4.9%) were non-Hispanic Asian, 3333 (14%) were non-Hispanic Black, 14 402 (61%) were non-Hispanic White, and 846 (3.6%) identified as non-Hispanic other. In survey-weighted regression models, higher digital engagement was associated with higher psychological distress (β = 0.51; 95% CI, 0.27-0.75; P < .001). Exploratory generalized additive models suggested nonlinearity in the association, although it remained positive across the observed range of engagement. Similar associations were observed among respondents reporting excellent, very good, or good health. Associations were strongest for active digital behaviors, including electronic communication with clinicians and use of health-related mobile applications. Conclusions and Relevance: In this cross-sectional study of US adults using data from the HINTS, higher digital health engagement was associated with modestly higher psychological distress. Engagement patterns may reflect not only patient activation but also underlying psychological distress.