{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:23:49Z","timestamp":1793075029988,"version":"4.5.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The health care workforce continues to experience high rates of depression and anxiety. Finding ways to effectively support the mental health and well-being of health care workers is challenging.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test the effectiveness of remote, pushed digital assessments and engagement to improve depression and anxiety among health care workers compared with usual care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a 9-month randomized clinical trial with a 6-month intervention period. Participants were health care workers with self-reported daily access to a smartphone and at least 4 clinical hours per week. Participants were randomized to usual care or the intervention between January 2022 and March 2023. Data analyses were conducted between May and July 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n All participants completed baseline, 6-month, and 9-month mental health, well-being, and burnout assessments. The control group had open access to a web-based mental health platform. Participants in the intervention group received monthly text messaging about mental health, mental health assessments, and linkages to care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were mean change in depression and anxiety scores at 6 months from baseline. Secondary outcomes include mean change in well-being, burnout, and self-reported workplace productivity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In this study, 1275 participants were randomized (642 [50.4%] to the intervention group and 633 [49.6%] to control group). Participants had a mean (SD) age of 38.6 (10.9) years, 1063 participants (83.4%) were female, 320 (25.1%) self-identified as Black, and 793 (62.2%) self-identified as White. Across the groups, the mean difference in depression score was significantly different at 6 months (\u22120.96 [95% CI, \u22121.52 to \u22120.40]) and at 9 months (\u22121.14 [95% CI, \u22121.69 to \u22120.58]). The mean difference in anxiety score from baseline to 6 months was statistically significantly larger for those in the intervention group vs usual care (\u22120.71 [95% CI, \u22121.25 to \u22120.17]) and held true at 9 months (\u22121.06 [95% CI, \u22121.59 to \u22120.52]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In a trial of health care workers, a proactive digital engagement strategy, including pushed text messaging, mobile mental health assessments, and connection to care, improved depression and anxiety over a 6-month period compared with simply making the same resources available for individuals to find and use.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05028075<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.10994","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T11:31:33Z","timestamp":1716550293000},"page":"e2410994","source":"Crossref","is-referenced-by-count":27,"title":["Digital Engagement Strategy and Health Care Worker Mental Health"],"prefix":"10.1001","volume":"7","author":[{"given":"Anish K.","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"},{"name":"Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Southwick","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"},{"name":"Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E.","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"},{"name":"Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Bellini","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Asch","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy A.","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandita","family":"Mitra","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Josephs","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kopinksy","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Kishton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan","family":"Balachandran","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Benjamin Wolk","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Becker-Haimes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raina M.","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania"},{"name":"Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"issue":"11","key":"zoi240395r1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.4163","article-title":"Trends in clinician burnout with associated mitigating and aggravating factors during the COVID-19 pandemic.","volume":"3","author":"Linzer","year":"2022","journal-title":"JAMA Health Forum"},{"issue":"1","key":"zoi240395r2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.43160","article-title":"Physician health care visits for mental health and substance use during the COVID-19 pandemic in Ontario, Canada.","volume":"5","author":"Myran","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"9","key":"zoi240395r3","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1001\/jama.2020.14797","article-title":"Women physicians and the COVID-19 pandemic.","volume":"324","author":"Brubaker","year":"2020","journal-title":"JAMA"},{"issue":"21","key":"zoi240395r4","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1001\/jama.2020.5893","article-title":"Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic.","volume":"323","author":"Shanafelt","year":"2020","journal-title":"JAMA"},{"key":"zoi240395r5","doi-asserted-by":"publisher","first-page":"m1211","DOI":"10.1136\/bmj.m1211","article-title":"Managing mental health challenges faced by healthcare workers during COVID-19 pandemic.","volume":"368","author":"Greenberg","year":"2020","journal-title":"BMJ"},{"issue":"5","key":"zoi240395r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.12708","article-title":"Investigating social media to evaluate emergency medicine physicians\u2019 emotional well-being during COVID-19.","volume":"6","author":"Agarwal","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"8","key":"zoi240395r7","doi-asserted-by":"publisher","first-page":"1920","DOI":"10.1007\/s11606-023-08153-z","article-title":"The Association of work overload with burnout and intent to leave the job across the healthcare workforce during COVID-19.","volume":"38","author":"Rotenstein","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"3","key":"zoi240395r8","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1093\/hsw\/hlab020","article-title":"COVID-19 impacts on social work and nursing now and into the future: national administration plans.","volume":"46","author":"Evans","year":"2021","journal-title":"Health Soc Work"},{"issue":"3","key":"zoi240395r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2022.100640","article-title":"COBALT: supporting the mental well-being of the health care workforce with technology-facilitated care during COVID-19 and beyond.","volume":"10","author":"Livesey","year":"2022","journal-title":"Healthc (Amst)"},{"issue":"11","key":"zoi240395r10","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1001\/jamapsychiatry.2023.2706","article-title":"Effects of 12 Weeks of at-home, application-based exercise on health care workers\u2019 depressive symptoms, burnout, and absenteeism: a randomized clinical trial.","volume":"80","author":"Boucher","year":"2023","journal-title":"JAMA Psychiatry"},{"key":"zoi240395r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2021.113847","article-title":"Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19.","volume":"299","author":"Buselli","year":"2021","journal-title":"Psychiatry Res"},{"issue":"5","key":"zoi240395r12","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1097\/ACM.0000000000003998","article-title":"Professional stigma of mental health issues: physicians are both the cause and solution.","volume":"96","author":"Brower","year":"2021","journal-title":"Acad Med"},{"issue":"9","key":"zoi240395r13","first-page":"1","article-title":"On the way to health.","volume":"17","author":"Asch","year":"2012","journal-title":"LDI Issue Brief"},{"key":"zoi240395r14","doi-asserted-by":"publisher","first-page":"l1476","DOI":"10.1136\/bmj.l1476","article-title":"Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.","volume":"365","author":"Levis","year":"2019","journal-title":"BMJ"},{"issue":"22","key":"zoi240395r15","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.1001\/jama.2015.15845","article-title":"Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis.","volume":"314","author":"Mata","year":"2015","journal-title":"JAMA"},{"issue":"12","key":"zoi240395r16","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1002\/da.v26:12","article-title":"The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses.","volume":"26","author":"Mealer","year":"2009","journal-title":"Depress Anxiety"},{"issue":"12","key":"zoi240395r17","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.30898","article-title":"Association of burnout with depression and anxiety in critical care clinicians in Brazil.","volume":"3","author":"Fischer","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"7","key":"zoi240395r18","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1097\/JXX.0000000000000179","article-title":"Efficacy of the Well-Being Index to identify distress and stratify well-being in nurse practitioners and physician assistants.","volume":"31","author":"Dyrbye","year":"2019","journal-title":"J Am Assoc Nurse Pract"},{"issue":"6","key":"zoi240395r19","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1097\/NNR.0000000000000313","article-title":"Efficacy of the well-being index to identify distress and well-being in US nurses.","volume":"67","author":"Dyrbye","year":"2018","journal-title":"Nurs Res"},{"issue":"3","key":"zoi240395r20","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000376585","article-title":"The WHO-5 Well-Being Index: a systematic review of the literature.","volume":"84","author":"Topp","year":"2015","journal-title":"Psychother Psychosom"},{"issue":"1","key":"zoi240395r21","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/1471-244X-9-78","article-title":"A new clinical rating scale for work absence and productivity: validation in patients with major depressive disorder.","volume":"9","author":"Lam","year":"2009","journal-title":"BMC Psychiatry"},{"issue":"12","key":"zoi240395r22","doi-asserted-by":"publisher","first-page":"1766","DOI":"10.1001\/jamainternmed.2017.5138","article-title":"Work-family conflict and the sex difference in depression among training physicians.","volume":"177","author":"Guille","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi240395r23","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.v30.4","article-title":"Multiple imputation using chained equations: issues and guidance for practice.","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"issue":"15","key":"zoi240395r24","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1001\/jama.2019.3307","article-title":"Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial.","volume":"321","author":"Song","year":"2019","journal-title":"JAMA"},{"issue":"9","key":"zoi240395r25","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1001\/jamapsychiatry.2023.2355","article-title":"Envisioning the future of well-being efforts for health care workers-successes and lessons learned from the COVID-19 pandemic.","volume":"80","author":"Mangurian","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"zoi240395r26","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.43167","article-title":"The health care workforce under stress-clinician heal thyself.","volume":"5","author":"Chang","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi240395r30","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1176\/appi.ps.202000424","article-title":"Health care workers\u2019 mental health and quality of life during COVID-19: results from a mid-pandemic, national survey.","volume":"72","author":"Young","year":"2021","journal-title":"Psychiatr Serv"},{"key":"zoi240395r27","unstructured":"Clinician well-being a top priority, Surgeon General says. The Hospitalist. Accessed May 17, 2021. https:\/\/www.the-hospitalist.org\/hospitalist\/article\/239812\/mixed-topics\/clinician-well-being-top-priority-surgeon-general-says"},{"key":"zoi240395r28","unstructured":"Any Anxiety Disorder. National Institute of Mental Health. Accessed February 8, 2024. https:\/\/www.nimh.nih.gov\/health\/statistics\/any-anxiety-disorder"},{"key":"zoi240395r29","unstructured":"Major Depression. National Institute of Mental Health. February 8, 2024. https:\/\/www.nimh.nih.gov\/health\/statistics\/major-depression"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2819255\/agarwal_2024_oi_240395_1716222782.24731.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T11:31:41Z","timestamp":1716550301000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2819255"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,5,24]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.10994","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,24]]}}}