Background:

 Supporting psychological wellness and using equitable approaches to care are integral parts of effective cardiometabolic (CMB) risk management. We evaluated change in depression and anxiety symptoms after enrolling in a virtual CMB program with integrated behavioral health support overall, among those with greater symptom burden, and within demographic subgroups. 

Methods:

Eligibility criteria included self-reported obesity, diabetes (DM), and/or hypertension (HTN), virtual CMB program enrollment between 10/2021 and 04/2024, and baseline and 16-week PHQ-4 values. The virtual programs offered condition-specific care with a lifestyle-behavior focused curriculum, including self-help cognitive behavioral and mindfulness tools, and a care team that included member-facing health coaches and CMB Specialists (for DM and/or HTN) and licensed clinical social workers available to consult with member-facing care teams on behavioral health needs. Change in PHQ-4 score was evaluated overall and by race/ethnicity and education using t-tests. Changes in PHQ-4 category (0-2=None; 3-5=Mild; 6-8=Moderate; 9-12=Severe) were evaluated with Stuart Maxwell and chi-squared tests. A subgroup analysis was conducted for those with baseline PHQ-4 scores ≥6. 

Results:

Among the eligible member sample (n=18,142), 73% were female, 81% identified as white, 8.4% Hispanic, and 6.6% Black, and 22% had a high-school or less education level. The percentage of members in each PHQ-4 category at baseline was 62% None, 26% Mild, 8% Moderate, and 2% Severe. Mean PHQ-4 score improved overall (-0.7, p<.01) and in the Moderate+ subgroup (n=2,202; -3.2, p<.01). There was a statistically significant difference in PHQ-4 category from baseline to follow-up overall (p<.01) and in the Moderate+ subgroup (p<.01), with 24% shifting into a lower severity category overall and 72% shifting into a lower severity category in the Moderate+ subgroup. Significant PHQ-4 improvements were observed across all race/ethnicity and education groups overall (PHQ-4 difference range: -0.6 to -0.9; all p<.01) and in the Moderate+ subgroup (PHQ-4 difference range: -3.1 to -3.6; all p<.01). 

Discussion:

Improvements in depression and anxiety symptoms were seen among members in virtual CMB programs overall and across demographic subgroups and were greatest among those with higher baseline symptom severity. Improved mental health support and well-being tools could help reduce CMB disease development and complications.