Table 4.
Total and constituent effects of digital mental health intervention engagement (exposure) on PROMIS score changes (outcomes) over a 1-month time interval among 30 patients who presented to an orthopedic clinic for management of chronic neck or back pain between January 2022 and May 2022.a,b
| Outcome | Total effect | Direct effectsc | Indirect effectsd | ||||||||||
| PROMISe domain | Estimate (80% CI) | P value | Estimate (80% CI) | P value | Estimate (80% CI) | P value | |||||||
| Proposed mediator: behavioral activation (BADS-SFf) | |||||||||||||
|
|
Anxiety | –0.9 (–1.4 to –0.4) | .03g | –0.5 (–1.0 to 0.0) | .16g | –0.4 (–0.7 to –0.1) | .13g | ||||||
|
|
Depression | –0.7 (–1.5 to 0.2) | .32 | –0.1 (–0.9 to 0.7) | .90 | –0.6 (–1.0 to –0.1) | .12g | ||||||
|
|
Pain interference | 0.1 (–0.6 to 0.9) | .83 | 0.4 (–0.3 to 1.1) | .47 | –0.3 (–0.6 to 0.1) | .35 | ||||||
|
|
Physical function | 0.5 (–0.3 to 1.2) | .41 | 0.3 (–0.5 to 1.0) | .63 | 0.2 (–0.1 to 0.5) | .32 | ||||||
| Proposed mediator: pain acceptance (CPAQ-8h) | |||||||||||||
|
|
Anxiety | –0.8 (–1.4 to –0.2) | .08g | –0.7 (–1.3 to –0.1) | .11g | –0.1 (–0.2 to 0.1) | .49 | ||||||
|
|
Depression | –0.5 (–1.4 to 0.4) | .50 | –0.4 (–1.3 to 0.5) | .59 | –0.1 (–0.3 to 0.1) | .53 | ||||||
|
|
Pain interference | 0.0 (–0.7 to 0.7) | .99 | 0.0 (–0.7 to 0.7) | .97 | 0.0 (–0.1 to 0.2) | .94 | ||||||
|
|
Physical function | 0.2 (–0.4 to 0.8) | .71 | 0.2 (–0.4 to 0.8) | .71 | 0.0 (0.0 to 0.0) | .95 | ||||||
| Proposed mediator: sleep quality (AISi) | |||||||||||||
|
|
Anxiety | –0.8 (–1.3 to –0.3) | .06g | –0.6 (–1.1 to –0.1) | .11g | –0.1 (–0.4 to 0.1) | .36 | ||||||
|
|
Depression | –0.5 (–1.3 to 0.4) | .49 | –0.2 (–1.1 to 0.6) | .73 | –0.2 (–0.5 to 0.1) | .32 | ||||||
|
|
Pain interference | –0.2 (–0.9 to 0.5) | .75 | 0.0 (–0.6 to 0.6) | .99 | –0.2 (–0.6 to 0.2) | .59 | ||||||
|
|
Physical function | 0.4 (–0.3 to 1.1) | .41 | 0.2 (–0.4 to 0.9) | .64 | 0.2 (–0.1 to 0.5) | .38 | ||||||
aFor a mediation effect to be considered statistically significant, both the total and indirect effects for a given mediator or outcome pair must meet statistical significance.
bModels are adjusted for age, sex, and baseline scores for the relevant proposed mediator (Behavioral Activation for Depression Scale–Short Form [BADS-SF], Chronic Pain Acceptance Questionnaire [CPAQ-8], or Athens Insomnia Scale [AIS]) and Patient-Reported Outcomes Measurement Information System [PROMIS] domain (Anxiety, Depression, Pain Interference, or Physical Function).
cDirect effects represent the effect attributed to the exposure (ie, intervention engagement).
dIndirect effects represent the effect attributed to the proposed mediator (ie, BADS-SF, CPAQ-8, or AIS).
ePROMIS: Patient-Reported Outcomes Measurement Information System.
fBADS-SF: Behavioral Activation for Depression Scale–Short Form.
gthese P values indicate P<.20.
hCPAQ-8: Chronic Pain Acceptance Questionnaire.
iAIS: Athens Insomnia Scale.