Supplementary Material for: Efficacy of an internet- and mobile-based intervention for subclinical anxiety and depression (ICare Prevent) with two guidance formats: Results from a three-armed randomized controlled trial

Introduction: Limited research exists on intervention efficacy for comorbid subclinical anxiety and depression is scarce, despite their common co-occurrence. Internet- and mobile-based interventions (IMI) are promising to reach individuals facing subclinical symptoms.
Objective: This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC).
Methods: Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥ 16) symptoms, who did not meet criteria for a full syndrome depression or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n=186) or AG-IMI (n=189) or WLC (n=191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6- and 12-months are reported.
Results: Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d=0.45, depression: d=0.43) and AG-IMI (anxiety: d=0.31, depression: d=0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI.
Conclusions: A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.