Outcomes of evidence-based psychotherapy for healthcare workers: a single-arm prospective cohort study

Healthcare workers (HCWs) experience high rates of depression and anxiety, yet face substantial barriers to accessing mental health care, including limited availability, scheduling constraints, cost, and concerns about confidentiality and stigma. Despite widespread efforts to support HCWs well-being, there is limited research on improving access to high-quality mental health care for this population.

To evaluate engagement and clinical outcomes associated with a scalable, employer-sponsored digital psychotherapy program implemented within a large health system to improve access to high-quality mental health care for HCWs and their dependents.

This prospective cohort study was conducted from March 2022 through July 2024 within an employer-sponsored digital mental health program at a large integrated healthcare system. Participants were 496 adults (employees or adult dependents) who enrolled in online psychotherapy and scored ≥ 5 on the Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) at baseline. Of these, 348 (70.2%) completed at least one follow-up assessment. Participants received weekly evidence-based psychotherapy delivered via a digital platform. Primary outcomes were change in PHQ-9 and GAD-7 scores from baseline to last follow-up; secondary outcomes included remission (score < 5 among those ≥ 10 at baseline) and treatment engagement (sessions attended, treatment completion).

Of the 496 participants who initiated psychotherapy, 348 (70.2%) completed at least one follow-up assessment. Among followed participants (mean age 35 years; 80% female), mean symptom reductions were 6.4 points on the PHQ-9 (95% confidence interval [CI], 5.7, 7.1) and 6.3 on the GAD-7 (95% CI, 5.8, 6.9; both ps < 0.001; d ≈ 1.3). In the clinical subsample, 36.5% achieved depression remission and 48.8% achieved anxiety remission. Engagement was high, with participants attending a mean of 15 sessions and 81.9% completing treatment. Treatment completion was significantly associated with greater symptom improvement.

A scalable, health system-based digital psychotherapy model was feasible to implement and achieved high engagement and clinically meaningful improvements among HCWs receiving care. These findings suggest that health systems can expand access to high-quality mental health care for their workforce through digitally delivered, evidence-based care models.

Not applicable.