The Real-World Impact of App-Based Mindfulness on Headspace Members With Moderate and Severe Perceived Stress: Observational Study

Background: Perceived stress in the United States has drastically increased since the COVID-19 pandemic and is associated with negative mental health outcomes such as depression and anxiety. Digital mental health (DMH) interventions reduce severity of psychological symptoms (eg, anxiety, depression, perceived stress) in controlled settings, yet less is known about their real-world effectiveness. Objective: To (1) characterize baseline perceived stress patterns and changes among Headspace members with moderate and severe baseline perceived stress and (2) examine associations between engagement with Headspace content and changes in perceived stress (dose-response). Methods: Real-world perceived stress and engagement data were evaluated at two time points among Headspace members meeting inclusion criteria. Perceived stress was measured with the Perceived Stress Scale (PSS-10); engagement metrics included active days, active minutes, and sessions, plus derived ratios (active days/week, active minutes/day, sessions/week). Descriptive statistics, correlations, and t tests compared members with improvement versus no improvement and ≥30% versus <30% improvement in PSS-10 scores. Results: 21,088 members were included. On average, members showed a 23.52% decrease in PSS-10 from baseline to follow-up. Mean engagement: 2.42 active days/week, 25.89 active minutes/day, 7.11 sessions/week. Members with improvements had higher baseline PSS-10 (Cohen d=0.56), more active days/week (d=0.33), and more sessions/week (d=0.27) than those without improvements (all P<.001). Members with ≥30% improvement had higher baseline PSS-10 (d=0.35), more active days/week (d=0.36), and more sessions/week (d=0.31) than those with <30% improvement (all P<.001). Conclusions: Real-world Headspace use is associated with decreased perceived stress. Greater engagement—especially more weekly active days and sessions—is associated with a higher likelihood of stress reduction.

Christine Callahan, Justin Kimber, Emily Hu, Leah Tanner, Sarah Kunkle