Shorter Treatment Length Make mHealth App Interventions More Effective

While mHealth application-based interventions are effective in treating moderate and severe depression, certain factors impact their efficacy, like in-app notifications and the length of treatment delivery, recent research shows.

Published last month in JAMA Network Open, the study aims to provide insight into the characteristics associated with benefiting from the use of mHealth app interventions for depression. Researchers from South Korea searched the PubMed, Embase, and PsycINFO databases from their inception to January 22, 2023, for randomized clinical trials (RCTs) evaluating mHealth apps that treat adults with moderate to severe depression.

The researchers assessed relevant studies, their risk of bias, the characteristics of the population and study design, and the components of the intervention program. The primary outcome of the research was changes in depression symptom severity from before to after treatment.

They identified 2,128 studies, and after removing duplicates and irrelevant studies, they included 13 studies evaluating 16 intervention apps with 1,470 participants in the analysis. Three studies were conducted in the United States, three in Europe, six in Asia, and one in Australia.

A meta-analysis of the studies showed that mHealth app interventions were linked to significantly reduced depressive symptoms.

In a subgroup analysis of three studies that recruited participants belonging to marginalized groups, they found that mHealth app interventions for depression showed a medium-to-high effect size. Effect size is “a dimensionless measure of the difference in outcomes under two different treatment interventions.”

They also found that participants receiving ongoing psychotherapy or psychotropic medications showed significantly smaller effect sizes than those who did not receive any ongoing treatments.

Further, study participants with non-Western ethnicities experienced greater treatment efficacy when using app-based interventions, while participants with Western ethnicities did not.

“This discrepancy could be attributed to the higher mental disorder stigma in non-Western cultures, leading to a greater preference for mHealth interventions, thereby positively contributing to symptom improvement,” the researchers noted.

Regarding intervention components, effect sizes were more significant for app-based interventions without professional support and in-app notifications. While there were no significant differences in the effect sizes of interventions with and without cognitive behavioral therapy and behavioral activation modules, researchers observed that interventions with acceptance and commitment therapy or mindfulness and mood tracker modules had significantly smaller effect sizes than those without.

Additionally, interventions delivered for less than eight weeks were associated with a greater effect size than those delivered for eight weeks or longer.

Thus, researchers concluded that “…our study underscores the importance of proactively considering population and study design characteristics and app-based program components to further improve the effectiveness of mHealth apps.”

Nearly one-third of American adults (29 percent) report being diagnosed with depression at some point in their life, up 10 percentage points from 2015, according to a 2023 Gallup poll. The survey polled 5,167 US adults between February 21 and 28, 2023.

The survey results also show that a higher proportion of women (36.7 percent) report having been diagnosed with depression, compared with men (20.4 percent). Those who are younger than 44 and Black or Hispanic also reported greater depression diagnosis rates in their lifetime than their older and White counterparts.

These figures point to the urgent need to address the issue of depression in the US. With the growing popularity of digital tools, mHealth apps can play a key role.

In 2023, about 40 percent of US adults said they were using healthcare-related apps, up 6 percentage points from 2018, a Morning Consult survey shows. The survey, conducted between January 23 and Jan. 25, 2023, included responses from 2,201 adults.

However, even though the use of mHealth apps is growing, 37 percent of health app users said they are concerned about data privacy.