Certain smartphone-based mental health interventions may provide effective treatment to patients with depressive symptoms, according to research published in World Psychiatry.
Researchers conducted a meta-analysis of 18 randomized controlled trials focused on 22 smartphone apps. The trials included data on 3414 participants (median age 39 years). Participants had a wide range of mood disorders, including mild-to-moderate or major depression, bipolar disorder, social anxiety, insomnia, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, memory complaints, and suicidal thoughts. The duration of the examined smartphone interventions took place between 4 and 24 weeks.
The primary outcome for 12 studies was improvement of depressive symptoms; the remaining 6 studies included improvement of depressive symptoms as a secondary end point.
Overall, researchers identified small to moderate positive effect sizes for smartphone app use as a mental health intervention (Hedge’s g=0.383; 95% CI, 0.24-0.52; P <.001). Despite heterogeneity in data, they noted “no evidence of publication bias” (P =.255), and preplanned subgroup analyses found that effect sizes were “significantly greater when comparing smartphone interventions to inactive conditions than when using active control conditions” (P =.002).
Additional comparative subgroup analyses were performed to identify which specific aspects of smartphone app use were effective for depression intervention. Those apps involving in-person feedback had nonspecific, small effects on depressive symptoms (g=0.137; 95% CI, -0.08-0.35; P =.214); more positive effects were noted with apps that did not include this component (g=0.465; 95% CI, 0.30-0.63; P <.001; between-group difference P =.017).
Researchers found larger effect sizes in 10 studies that used apps that included in-app feedback (g=0.534; 95% CI, 0.26-0.81; P <.001), whereas 4 studies that included cognitive training apps had a “significantly smaller effect size” on depression outcome (g=0.123; 95% CI, -0.012-0.26; P =.074) vs those apps that focused on mental health alone (g=0.518; 95% CI, 0.28-0.60; P <.001). Mindfulness training and cognitive behavioral therapy-based apps did not influence study effect sizes (all P >.1).
“To our knowledge, this is the first meta-analysis to examine the efficacy of smartphone interventions for depressive symptoms,” the researchers concluded. “[T]he evidence to date indicates that mental health interventions delivered via smartphone devices can reduce depressive symptoms. However, delivering treatments via smartphone introduces several new aspects which need to be considered [including] feedback loops, expectancy effects, and individual patient characteristics.”
Researchers indicated that future research should investigate feasible methods for implementing smartphone-based interventions into the healthcare system.
Firth J, Torous J, Nicholas J, et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017;16(3):287-298.