Monday, September 25, 2017

Smartphone Apps May Help Reduce Depressive Symptoms

Smartphone applications (apps) can be effective tools for improving symptoms of mild to moderate depression, reports a meta-analysis published in World Psychiatry. Apps that are entirely smartphone based and apps that provide direct feedback are associated with better results than those that require additional components or feedback from humans.

"Patients and doctors are faced with a vast array of mental health apps these days, and knowing which ones are helpful is imperative," said study co-author John Torous, M.D., co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center and a chair of APA’s Smartphone App Evaluation Work Group.

Torous and his colleagues evaluated 18 clinical studies with 3,400 participants who tested mobile health apps for depressive symptoms. The 18 studies included people with clinical or self-reported depression as well as other disorders with depressive elements such as bipolar disorder, anxiety, or posttraumatic stress disorder.

Overall, the authors found that the use of a mental health app provides modest improvements in symptoms, with larger effects seen when the app was compared with an inactive control (like a waitlist) versus an active control (such as a non-mental health app). That suggests that some of the improvements are due to having a device--a sort of digital placebo. 

Benefits were also more pronounced for patients with mild to moderate depression; smartphone apps did not appear helpful for individuals with major depressive disorder, bipolar disorder, or anxiety disorders. The the data for these conditions, however, were limited.

Next, the authors separated the studies on the basis of common features to gain insight into which aspects of smartphone interventions make them effective. They found that apps delivered entirely via smartphones had significantly greater effects than those that also required external components/devices, such as downloadable training modules. Similarly, apps that provided users with specific feedback, like summary statistics and progress scores, were more effective than those without such measurements. In contrast, apps that included therapist chats or other “in-person feedback” elements had generally lower effects than those thatdid not.

“It seems counterintuitive that additional features/human feedback would decrease smartphone effectiveness,” Torous and colleagues wrote. “However, this relationship is likely due to the fact that apps not relying on external components have been designed as more comprehensive and self-contained tools.”

To read more about this topic, see the Psychiatric News article, “How Might Technology Change Mental Health Care?” Also, information about mental health apps, including APA's mobile app evaluation tool, is available here