Smartphone-Based Interventions for Depression

Technology is rapidly advancing and more people are depending on it to stay in touch with friends, finding the quickest way to work or doing their weekly shopping. It is no surprise that people are turning to their smartphones to improve their mental wellbeing. There are many mobile applications available on smartphones that claim to improve your mental health, however not all mental health apps are created equal and it is important to know how to make sure the one you are using is truly helpful.

Joseph Firth and colleagues conducted the first meta-analysis of apps for depressive symptoms in October 2017, which was published in the Official Journal of the World Psychiatric Association. Depression is typically a treatable mental health condition with a variety of different treatments, ranging from mindfulness-based interventions to medication. Though treatable, a high number of individuals with depression do not actively seek support from mental health professionals.

One in 27 people in poorer countries seek support, while 1 in 5 seek support in richer countries. So, if only 1 in 5 people are visiting their doctor when they are feeling particularly depressed even though they are in a country where support should be easily accessible and affordable, what is stopping people from accessing help? It could be due to a lack of trained psychologists in your area, the cost of therapy or the stigma surrounding mental health conditions. Not only this, but according to Firth, almost half of the world’s population live in countries where there is less than 1 psychiatrist per 100,000 people — making effective therapy almost impossible. Following this, even in countries where high standard therapy can be carried out, people can relapse and become depressed again. Given the barriers to access effective treatment “methods for reducing depression on a population scale are urgently needed.”¹ Mobile applications may be part of the solution as they can be a way to enable access to effective treatment methods at a low cost to a large population.

The study conducted by Firth and colleagues started by identifying all studies exploring how effective mobile applications were for treating depressive symptoms. The articles included were all in English and eligible studies were all randomized controlled trials which explored the impact of a mental health intervention delivered via smartphone on at least one measure for symptoms of depression. After weeding out all the low-quality studies the authors found 18 studies which they could include in their analysis. These studies assessed a total of 22 different smartphone mental health interventions.

The mean sample ages ranged from 18 years of age to 59 years of age. Two of the studies in the meta-analysis included people with major depression, two individuals with bipolar disorder, one included young people with any mental health condition and the rest recruited participants with self-reported mild to moderate depression, suicidal tendencies, ADHD (attention deficit disorder), anxiety, insomnia or PTSD (post traumatic stress disorder.) The intervention via smartphone lasted anywhere between 4 and 24 weeks.

Overall, the effectiveness of smartphone intervention on depressive symptoms were small to moderate in comparison to no intervention. Further analysis was explored on what particular intervention was more effective for depression. The studies involved were separated into different groups depending on techniques, feedback types and characteristics. The analyses suggested that smartphone interventions which involved humans had small effects on depressive symptoms whereas those which did not use in-person feedback had more of a positive effect. Following this, applications which as “in-app feedback”, such as progress on mental well-being had greater effect on those which did not. Finally, applications which were primarily focused on cognitive training had a smaller effect on depression outcomes than those apps which focused on mental health. The authors concluded that smart-phone interventions have been found to have a moderate positive effect on depressive symptoms.

The take away messages from the study are:

• Smartphone applications for depression can be a good first step, particularly for mild forms of depression.
• People working on their own can do quite well, making these solutions scalable as face-to-face contact with therapists does not appear to be essential.
• The content of the app should be based on evidence.
• The content should focus on mental health, rather than brain training.

The other important aspect of using a mental health application for depression is to make sure your data is kept safe and used only to provide the service. App developers should not be selling your data to third parties. Other than that, smartphone applications for depression can be a very useful tool to help with recovery.

 

Reference:

1. Firth, J., Torous, J., Nicholas, J., Carney, R., Pratap, A., Rosenbaum, S., & Sarris, J. (2017). The efficacy of smartphone‐based mental health interventions for depressive symptoms: a meta‐analysis of randomized controlled trials. World Psychiatry, 16(3), 287–298. http://ift.tt/2yjw7EZ

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