Mobile apps can help treat moderate to severe depression

A meta-analysis found that the apps were effective regardless of whether patients were currently receiving depression treatment. Interventions that lasted less than eight weeks were more effective than longer ones.

Mobile app interventions are effective at treating moderate and severe depression, both as stand-alone treatments and adjuncts to conventional therapies, a new analysis found.

Investigators conducted a systematic review and meta-analysis to better understand the efficacy of mobile app interventions and any factors associated with better outcomes. A total of 13 randomized clinical trials, with 16 different apps and 1,470 participants, were included in the review. Of the included patients, 756 were in intervention groups and 714 were in control groups. All studies were published between 2017 and 2021 and conducted in the U.S., Europe, Asia, or Australia. Findings from the meta-analysis were published by JAMA Network Open on Nov. 20.

Patients with moderate to severe depression who used the apps had significantly reduced depressive symptoms, with a medium effect size (assessed by the standardized mean difference [SMD]) of 0.50 (95% CI, 0.40 to 0.61). Apps with notifications were associated with significantly lower effect on depression (SMD, 0.45; 95% CI, 0.29 to 0.60) compared with apps without notifications (SMD, 0.71; 95% CI, 0.54 to 0.87; P=0.02). Shorter interventions were also linked to greater treatment efficacy, with a significantly greater effect size for those delivered for less than eight weeks versus those lasting eight weeks or longer (SMD, 0.77 [95% CI, 0.59 to 0.96] vs. 0.43 [95% CI, 0.30 to 0.57]; P=0.004).

A subgroup analysis showed that app interventions have potential to treat marginalized groups, as they were significantly more effective in participants with non-Western ethnicities compared with those with Western ethnicities, a finding researchers hypothesize could be due to greater stigma surrounding mental health disorders in non-Western cultures. The interventions led to significant reductions in depression severity both in patients who were receiving psychological or medication treatments and in those who were not. However, the authors noted that the effect sizes were more pronounced in patients not receiving ongoing treatment.

Additional research is needed to test the efficacy of these interventions among patients with mild depression and those ages 50 years and older, the authors said.

“The significant treatment efficacy of app-based interventions compared with active and inactive controls suggests the potential of mobile app interventions as an alternative to conventional psychotherapy, with further merits in accessibility, financial affordability, and safety from stigma,” they wrote.

In future interventions, “the user's cultural background, incorporation of in-app incentives and in-person reminders, duration of app use, and [cognitive behavioral therapy] and [behavioral activation]-based modules should be considered for more effective design and application of mobile app interventions for individuals with moderate to severe depression,” the researchers concluded.