There are many mobile apps aimed at patients that are intended as supplemental tools to enhance mental health outcomes, but there is little research as to the effectiveness of such products. To evaluate whether patients use these tools as intended, and whether they impact health outcomes, a group of researchers conducted a randomized controlled trial comparing use patterns and clinical outcomes between 3 self-guided mobile apps for depression. 626 adults with mild to moderate depression [Patient Health Questionnaire (PHQ-9) score of at least 5 or item 10 score of at least 2] were randomized to use 1 of 3 apps: Project: EVO, a cognitive training app designed as a video game and intended to relieve depression by improving cognitive control; iPST, which is based one problem-solving therapy and uses a 7-step model for managing mood; and Health Tips, which provides daily general health tips and served as the control. The mean age of the sample was 33.95 (SD 11.84) years; 79% were females and 60% were non-Hispanic white. 23% had a PHQ-9 score between 5 and 10 and 77% had a PHQ-9 score of at least 10. The researchers measured how often participants opened and used the app as instructed (active apps only, because the Health Tips app did not require interaction) as well as change in PHQ-9 and Sheehan Disability Scale scores at weeks 4, 8, and 12.
In the active app conditions, 57.9% of participants did not download their assigned app, with no demographic differences between those who did and those who did not. Higher baseline depression and anxiety (GAD-7) scores were associated with less use of the apps, while higher baseline disability scores were associated with greater use of the apps. All app use significantly declined over time.
For the total sample, there was no significant difference between the active apps and the control app for change in PHQ-9 score at week 4 or week 12. However, for patients with at least moderate depression at baseline (PHQ-9 score of at least 10), PHQ-9 scores at week 12 was significantly reduced for the iPST app compared to the control app (P=.02) but not for Project: EVO. Remission was defined as a 50% reduction in score from baseline; both active apps showed a higher remission rate at week 12 than the control app (P=.04). There was no significant between the active apps and the control apps in terms of change in disability scores, either for the total group or when evaluating by disability severity (i.e., SDS=15 and SDS greater than 15).
>> Arean PA et al. J Med Internet Res 2016;18(12):e330.