Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study

Abstract

Background User engagement is key to the effectiveness of digital mental health interventions. Considerable research has examined the clinical outcomes of overall engagement with mental health apps (eg, frequency and duration of app use). However, few studies have examined how specific app use behaviors can drive change in outcomes. Understanding the clinical outcomes of more nuanced app use could inform the design of mental health apps that are more clinically effective to users. Objective This study aimed to classify user behaviors in a suite of mental health apps and examine how different types of app use are related to depression and anxiety outcomes. We also compare the clinical outcomes of specific types of app use with those of generic app use (ie, intensity and duration of app use) to understand what aspects of app use may drive symptom improvement. Methods We conducted a secondary analysis of system use data from an 8-week randomized trial of a suite of 13 mental health apps. We categorized app use behaviors through a mixed methods analysis combining qualitative content analysis and principal component analysis. Regression analyses were used to assess the association between app use and levels of depression and anxiety at the end of treatment. Results A total of 3 distinct clusters of app use behaviors were identified: learning, goal setting, and self-tracking. Each specific behavior had varied effects on outcomes. Participants who engaged in self-tracking experienced reduced depression symptoms, and those who engaged with learning and goal setting at a moderate level (ie, not too much or not too little) also had an improvement in depression. Notably, the combination of these 3 types of behaviors, what we termed “clinically meaningful use,” accounted for roughly the same amount of variance as explained by the overall intensity of app use (ie, total number of app use sessions). This suggests that our categorization of app use behaviors succeeded in capturing app use associated with better outcomes. However, anxiety outcomes were neither associated with specific behaviors nor generic app use. Conclusions This study presents the first granular examination of user interactions with mental health apps and their effects on mental health outcomes. It has important implications for the design of mobile health interventions that aim to achieve greater user engagement and improved clinical efficacy.

Leveraging Implementation Science to Understand Factors Influencing Sustained Use of Mental Health Apps: a Narrative Review

“…As the field matures, there have been increasing calls to incorporate design thinking strategies and user experience testing into MH app development (Lemon et al 2020 ). Apps should be simple, allowing users to engage with them in short bursts versus requiring long stretches of sustained attention (Zhang et al 2019 ); indeed, MH apps designed for briefer interactions demonstrated higher engagement rates (Firth et al 2017a ). The most frequently downloaded MH apps involve discrete activities such as relaxation and mindfulness practices as opposed to full treatment protocols (Carlo et al 2019 ).…”

“…The number of app downloads and interactions over time may also capture sustained uptake. However, operationalizing meaningful app use is a challenge, as many downloaded apps are never used (Lattie et al 2016 ; Owen et al 2015 ), and multiple studies have found no relationship between the amount of time spent on an app and clinical outcomes (Kuhn et al 2017 ; Moberg et al 2019 ; Zhang et al 2019 ). Additional research is needed to determine whether the number of log-ins, clicks, or modules completed may be more appropriate metrics of sustained use (Bakker et al 2016 ; Donkin et al 2011 ; Hermes et al 2019 ; Mohr et al 2019 ).…”

Keberkesanan Penggunaan Sistem Pesanan Teks Sebagai Rawatan Masalah Kesihatan Mental: Ulasan Kajian Secara Sistematik

“…Jadual 5 menunjukkan sebanyak dua belas kajian yang menggunakan telefon asas untuk menghantar pesanan teks ringkas seperti SMS bagi merawat kemurungan dan emosi (Islam et al, 2019;Almeidaa, Almeida & Figueiredo-Braga, 2018;Aguilera et al, 2017;García et al, 2019;Anstiss & Davies, 2015;Wolf et al, 2016;Zhang et al, 2019), melatih kesedaran minda (Kraft et al, 2017;Wolf et al, 2016), anorexia serta bulimia (Shingleton et al, 2016), skizofrenia (Xu et al, 2018) dan penyalahgunaan alkohol (Bock et al, 2016;Agyapong et al, 2018). Daripada semua kajian, enam makalah (Arean et al, 2016;Agyapong et al, 2017;Kodama et al, 2016;Menezes et al, 2019;Zhang et al, 2019;Renfrew et al, 2020) menggunakan platform aplikasi teks telefon pintar sebagai medium terapi teks untuk pesakit yang mengalami kemurungan, kebimbangan, kecelaruan emosi, kecenderungan bunuh diri, mencederakan diri, skizofrenia, skizotipal, halusinasi dan khayalan. Sorotan bacaan mendapati terdapat tiga kajian yang telah menggunakan laman sesawang untuk merawat masalah kesihatan mental yang berkaitan dengan kemurungan atau cubaan membunuh diri (Christensen et al, 2013;Renfrew et al, 2020;Zhang et al, 2019), dan satu kajian (Almeidaa, Almeida & Figueiredo-Braga, 2018) pula telah menggunakan kaedah perbualan dalam talian (chat) untuk merawat kemurungan dan gangguan emosi.…”

“…Daripada semua kajian, enam makalah (Arean et al, 2016;Agyapong et al, 2017;Kodama et al, 2016;Menezes et al, 2019;Zhang et al, 2019;Renfrew et al, 2020) menggunakan platform aplikasi teks telefon pintar sebagai medium terapi teks untuk pesakit yang mengalami kemurungan, kebimbangan, kecelaruan emosi, kecenderungan bunuh diri, mencederakan diri, skizofrenia, skizotipal, halusinasi dan khayalan. Sorotan bacaan mendapati terdapat tiga kajian yang telah menggunakan laman sesawang untuk merawat masalah kesihatan mental yang berkaitan dengan kemurungan atau cubaan membunuh diri (Christensen et al, 2013;Renfrew et al, 2020;Zhang et al, 2019), dan satu kajian (Almeidaa, Almeida & Figueiredo-Braga, 2018) pula telah menggunakan kaedah perbualan dalam talian (chat) untuk merawat kemurungan dan gangguan emosi.…”

Implementing Measurement-Based Care for Depression: Practical Solutions for Psychiatrists and Primary Care Physicians

“…Online and mobile depression applications still show little uptake by patients, although attention to specific components such as self-tracking, goal setting and educational learning may increase engagement. 69 Very few mental health apps have been adequately evaluated for effectiveness or harms, 70 although recent efforts are converging on consensus evaluation frameworks. 71,72 Security and privacy concerns are paramount among patients, 73 hence apps should have transparent policies for how data are used, shared and protected.…”