Abstract:Background: A systematic review and meta-analysis was conducted to evaluate the effectiveness of mobile applications used by patients diagnosed with mental disorders. Methods: An electronic literature search in five databases including PubMed, Embase, the Cochrane Library, CINAHL, and PsychInfo was conducted. The keywords used were "mental disorder," "mental illness," "mobile phone," "smartphone," "mHealth," "application," and "app". The search was restricted to randomized controlled trials (RCTs) written in E… Show more
“…This finding highlights the potential for app-based interventions to produce positive outcomes for individuals struggling with moderate and severe depression, even without professional support. Some studies contradicted our results, which may have been due to our study limiting the depression severity to moderate and severe.…”
Section: Discussioncontrasting
confidence: 96%
“…In addition, limited research has explored the factors influencing better treatment outcomes, with some studies yielding inconsistent findings. 20,22,27 These findings call for further investigation into the efficacy and potential factors that could enhance or attenuate the effectiveness of app-based treatments for moderate to severe depression. Therefore, this systematic review and meta-analysis aimed to examine the efficacy and associated variables of app-based interventions for depression.…”
Section: Introductionmentioning
confidence: 99%
“…Furthermore, research on the efficacy of mobile app interventions, particularly for treating moderate and severe depression, is scarce despite their urgency in treatment. In addition, limited research has explored the factors influencing better treatment outcomes, with some studies yielding inconsistent findings . These findings call for further investigation into the efficacy and potential factors that could enhance or attenuate the effectiveness of app-based treatments for moderate to severe depression.…”
ImportanceMobile mental health applications (apps) for moderate to severe depression are proliferating, likely owing to their capacity to overcome the limitations of conventional psychotherapy, but research on the potential moderators of treatment efficacy is lacking.ObjectiveTo examine the treatment efficacy associated with mobile app interventions for moderate to severe depression and identify the potential moderators associated with better treatment outcomes.Data SourcesPubMed, Embase, and PsycINFO were searched from their inception to January 22, 2023.Study SelectionOnly randomized clinical trials evaluating mobile app treatments in adults with moderate to severe depression that published their results in English were included in the analysis.Data Extraction and SynthesisThree independent researchers extracted and assessed relevant studies, their risk of bias, the characteristics of the population and study design, and the components of the intervention program following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. A fixed-effects model was used for data analysis, and exploratory post hoc meta-regression and subgroup analyses were also conducted. Data were analyzed from February 16 to March 25, 2023.Main Outcomes and MeasuresThe main outcome was changes in depression symptom severity from before to after treatment, measured by standardized depression assessment instruments. Secondary outcomes included study-, intervention-, and patient-level factors associated with app efficacy.ResultsOf 2128 studies identified, 13 studies evaluating 16 intervention apps with 1470 participants with moderate to severe depression were included in the analysis. The overall pooled effect size of mobile app interventions vs both active and inactive control groups was 0.50 (95% CI, 0.40 to 0.61). Interventions with in-app notifications were associated with significantly lower treatment outcomes (standardized mean difference [SMD], 0.45; 95% CI, 0.29-0.60) than interventions without (SMD, 0.71; 95% CI, 0.54-0.87; P = .02). In addition, app interventions delivered for less than 8 weeks were associated with a significantly greater effect size (SMD, 0.77; 95% CI, 0.59-0.96) than interventions delivered for 8 weeks or longer (SMD, 0.43; 95% CI, 0.30-0.57; P = .004).Conclusions and RelevanceIn this systematic review and meta-analysis, the feasibility and efficacy of mobile app interventions were supported in treating moderate and severe depression, and practical implications were also provided for developing effective app-based interventions in clinical practice.
“…This finding highlights the potential for app-based interventions to produce positive outcomes for individuals struggling with moderate and severe depression, even without professional support. Some studies contradicted our results, which may have been due to our study limiting the depression severity to moderate and severe.…”
Section: Discussioncontrasting
confidence: 96%
“…In addition, limited research has explored the factors influencing better treatment outcomes, with some studies yielding inconsistent findings. 20,22,27 These findings call for further investigation into the efficacy and potential factors that could enhance or attenuate the effectiveness of app-based treatments for moderate to severe depression. Therefore, this systematic review and meta-analysis aimed to examine the efficacy and associated variables of app-based interventions for depression.…”
Section: Introductionmentioning
confidence: 99%
“…Furthermore, research on the efficacy of mobile app interventions, particularly for treating moderate and severe depression, is scarce despite their urgency in treatment. In addition, limited research has explored the factors influencing better treatment outcomes, with some studies yielding inconsistent findings . These findings call for further investigation into the efficacy and potential factors that could enhance or attenuate the effectiveness of app-based treatments for moderate to severe depression.…”
ImportanceMobile mental health applications (apps) for moderate to severe depression are proliferating, likely owing to their capacity to overcome the limitations of conventional psychotherapy, but research on the potential moderators of treatment efficacy is lacking.ObjectiveTo examine the treatment efficacy associated with mobile app interventions for moderate to severe depression and identify the potential moderators associated with better treatment outcomes.Data SourcesPubMed, Embase, and PsycINFO were searched from their inception to January 22, 2023.Study SelectionOnly randomized clinical trials evaluating mobile app treatments in adults with moderate to severe depression that published their results in English were included in the analysis.Data Extraction and SynthesisThree independent researchers extracted and assessed relevant studies, their risk of bias, the characteristics of the population and study design, and the components of the intervention program following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. A fixed-effects model was used for data analysis, and exploratory post hoc meta-regression and subgroup analyses were also conducted. Data were analyzed from February 16 to March 25, 2023.Main Outcomes and MeasuresThe main outcome was changes in depression symptom severity from before to after treatment, measured by standardized depression assessment instruments. Secondary outcomes included study-, intervention-, and patient-level factors associated with app efficacy.ResultsOf 2128 studies identified, 13 studies evaluating 16 intervention apps with 1470 participants with moderate to severe depression were included in the analysis. The overall pooled effect size of mobile app interventions vs both active and inactive control groups was 0.50 (95% CI, 0.40 to 0.61). Interventions with in-app notifications were associated with significantly lower treatment outcomes (standardized mean difference [SMD], 0.45; 95% CI, 0.29-0.60) than interventions without (SMD, 0.71; 95% CI, 0.54-0.87; P = .02). In addition, app interventions delivered for less than 8 weeks were associated with a significantly greater effect size (SMD, 0.77; 95% CI, 0.59-0.96) than interventions delivered for 8 weeks or longer (SMD, 0.43; 95% CI, 0.30-0.57; P = .004).Conclusions and RelevanceIn this systematic review and meta-analysis, the feasibility and efficacy of mobile app interventions were supported in treating moderate and severe depression, and practical implications were also provided for developing effective app-based interventions in clinical practice.
“…Most reviews targeted specific indications, including type 2 diabetes (T2DM) ( n = 5) 19 , 20 , 22 , 23 , 26 , hypertension ( n = 4) 15 , 27 , 31 , 38 , depression ( n = 3) 33 , 53 , 61 , overweight/obesity ( n = 3) 40 , 41 , 52 , chronic obstructive pulmonary disease (COPD) ( n = 2) 35 , 39 , urinary incontinence ( n = 2) 56 , 62 , asthma ( n = 1) 57 , autism spectrum disorders ( n = 1) 32 , post-traumatic stress disorder (PTSD) ( n = 1) 59 , type 1 diabetes ( n = 1) 47 , Parkinson’s disease ( n = 1) 45 , knee arthroplasty ( n = 1) 46 and lower back pain ( n = 1) 51 . Twenty-two reviews covered multiple conditions within their scope, such as diabetes of various types ( n = 7) 18 , 21 , 24 , 25 , 36 , 37 , 50 , chronic non-communicable diseases ( n = 2) 55 , 58 , anxiety and depression ( n = 2) 43 , 49 , conditions requiring rehabilitation ( n = 2) 42 , 44 , pediatric diseases ( n = 1) 54 , diseases requiring medication ( n = 2) 17 , 34 , cardiovascular diseases ( n = 2) 16 , 30 , pain conditions ( n = 2) 48 , 60 , mental illnesses ( n = 1) 28 , or a combination of diabetes and hypertension ( n = 1) 29 . …”
Section: Resultsmentioning
confidence: 99%
“…Two reviews additionally reported results for medication adherence 17 , 61 , one 61 on psychiatric admissions, medication adherence and side effects, resilience, attitudes, sleep disturbances and further psychological and behavioral outcomes 61 . Further reviews reported on depressive 28 , 43 , 49 , mania and psychotic symptoms as well as adverse events 28 and anxiety symptoms 43 , 49 in samples that did include depression patients, however not exclusively. Outcomes evaluated in other mental health indications included symptoms related to PTSD 59 , positive and negative psychotic symptoms including hallucinations or delusions and absence of experience (in schizophrenia), mania and depression symptoms (bipolar disorder) 28 , and autism-related outcomes based on the Mullen Scales of Early Learning, MacCarthur-Bates Communication Development Inventory and Communication and Symbolic Behavior Scales 32 .…”
Health interventions based on mobile phone or tablet applications (apps) are promising tools to help patients manage their conditions more effectively. Evidence from randomized controlled trials (RCTs) on efficacy and effectiveness of such interventions is increasingly available. This umbrella review aimed at mapping and narratively summarizing published systematic reviews on efficacy and effectiveness of mobile app-based health interventions within patient populations. We followed a pre-specified publicly available protocol. Systematic reviews were searched in two databases from inception until August 28, 2023. Reviews that included RCTs evaluating integrated or stand-alone health app interventions in patient populations with regard to efficacy/effectiveness were considered eligible. Information on indications, outcomes, app characteristics, efficacy/effectiveness results and authors’ conclusions was extracted. Methodological quality was assessed using the AMSTAR2 tool. We identified 48 systematic reviews published between 2013 and 2023 (35 with meta-analyses) that met our inclusion criteria. Eleven reviews included a broad spectrum of conditions, thirteen focused on diabetes, five on anxiety and/or depression, and others on various other indications. Reported outcomes ranged from medication adherence to laboratory, anthropometric and functional parameters, symptom scores and quality of life. Fourty-one reviews concluded that health apps may be effective in improving health outcomes. We rated one review as moderate quality. Here we report that the synthesized evidence on health app effectiveness varies largely between indications. Future RCTs should consider reporting behavioral (process) outcomes and measures of healthcare resource utilization to provide deeper insights on mechanisms that make health apps effective, and further elucidate their impact on healthcare systems.
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