Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications

Abstract

Background Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. Objective The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. Methods A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. Results The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. Conclusions No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies.

Efficacy of Smartphone Apps in Patients With Depressive Disorders: A Systematic Review

“…The findings of this review contrast with those of Hrynyschyn and Dockweiler (16), who found contradictory results on the efficacy of CBT-based apps in reducing depressive symptomatology in patients with mild or moderate depression, and highlight the considerable degree of heterogeneity of the articles included in their work. The review of these authors only included studies from 2015 onward, which only analyzed the efficacy of CBT-based apps in patients with mild to moderate depression (who in the majority of studies were recruited from a cutoff score on a depressive symptom questionnaire).…”

“…However, maintaining user engagement is a challenge in relation to app interventions because, often, there is a rapid drop in their use (6). In a previous systematic review, contradictory results regarding the efficacy of apps based on Cognitive Behavioral Therapy (CBT) in patients suffering from mild and moderate depression were found (16). According to Hrynyschyn and Dockweiler (16), the clinical and methodological heterogeneity in the clinical trials interferes with the outcome analyses and prevents us from drawing solid conclusions.…”

“…In a previous systematic review, contradictory results regarding the efficacy of apps based on Cognitive Behavioral Therapy (CBT) in patients suffering from mild and moderate depression were found (16). According to Hrynyschyn and Dockweiler (16), the clinical and methodological heterogeneity in the clinical trials interferes with the outcome analyses and prevents us from drawing solid conclusions. However, the review conducted by Hrynyschyn and Dockweiler (16) provides limited evidence about the efficacy of these interventions, since it focuses exclusively on apps based on CBT, includes patients with mild or moderate depression selected by using cutoff scores in questionnaires about depression (without the need of being diagnosed by a health professional) and only analyzes studies carried out from 2015 onward.…”

“…According to Hrynyschyn and Dockweiler (16), the clinical and methodological heterogeneity in the clinical trials interferes with the outcome analyses and prevents us from drawing solid conclusions. However, the review conducted by Hrynyschyn and Dockweiler (16) provides limited evidence about the efficacy of these interventions, since it focuses exclusively on apps based on CBT, includes patients with mild or moderate depression selected by using cutoff scores in questionnaires about depression (without the need of being diagnosed by a health professional) and only analyzes studies carried out from 2015 onward. In their meta-analysis, Serrano-Ripoll et al (17) found smartphone app interventions had a moderate effect on depressive symptomatology.…”

Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials

“…The newer generation of investigation now focuses on engagement, efficacy (i.e., performance in ideal conditions), and effectiveness (i.e., performance in naturalistic contexts) in ultimately seeking to answer questions around real world use of these interventions towards improving outcomes. Yet surprisingly, this research has not yielded clear answers with recent 2021 systematic reviews of app interventions reporting outcomes ranging from "inconsistent results" [18] to "proven effectiveness" [19].…”