Impact of Smartphone App–Based Psychological Interventions for Reducing Depressive Symptoms in People With Depression: Systematic Literature Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background Depression is a serious, disabling mental disorder that severely affects quality of life. Patients with depression often do not receive adequate treatment. App-based psychotherapy is considered to have great potential to treat depression owing to its reach and easy accessibility. Objective We aim to analyze the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Methods We conducted a systematic literature review and meta-analysis. We searched Medline, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials from inception to December 23, 2020. We selected randomized controlled trials to examine the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Study selection, data extraction, and critical appraisal (using the Cochrane Risk of Bias tool for randomized studies and the ROBINS-I tool for nonrandomized studies) were conducted independently by 2 reviewers. Where possible, we pooled data using random effects meta-analyses to obtain estimates of the effect size of the intervention. We conducted post hoc meta-regression analyses to explore the factors associated with intervention success. Results After screening 3468 unique references retrieved from bibliographic searches and assessing the eligibility of 79 full texts, we identified 12 trials (2859 participants) evaluating 14 different interventions. Of 14 trials, 7 (58%) were conducted in the United States; 3 (25%) trials, in Asia (Japan, South Korea, and China); 1 (8%) trial, in Australia; and 1 (8%) trial, in Germany. Of the 12 trials, 5 (42%) trials presented a low risk of bias. The mean duration of the interventions was 6.6 (SD 2.8) weeks. Two-thirds of the interventions were based on cognitive behavioral therapy alone or included it in combination with cognitive control therapy, positive psychology, brief behavioral activation, or mindfulness- and acceptance-based therapy. With no evidence of publication bias, a pooled analysis of 83% (10/12) of the trials and 86% (12/14) of the interventions showed that app-based interventions, compared with a control group receiving usual care or minimal intervention, produced a moderate reduction in depressive symptoms (standardized mean difference [SMD] −0.51, 95% CI −0.69 to −0.33; 2018/2859, 70.58% of the participants; I2=70%). Our meta-regression analyses indicated that there was a greater reduction in symptoms of depression (P=.04) in trials that included participants with moderate to severe depression (SMD −0.67, 95% CI −0.79 to −0.55), compared with trials with participants exhibiting mild to moderate depression (SMD −0.15, 95% CI −0.43 to −0.12). Conclusions App-based interventions targeted at people with depression produce moderate reductions in the symptoms of depression. More methodologically robust trials are needed to confirm our findings, determine which intervention features are associated with greater improvements, and identify those populations most likely to benefit from this type of intervention. Trial Registration PROSPERO CRD42019145689; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145689

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

“…The results of this systematic review are not consistent with those of Serrano-Ripoll et al (17), who found that app-based interventions resulted in a moderate reduction in depressive symptoms. These authors included in their meta-analysis participants with depressive symptoms, which in some studies had not necessarily been diagnosed by a health professional.…”

“…The fact that within-group improvements in app intervention groups have been observed offers promise for future treatments. Another difference between our systematic review and that of Serrano-Ripoll et al (17) is that our work only involves patients with depressive disorders diagnosed by a health professional. This allows us to ensure that the sample of patients between the different studies is as homogeneous as possible.…”

“…These authors included in their meta-analysis participants with depressive symptoms, which in some studies had not necessarily been diagnosed by a health professional. In terms of interpreting the findings of Serrano-Ripoll (17), we should be taking into account that these authors analyzed studies comparing an app intervention group to a non-active control group, which could account for the effect found. App interventions rarely outperform active interventions [i.e., therapeutic interventions acting as an active control group; (6,33)].…”

“…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. Nonetheless, these authors include studies conducted with participants with depressive symptoms, and not in all the studies were the patients diagnosed by a health professional.…”

Application of Telemedicine in COVID-19: A Bibliometric Analysis

“…The most common forms of intervention include using smartphone APP [like PsyCovidApp ( 31 ), Insight Timer Meditation App ( 32 )], videoconferencing ( 33 , 34 ), internet ( 35 , 36 ), and so on. Mobile applications ( 37 ), videoconferencing ( 38 ), text messaging ( 39 ), and social media ( 40 ) have shown to be useful communication methods for delivering mental health services.…”