Behavioral and cognitive intervention strategies delivered via coached apps for depression: Pilot trial.

Stiles‐Shields, Colleen; Montague, Enid; Kwasny, Mary J.; Mohr, David C.

doi:10.1037/ser0000261

Cited by 56 publications

(121 citation statements)

References 17 publications

Supporting

Mentioning

120

Contrasting

Order By: Relevance

“…The included trials represented a range of psychiatric disorders. Numbers in parentheses represent relevant chapter and coding according to International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10): 2 on drug or alcohol misuse (F10-F19) [24,37], 3 on psychosis (F20-29) [35,38,41], 10 on affective disorders (F30-39) [22,25-28,32,36,40,42,45] (comprising 3 on bipolar disorder and 7 on unipolar depressive disorder), 9 on anxiety and posttraumatic stress disorder posttraumatic stress disorder (F40-F48) [23,30,34,39,43,44,46-48], 1 on eating disorders (F50-F59) [31], and 1 on attention-deficit disorder (F90-F98) [29]. One trial included patients with severe mental disorders across ICD-10 diagnoses [33].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 8 trials were conducted in traditional clinical settings, with patients referred by clinical staff or contacted in their treatment clinic [24,27,32,33,35,37,40,41]. Others used remote designs where patients who self-identified as having a psychiatric disorder applied for participation [22,23,25,26,28,30,34,38,39,42-44,46,48]. None of the trials compared participants with nonparticipants.…”

Section: Resultsmentioning

confidence: 99%

“…All but 2 trials [43,44] presented a flowchart of eligible subjects with varying details on reasons not to participate. Trials with open recruitment (eg, internet forums, Web pages, Facebook, and advertising) [22,23,25,26,28-30,34,36,38,39,42-46,48] only had information on people who signed up. Completion rates were reported very differently and varied from 163 patients out of 164 (99.4% [163/164]) completing the primary outcome [32] to 74 out of 283 patients (26.1% [74/283]) [45].…”

Section: Resultsmentioning

confidence: 99%

“…Completion rates were reported very differently and varied from 163 patients out of 164 (99.4% [163/164]) completing the primary outcome [32] to 74 out of 283 patients (26.1% [74/283]) [45]. In addition, 12 trials compensated for participation in trial assessments with money or gift cards [26,33-38,42,43,46-48].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 5 trials based their diagnosis solely on clinical-based information [24,33,35,37,41]. Furthermore, 15 trials used research-based diagnoses without clinical information, using either questionnaires [44-46,48], phone calls [22,23,25,28,34,42], video interviews [38], or personal interviews [31,36,39,43] to validate the self-reported diagnoses. In addition, 7 trials included patients with a clinical diagnosis that was subsequently assessed and validated by the researchers using questionnaires [47], phone calls [29,30], or personal interviews [26,27,32,40].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Methodological Challenges in Randomized Controlled Trials on Smartphone-Based Treatment in Psychiatry: Systematic Review

Tønning¹,

Kessing²,

Bardram³

et al. 2019

J Med Internet Res

View full text Add to dashboard Cite

BackgroundSmartphone-based technology is developing at high speed, and many apps offer potential new ways of monitoring and treating a range of psychiatric disorders and symptoms. However, the effects of most available apps have not been scientifically investigated. Within medicine, randomized controlled trials (RCTs) are the standard method for providing the evidence of effects. However, their rigidity and long time frame may contrast with the field of information technology research. Therefore, a systematic review of methodological challenges in designing and conducting RCTs within mobile health is needed.ObjectiveThis systematic review aimed to (1) identify and describe RCTs investigating the effect of smartphone-based treatment in adult patients with a psychiatric diagnosis, (2) discuss methodological challenges in designing and conducting individual trials, and (3) suggest recommendations for future trials.MethodsA systematic search in English was conducted in PubMed, PsycINFO, and EMBASE up to August 12, 2019. The search terms were (1) psychiatric disorders in broad term and for specific disorders AND (2) smartphone or app AND (3) RCT. The Consolidated Standards of Reporting Trials electronic health guidelines were used as a template for data extraction. The focus was on trial design, method, and reporting. Only trials having sufficient information on diagnosis and acceptable diagnostic procedures, having a smartphone as a central part of treatment, and using an RCT design were included.ResultsA total of 27 trials comprising 3312 patients within a range of psychiatric diagnoses were included. Among them, 2 trials were concerning drug or alcohol abuse, 3 psychosis, 10 affective disorders, 9 anxiety and posttraumatic stress disorder, 1 eating disorder, and 1 attention-deficit/hyperactivity disorder. In addition, 1 trial used a cross-diagnostic design, 7 trials included patients with a clinical diagnosis that was subsequently assessed and validated by the researchers, and 11 trials had a sample size above 100. Generally, large between-trial heterogeneity and multiple approaches to patient recruitment, diagnostic procedures, trial design, comparator, outcome measures, and analyses were identified. Only 5 trials published a trial protocol. Furthermore, 1 trial provided information regarding technological updates, and only 18 trials reported on the conflicts of interest. No trial addressed the ethical aspects of using smartphones in treatment.ConclusionsThis first systematic review of the methodological challenges in designing and conducting RCTs investigating smartphone-based treatment in psychiatric patients suggests an increasing number of trials but with a lower quality compared with classic medical RCTs. Heterogeneity and methodological issues in individual trials limit the evidence. Methodological recommendations are presented.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Methodological Challenges in Randomized Controlled Trials on Smartphone-Based Treatment in Psychiatry: Systematic Review

Tønning¹,

Kessing²,

Bardram³

et al. 2019

J Med Internet Res

View full text Add to dashboard Cite

show abstract

App-Based Interventions for Moderate to Severe Depression

Bae,

Shin,

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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.

show abstract