Digital Mental Health Interventions for Depression: Scoping Review of User Engagement

Abstract

Background While many digital mental health interventions (DMHIs) have been found to be efficacious, patient engagement with DMHIs has increasingly emerged as a concern for implementation in real-world clinical settings. To address engagement, we must first understand what standard engagement levels are in the context of randomized controlled trials (RCTs) and how these compare with other treatments. Objective This scoping review aims to examine the state of reporting on intervention engagement in RCTs of mobile app–based interventions intended to treat symptoms of depression. We sought to identify what engagement metrics are and are not routinely reported as well as what the metrics that are reported reflect about standard engagement levels. Methods We conducted a systematic search of 7 databases to identify studies meeting our eligibility criteria, namely, RCTs that evaluated use of a mobile app–based intervention in adults, for which depressive symptoms were a primary outcome of interest. We then extracted 2 kinds of information from each article: intervention details and indices of DMHI engagement. A 5-element framework of minimum necessary DMHI engagement reporting was derived by our team and guided our data extraction. This framework included (1) recommended app use as communicated to participants at enrollment and, when reported, app adherence criteria; (2) rate of intervention uptake among those assigned to the intervention; (3) level of app use metrics reported, specifically number of uses and time spent using the app; (4) duration of app use metrics (ie, weekly use patterns); and (5) number of intervention completers. Results Database searching yielded 2083 unique records. Of these, 22 studies were eligible for inclusion. Only 64% (14/22) of studies included in this review specified rate of intervention uptake. Level of use metrics was only reported in 59% (13/22) of the studies reviewed. Approximately one-quarter of the studies (5/22, 23%) reported duration of use metrics. Only half (11/22, 50%) of the studies reported the number of participants who completed the app-based components of the intervention as intended or other metrics related to completion. Findings in those studies reporting metrics related to intervention completion indicated that between 14.4% and 93.0% of participants randomized to a DMHI condition completed the intervention as intended or according to a specified adherence criteria. Conclusions Findings suggest that engagement was underreported and widely varied. It was not uncommon to see completion rates at or below 50% (11/22) of those participants randomized to a treatment condition or to simply see completion rates not reported at all. This variability in reporting suggests a failure to establish sufficient reporting standards and limits the conclusions that can be drawn about level of engagement with DMHIs. Based on these findings, the 5-element framework applied in this review may be useful as a minimum necessary standard for DMHI engagement reporting.

Individuals’ Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Web-Based Survey

“…Previous work has shown that despite interest in mental health apps among students, the use of these apps can be limited [57][58][59]. Building on the earlier work whose methodology we replicated, our ndings allowed us to uncover various factors associated with DMHA use in the academic community and, more particularly, its students.…”

Digital mental health care: five lessons from Act 1 and a preview of Acts 2–5

“…In spite of the power of AI (artificial intelligence) for deriving insights from medical records 3 or the sensitivity of digital phenotyping 4 , diagnosis still involves a human interviewer collecting patient data. Similarly, while companies creating autonomous agents and digital therapeutics have been funded robustly, most studies show that psychotherapy requires a human in the loop to optimize engagement 5 . Nevertheless, there is a continuing opportunity for objective data to augment subjective data through digital measures of sleep or activity or sociality 6 .…”

Longitudinal outcomes of a therapist‐supported digital mental health intervention for depression and anxiety symptoms: A retrospective cohort study

“…Compared to in‐person interventions, DMHIs can also be more accessible, standardized, cost‐effective, and convenient. Nevertheless, studies indicate that engagement and adherence vary widely in DMHIs, suggesting a need for standardized reporting guidelines to facilitate comparisons with other forms of care (Lipschitz et al., 2022).…”