Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis

Gan, Daniel Z Q; McGillivray, Lauren; Han, Jin; Christensen, Helen; Torok, Michelle

doi:10.3389/fdgth.2021.764079

Cited by 136 publications

(82 citation statements)

References 70 publications

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“…Issues of relevance, acceptability, and perceived benefits of digital therapeutics can be addressed through codesign and may help overcome issues of poor treatment engagement [ 36 ]. Pooled findings from prior research estimate that treatment dropout is 74% for unsupervised digital therapeutics [ 37 ], which is problematic as low engagement has been shown to reduce the efficacy [ 38 ]. The relatively high rates of treatment “completion” reported in the LifeBuoy condition (71.5%) does appear to support acceptability and relevance may be enhanced by codesign.…”

Section: Discussionmentioning

confidence: 99%

The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia

et al. 2022

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Background Suicidal ideation is a major risk for a suicide attempt in younger people, such that reducing severity of ideation is an important target for suicide prevention. Smartphone applications present a new opportunity for managing ideation in young adults; however, confirmatory evidence for efficacy from randomized trials is lacking. The objective of this study was to assess whether a therapeutic smartphone application (“LifeBuoy”) was superior to an attention-matched control application at reducing the severity of suicidal ideation. Methods and findings In this 2-arm parallel, double-blind, randomized controlled trial, 455 young adults from Australia experiencing recent suicidal ideation and aged 18 to 25 years were randomly assigned in a 2:2 ratio to use a smartphone application for 6 weeks in May 2020, with the final follow-up in October 2020. The primary outcome was change in suicidal ideation symptom severity scores from baseline (T0) to postintervention (T1) and 3-month postintervention follow-up (T2), measured using the Suicidal Ideation Attributes Scale (SIDAS). Secondary outcomes were symptom changes in depression (Patient Health Questionnaire-9, PHQ-9), generalized anxiety (Generalized Anxiety Disorder-7, GAD-7), distress (Distress Questionnaire-5, DQ5), and well-being (Short Warwick–Edinburgh Mental Well-Being Scale, SWEMWBS). This trial was conducted online, using a targeted social media recruitment strategy. The intervention groups were provided with a self-guided smartphone application based on dialectical behavior therapy (DBT; “LifeBuoy”) to improve emotion regulation and distress tolerance. The control group were provided a smartphone application that looked like LifeBuoy (“LifeBuoy-C”), but delivered general (nontherapeutic) information on a range of health and lifestyle topics. Among 228 participants randomized to LifeBuoy, 110 did not complete the final survey; among 227 participants randomized to the control condition, 91 did not complete the final survey. All randomized participants were included in the intent-to-treat analysis for the primary and secondary outcomes. There was a significant time × condition effect for suicidal ideation scores in favor of LifeBuoy at T1 (p < 0.001, d = 0.45) and T2 (p = 0.007, d = 0.34). There were no superior intervention effects for LifeBuoy on any secondary mental health outcomes from baseline to T1 or T2 [p-values: 0.069 to 0.896]. No serious adverse events (suicide attempts requiring medical care) were reported. The main limitations of the study are the lack of sample size calculations supporting the study to be powered to detect changes in secondary outcomes and a high attrition rate at T2, which may lead efficacy to be overestimated. Conclusions LifeBuoy was associated with superior improvements in suicidal ideation severity, but not secondary mental health outcomes, compared to the control application, LifeBuoy-C. Digital therapeutics may need to be purposefully designed to target a specific health outcome to have efficacy. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12619001671156

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Section: Discussionmentioning

confidence: 99%

The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia

et al. 2022

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“…One of the most common barriers to mHealth programs are uptake and engagement with the intervention [ 37 ]. This is important as higher levels of engagement with digital programs are associated with improved mental health outcomes [ 38 ]. Schools represent an ideal delivery avenue to enhance uptake and engagement with mHealth prevention programs, providing large numbers of adolescents with access to mental health content linked to existing well-being curricula.…”

Section: Resultsmentioning

confidence: 99%

Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach

Birrell¹,

Furneaux-Bate²,

Debenham³

et al. 2022

JMIR Form Res

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Background Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use–related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program.

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“…As health care service delivery is becoming increasingly digital and accessible through personal devices like smartphones and wearables [ 6 , 7 ], there is a need to ensure that these digital interventions are achieving their intended outcomes. The potential impact of digital interventions is limited by the extent of users’ engagement with them [ 8 - 10 ]; a meta-analysis of engagement with digital mental health interventions found a significant positive association between engagement and mental health outcomes [ 11 ]. However, the variety in the definitions and measures of engagement means that reliable quantitative estimates of the relationship between engagement and outcomes are still lacking [ 8 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The potential impact of digital interventions is limited by the extent of users’ engagement with them [ 8 - 10 ]; a meta-analysis of engagement with digital mental health interventions found a significant positive association between engagement and mental health outcomes [ 11 ]. However, the variety in the definitions and measures of engagement means that reliable quantitative estimates of the relationship between engagement and outcomes are still lacking [ 8 , 11 ]. Maintaining engagement with digital health interventions is a common challenge.…”

Section: Introductionmentioning

confidence: 99%

Associations Between Behavior Change Techniques and Engagement With Mobile Health Apps: Protocol for a Systematic Review

Milne‐Ives¹,

Homer²,

Andrade³

et al. 2022

JMIR Res Protoc

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Background Digitally enabled care along with an emphasis on self-management of health is steadily growing. Mobile health apps provide a promising means of supporting health behavior change; however, engagement with them is often poor and evidence of their impact on health outcomes is lacking. As engagement is a key prerequisite to health behavior change, it is essential to understand how engagement with mobile health apps and their target health behaviors can be better supported. Although the importance of engagement is emphasized strongly in the literature, the understanding of how different components of engagement are associated with specific techniques that aim to change behaviors is lacking. Objective The purpose of this systematic review protocol is to provide a synthesis of the associations between various behavior change techniques (BCTs) and the different components and measures of engagement with mobile health apps. Methods The review protocol was structured using the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) and the PICOS (Population, Intervention, Comparator, Outcome, and Study type) frameworks. The following seven databases will be systematically searched: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, ScienceDirect, Cochrane Library, and Web of Science. Title and abstract screening, full-text review, and data extraction will be conducted by 2 independent reviewers. Data will be extracted into a predetermined form, any disagreements in screening or data extraction will be discussed, and a third reviewer will be consulted if consensus cannot be reached. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools; descriptive and thematic analyses will be conducted to summarize the relationships between BCTs and the different components of engagement. Results The systematic review has not yet started. It is expected to be completed and submitted for publication by May 2022. Conclusions This systematic review will summarize the associations between different BCTs and various components and measures of engagement with mobile health apps. This will help identify areas where further research is needed to examine BCTs that could potentially support effective engagement and help inform the design and evaluation of future mobile health apps. Trial Registration PROSPERO CRD42022312596; https://tinyurl.com/nhzp8223 International Registered Report Identifier (IRRID) PRR1-10.2196/35172

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Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis

Cited by 136 publications

References 70 publications

The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia

The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia

Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach

Associations Between Behavior Change Techniques and Engagement With Mobile Health Apps: Protocol for a Systematic Review

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