Feasibility of a Therapist-Supported, Mobile Phone–Delivered Online Intervention for Depression: Longitudinal Observational Study

Abstract

BackgroundDepression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone–delivered 8-week intervention administered at the Meru Health Online Clinic in Finland.ObjectiveWe conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms.MethodsA total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models.ResultsFor studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ∆R2=.38, P=.004 and ∆R2=.38, P=.002, respectively; Study 2: ∆R2=.16, P<.001 and ∆R2=.08, P=.002, respectively).ConclusionsThis therapist-supported, mobile phone–delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention.

One-year outcomes of a therapist-supported, smartphone-based intervention for elevated symptoms of depression and anxiety

“…An important but largely unanswered question is who is likely to benefit the most from app-based psychological interventions, and what factors are predictive of the degree to which individuals benefit over time. Our previous feasibility study suggested that a greater volume of app-based practice predicted the occurrence of fewer depressive symptoms 4-weeks after completing the Ascend intervention 38 . In the present study, the degree of engagement with Ascend did not impact depression or anxiety scores at 6-or 12-months post-intervention, though this analysis was likely underpowered due to a large proportion of missing data at these time-points.…”

“…The Meru Health Ascend intervention has been described in detail previously 38 Participants are enrolled in groups of between 10-15 individuals that work through the intervention at the same time, and can provide anonymous support to one another via a discussion board within the app. Specifically, participants can post anonymous reflections on practices and lessons to the discussion board, to which their therapist can respond freely, and to which other group members can respond with pre-written empathy statements and/or emoticons.…”

“…The Meru Health Ascend intervention is a newly-developed, smartphone-based, therapist-supported intervention for depression and anxiety designed to overcome common barriers to treatment. A recent feasibility study reported that the intervention is feasible and associated with reduced depression symptoms immediately after the intervention 38 . The present follow-up study extends these findings by demonstrating that the intervention is associated with clinically significant reductions in symptoms of both depression and anxiety, and that these reductions are maintained up to 1 year and 6 months after intervention completion, respectively.…”

“…As with the former feasibility study 38 , the present study used a non-randomized, uncontrolled design, which precludes causal inferences regarding the intervention and patient-reported outcome changes. In addition, the effect sizes reported in the present study are likely an overestimate of the true treatment effect relative to an active control or treatment as usual.…”

Feasibility and efficacy of the addition of heart rate variability biofeedback to a remote digital health intervention for depression

“…Content delivered in the weekly modules is derived from several evidence-based treatments for depression including Mindfulness-Based Meditation (MM) 14,15 , Cognitive-Behavioral Therapy (CBT) 16 , and Behavioral Activation Therapy (BAT) 17 delivered via texts, videos, and daily practices. Analyses of this program have indicated post-intervention clinically significant reductions in depressive symptoms that remain at 6-and 12-month follow-up assessments 18,19 .…”