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Linardon J, Firth J, Torous J, Messer M, Fuller-Tyszkiewicz M. Efficacy of mental health smartphone apps on stress levels: a meta-analysis of randomised controlled trials. Health Psychol Rev 2024:1-14. [PMID: 39041586 DOI: 10.1080/17437199.2024.2379784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
The management of stress has evolved in recent years due to widespread availability of mobile-device applications (apps) and their capacity to deliver psychological interventions. We evaluated the efficacy of mental health apps on stress and sought to identify characteristics associated with effect size estimates. Sixty-nine randomised controlled trials (RCTs) were included. Random effects meta-analyses were performed and putative moderators were examined at univariate and multivariate (combinations and interactions) levels. From 78 comparisons, we observed a small but significant pooled effect of apps over control conditions on perceived stress levels (g = 0.27; 95% CI = 0.20, 0.34; I2 = 68%). This effect weakened after taking into account small-study bias according to the trim-and-fill procedure (g = 0.10; 95% CI = 0.02, 0.19; I2 = 78%). Delivery of apps with stress monitoring features produced smaller efficacy estimates, although this association interacted with other trial features (small sample size and inactive control group) in multivariate analyses, suggesting that this effect may have been explained by features characteristic of low-quality trials. Mental health apps appear to have small, acute effects on reducing perceived stress. Future research should shift focus towards identifying change mechanisms, longitudinal outcomes, features that facilitate sustained app usage, and tangible pathways to integrating apps into real-world clinical settings.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Geelong, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Australia
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Areán PA, Pullmann MD, Griffith Fillipo IR, Wu J, Mosser BA, Chen S, Heagerty PJ, Hull TD. Randomized Trial of the Effectiveness of Videoconferencing-Based Versus Message-Based Psychotherapy on Depression. Psychiatr Serv 2024:appips20230176. [PMID: 39026468 DOI: 10.1176/appi.ps.20230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The authors compared the engagement, clinical outcomes, and adverse events of text or voice message-based psychotherapy (MBP) versus videoconferencing-based psychotherapy (VCP) among adults with depression. METHODS The study used a sequential multiple-assignment randomized trial design with data drawn from phase 1 of a two-phase small business innovation research study. In total, 215 adults (ages ≥18 years) with depression received care from Talkspace, a digital mental health care company. Participants were initially randomly assigned to receive either asynchronous MBP or weekly VCP. All therapists provided evidence-based treatments such as cognitive-behavioral therapy. After 6 weeks of treatment, participants whose condition did not show a response on the Patient Health Questionnaire-9 or was rated as having not improved on the Clinical Global Impressions scale were randomly reassigned to receive either weekly VCP plus MBP or monthly VCP plus MBP. Longitudinal mixed-effects models with piecewise linear time trends applied to multiple imputed data sets were used to address missingness of data. RESULTS Participants who were initially assigned to the MBP condition engaged with their therapists over more weeks than did participants in the VCP condition (7.8 weeks for MBP vs. 4.9 weeks for VCP; p<0.001). No meaningful differences were observed between the two groups in rates of change by 6 or 12 weeks for depression, anxiety, disability, or global ratings of improvement. Neither treatment resulted in any adverse events. CONCLUSIONS MBP appears to be a viable alternative to VCP for treating adults with depression.
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Affiliation(s)
- Patricia A Areán
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Isabell R Griffith Fillipo
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Jerilyn Wu
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Brittany A Mosser
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Patrick J Heagerty
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
| | - Thomas D Hull
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle (Areán, Pullmann, Griffith Fillipo, Mosser, Chen); Talkspace, New York City (Wu, Hull); Department of Biostatistics, School of Public Health, University of Washington, Seattle (Heagerty)
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McCallum M, Baldwin M, Thompson P, Blessing K, Frisch M, Ho A, Ainsworth MC, Mitchell ES, Michaelides A, May CN. Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study. JMIR Mhealth Uhealth 2024; 12:e54634. [PMID: 38935946 PMCID: PMC11240065 DOI: 10.2196/54634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/21/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. OBJECTIVE Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. METHODS A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). RESULTS The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). CONCLUSIONS This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.
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Affiliation(s)
| | - Matthew Baldwin
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Paige Thompson
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Kelly Blessing
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Maria Frisch
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Annabell Ho
- Academic Research, Noom, Inc, New York City, NY, United States
| | | | | | | | - Christine N May
- Academic Research, Noom, Inc, New York City, NY, United States
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Borg DJ, Haritopoulou-Sinanidou M, Gabrovska P, Tseng HW, Honeyman D, Schweitzer D, Rae KM. Barriers and facilitators for recruiting and retaining male participants into longitudinal health research: a systematic review. BMC Med Res Methodol 2024; 24:46. [PMID: 38389065 PMCID: PMC10882922 DOI: 10.1186/s12874-024-02163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Successfully recruiting male participants to complete a healthcare related study is important for healthcare study completion and to advance our clinical knowledgebase. To date, most research studies have examined the barriers and facilitators of female participants in longitudinal healthcare-related studies with limited information available about the needs of males in longitudinal research. This systematic review examines the unique barriers and facilitators to male recruitment across longitudinal healthcare-related research studies. METHODS Following PRIMSA guidelines, MEDLINE, Embase, CINAHL and Web of Science databases were systematically searched using the terms recruitment and/or retention, facilitators and/or barriers and longitudinal studies from 1900 to 2023 which contained separate data on males aged 17-59 years. Health studies or interventions were defined longitudinal if they were greater than or equal to 12 weeks in duration with 3 separate data collection visits. RESULTS Twenty-four articles published from 1976-2023 met the criteria. One-third of the studies had a predominantly male sample and four studies recruited only male participants. Males appear disinterested towards participation in health research, however this lack of enthusiasm can be overcome by clear, non-directive communication, and studies that support the participants interests. Facilitating factors are diverse and may require substantial time from research teams. CONCLUSIONS Future research should focus on the specific impact of these factors across the spectrum of longitudinal health-related studies. Based on the findings of this systematic review, researchers from longitudinal health-related clinical trials are encouraged to consider male-specific recruitment strategies to ensure successful recruitment and retention in their studies. REGISTRATION This systemic review is registered with the PROSPERO database (CRD42021254696).
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Affiliation(s)
- Danielle J Borg
- Pregnancy and Development Group, Mater Research - The University of Queensland, Aubigny Place, South Brisbane, 4101, Australia
- Faculty of Medicine, University of Queensland, Herston, 4006, Australia
| | | | - Pam Gabrovska
- Indigenous Health Group, Mater Research Institute - The University of Queensland, Aubigny Place, South Brisbane, 4101, Australia
| | - Hsu-Wen Tseng
- Stem Cell Biology Group, Mater Research Institute - The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia
| | - David Honeyman
- Library, University of Queensland, St Lucia, 4072, Australia
| | - Daniel Schweitzer
- Faculty of Medicine, University of Queensland, Herston, 4006, Australia
- Department of Neurology, Mater Health, South Brisbane, 4101, Australia
| | - Kym M Rae
- Faculty of Medicine, University of Queensland, Herston, 4006, Australia.
- Indigenous Health Group, Mater Research Institute - The University of Queensland, Aubigny Place, South Brisbane, 4101, Australia.
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Krukowski RA, Ross KM, Western MJ, Cooper R, Busse H, Forbes C, Kuntsche E, Allmeta A, Silva AM, John-Akinola YO, König LM. Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process. Trials 2024; 25:98. [PMID: 38291539 PMCID: PMC10826214 DOI: 10.1186/s13063-024-07937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Digital interventions offer many possibilities for improving health, as remote interventions can enhance reach and access to underserved groups of society. However, research evaluating digital health interventions demonstrates that such technologies do not equally benefit all and that some in fact seem to reinforce a "digital health divide." By better understanding these potential pitfalls, we may contribute to narrowing the digital divide in health promotion. The aim of this article is to highlight and reflect upon study design decisions that might unintentionally enhance inequities across key research stages-recruitment, enrollment, engagement, efficacy/effectiveness, and retention. To address the concerns highlighted, we propose strategies including (1) the standard definition of "effectiveness" should be revised to include a measure of inclusivity; (2) studies should report a broad range of potential inequity indicators of participants recruited, randomized, and retained and should conduct sensitivity analyses examining potential sociodemographic differences for both the effect and engagement of the digital interventions; (3) participants from historically marginalized groups should be involved in the design of study procedures, including those related to recruitment, consent, intervention implementation and engagement, assessment, and retention; (4) eligibility criteria should be minimized and carefully selected and the screening process should be streamlined; (5) preregistration of trials should include recruitment benchmarks for sample diversity and comprehensive lists of sociodemographic characteristics assessed; and (6) studies within trials should be embedded to systematically test recruitment and retention strategies to improve inclusivity. The implementation of these strategies would enhance the ability of digital health trials to recruit, randomize, engage, and retain a broader and more representative population in trials, ultimately minimizing the digital divide and broadly improving population health.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
| | - Kathryn M Ross
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Max J Western
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Cynthia Forbes
- Hull York Medical School, University of Hull, Allam Medical Building, Cottingham Road, Hull, UK
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, 3086 VIC, Australia
| | - Anila Allmeta
- University of Bayreuth, Fritz-Hornschuch-Straße 13, 95326, Kulmbach, Germany
| | - Anabelle Macedo Silva
- Instituto de Estudos Em Saúde Coletiva IESC/ Universidade Federal Do Rio de Janeiro /Leibiniz Science Campus Digital Public Health/Ministério Público Do Estado Do Rio de Janeiro, Rua das Bauhineas 200, Bl B 1602, Península, Barra da Tijuca, Rio de Janeiro, 22776-090, Brazil
| | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, College of Medicine, Queen Elizabeth Road, UCH Campus, Ibadan, Nigeria
| | - Laura M König
- University of Bayreuth, Faculty of Life Sciences: Food, Nutrition and Health University of Vienna, Faculty of Psychology, Wächtergasse 1, 1010, Vienna, Austria
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Lenze E, Torous J, Arean P. Digital and precision clinical trials: innovations for testing mental health medications, devices, and psychosocial treatments. Neuropsychopharmacology 2024; 49:205-214. [PMID: 37550438 PMCID: PMC10700595 DOI: 10.1038/s41386-023-01664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
Mental health treatment advances - including neuropsychiatric medications and devices, psychotherapies, and cognitive treatments - lag behind other fields of clinical medicine such as cardiovascular care. One reason for this gap is the traditional techniques used in mental health clinical trials, which slow the pace of progress, produce inequities in care, and undermine precision medicine goals. Newer techniques and methodologies, which we term digital and precision trials, offer solutions. These techniques consist of (1) decentralized (i.e., fully-remote) trials which improve the speed and quality of clinical trials and increase equity of access to research, (2) precision measurement which improves success rate and is essential for precision medicine, and (3) digital interventions, which offer increased reach of, and equity of access to, evidence-based treatments. These techniques and their rationales are described in detail, along with challenges and solutions for their utilization. We conclude with a vignette of a depression clinical trial using these techniques.
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Affiliation(s)
- Eric Lenze
- Departments of Psychiatry and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA.
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Patricia Arean
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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