Digital health has evolved significantly over the past three years. Currently, the area of digital therapeutics – apps and sensors that reliably translate the evidence base to assess, monitor, or manage a clinical condition to demonstrable clinical endpoints is rapidly evolving. Given how many apps exist in the app store, there is a LOT OF NOISE and some signal on how beneficial they are in impacting health and wellness. Digital mental health tools form at least a third of the apps available to consumers, and more research is emerging on the efficacy of these solutions.
A new paper Kiona Weisel and colleagues the University Erlangen- Nuremberg in Germany, published in Nature Digital Medicine, conducted a systematic review and meta-analysis to determine of standalone apps for mental health. The authors included 165 full-effect articles, of which nineteen were included in the final analysis in clinical domains, including depression, anxiety, Post Traumatic Stress Disorder (PTSD), substance use, smoking cessation, and self-injurious behavior.
The only clinical areas to show a significant effects were depression and smoking cessation. Hedges’ g = .33 for depression and g= .39 for smoking- both would be considered of low to moderate impact.
Where does this leave us as the numbers seeking care outnumber capacity globally, apps point to promising ways to make tools available more freely than before- yet the data shows standalone deployment isn’t having the desired impact. It is important to note that not all apps under the clinical domain have developed at the same pace. It is not surprising that depression and smoking cessation had the most substantial impact. The authors conclude the evidence base doesn’t support the deployment of tools in a standalone manner; instead, should augment ongoing care.
I don’t share this viewpoint, how apps are deployed is critical but so it the quality of the solution. Rather than abandon standalone apps, leveraging deployment methods for proven tools should be explored to place these useful tools in the hands of people who could benefit from them. As this happens, more research will guide how best to deploy these tools.
The need is too great, and the burden of suffering is too high not to explore ways to get proven tools into the consumer’s hands. The other task at hand is to continue to push to standards for these tools, so get more signal and less noise while balancing the need for innovation to bring new ways to solve entrenched issues.
I remain optimistic about the role of digital therapeutics, and those of us in health care have a responsibility to continue to push for transparency in data use that respects privacy, so consumers are aware of the implications of their choices. Spreading what works will take time and effort and is necessary for digital health to move from a trend to a standard of care. The short answer is, no, we aren’t here yet. We are on our way.
Thanks for reading – Trina
(Opinions are my own)
References
Standalone smartphone apps for mental health—a systematic
review and meta-analysis
https://www.nature.com/articles/s41746-019-0188-8
