Digital Mental Health apps hold great promise to meet the growing demand for support to alleviate the symptoms of depression and anxiety globally. The newer realm of digital therapeutics is also demonstrating effectiveness in translating the evidence-base of Cognitive Behavioral Therapy (CBT) to achieve response (50% reduction in symptoms) or remission (rates back in mild range) rates on the Patient Health Questionnaire (PHQ-9). As digital tools become more sophisticated, it seems plausible that research can point us toward clusters of mechanisms of action for healing. Some paths may lead to more rapid and meaningful change than others- what aspects of CBT may be best to start within a digital therapeutic?
A new paper in the Journal of Medical Internet Research (JMIR) by Renwen Zhang and colleagues from Northwestern University explores the clinically meaningful aspects of digital mental health apps. In past blogs, I have written about the importance of engagement in digital health. While we don’t have a standard definition, it could be varying patterns of use of an app that relates to the frequency, intensity, time, and type of content consumed that leads to symptom improvement. This paper conducted a secondary analysis of 13 mental health apps that formed an 8-week randomized control trial to explore patterns of use as they relate to symptom alleviation.
The authors revealed three distinct clusters of app use that led to improved symptoms, learning, goal setting, and self-tracking were all essential app features that participants engaged in overtime that defined clinically meaningful use. These patterns were in evidence for depression but not for anxiety. While they often co-occur, it would seem different app patterns support different paths toward healing, which warrants further attention. The apps studied form the IntelliCare platform, and participants also had eight weeks of coaching by way of text messages.
Self-tracking has been shown in the broader behavior change literature to support lasting change. This study also underscores its importance in depressive symptom reduction. This paper has implications for design features in digital mental health apps for depression. It would seem we still have some work to do to understand meaningful use patterns for anxiety. This paper shows encouraging aspects of what works that can be used as a foundation for additional app features to engage users. I suspect 2020 will bring far more clarity to app design for digital mental health that can boost the signal for effective solutions and assist in more readily separating the signal from the noise in digital health.
Thanks for reading- Happy Holidays, Trina.
(Opinions are my own)
Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study