JMIR Publications

ABSTRACT

Background:

Depression is very common, impairs functioning, and is often untreated. More than 60% of treatment for depressive disorder occurs in primary care settings which often lack time and expertise to treat depression effectively. To address this gap, we developed a therapist-supported, smartphone-delivered 8-week intervention called Ascend. This program was administered at the Meru Health Online Clinic in Finland and is approved by the Finnish national health care regulator.

Objective:

We conducted three pilot studies to investigate whether the online Ascend intervention produced reductions in depression symptoms in self-referred adults with elevated symptoms of depression. We also explored the relationship between engagement in the intervention and changes in depression symptoms.

Methods:

Across three pilot studies, 117 Finnish adults with self-reported depression and elevated depressive symptoms (Beck Depression Inventory-II; BDI-II > 9 or Physician Health Questionniare-9; PHQ-9 > 4) enrolled in the 8-week online Ascend intervention. Ascend consists of cognitive-behavioral and mindfulness meditation exercises delivered through a smartphone application, 20-40 minutes per day of individual daily practice, anonymous online 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, week 2, 4, 6 and 8 during the intervention, immediately and 4-weeks post-intervention completion. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models.

Results:

We observed significant decreases in depression symptoms from baseline to 4-weeks post-intervention as measured by the BDI-II (p < .001, partial eta2 effect size (η2p) = .54) in Study1, PHQ-9 (p < .001, η2p = .34) in Study 2, and PHQ-9 (p < .001, η2p = .53) in Study 3. We also found a dose-reponse relationship between indicators of treatment engagment and treatment response. Greater daily practice completed during the Ascend intervention predicted larger decreases in depressive symptoms at 4-weeks post-intervention in Study 1 (p = .004, R2 = .38) and Study 2 (p = .001, R2 = .25), and a parallel trend in Study 3 (p = .06, ∆R2 = .07). Greater weekly chat group use predicted larger decreases in depressive symptoms at 4-weeks post-intervention in Study 1 (p = .002, R2 = .38) and Study 2 (p = .001, R2 = .23), but not in Study 3 (p = .73, R2 = .00).

Conclusions:

Engagement in treatment and reduction in depression symptoms during the online Ascend intervention are promising. However, validation from controlled study designs is needed to establish the evidence-base for the Ascend intervention.