Currently accepted at: JMIR Mental Health
Date Submitted: Dec 20, 2018
Date Accepted: Feb 12, 2019
(closed for review but you can still tweet)
Transdiagnostic mHealth: Smartphone Intervention Reduces Depressive Symptoms in People with Mood and Psychotic Disorders
Depression is the most prevalent mental health problem in the world. The need for effective treatments for depression far outstrips the availability of trained mental health professionals. Smartphones and other widely available technologies are increasingly being leveraged to deliver treatments for depression. Whether there are patient characteristics that affect the potency of smartphone interventions for depression is not well understood.
To evaluate whether patient characteristics including clinical diagnosis, depression severity, psychosis status, and current use of antidepressant medications impact the effects of an evidence-based smartphone intervention on depressive symptoms.
Data were collected as part of a two-arm randomized controlled trial comparing a multimodal smartphone intervention called FOCUS to a clinic-based intervention. Here we report on 82 participants assigned to twelve weeks of FOCUS treatment. We conducted assessments of depressive symptoms using the Beck Depression Inventory–Second Edition (BDI-II) at baseline, post-intervention (3 months), and follow-up (6 months). We tested for differences in the amount of improvement in BDI-II scores from baseline to post-treatment and 6-month follow-up between each of the following patient subgroups using 2 (group) × 2 (time) mixed effects models: diagnosis (i.e., schizophrenia spectrum-disorder vs. bipolar disorder vs. major depressive disorder), depression severity (i.e., minimal-mild vs. moderate-severe depression), psychosis status (i.e., presence vs. absence psychotic symptoms), and antidepressant use (i.e., taking antidepressants vs. not taking antidepressants).
The majority of participants were male (60%), African American (65%), middle aged (mean age 49), with a high school education or lower (63%). There were no differences in patient demographics across the variables that were used to stratify the analyses. There was a significant group × time interaction for baseline depression severity (F1,76.8=5.26, p=.02 [post-treatment] and F1,77.4=6.56, p=.01 [6-month follow-up]). Participants with moderate or severe depression had significant improvements (t42 = 3.20, p = .003 [post-treatment], t42 = 4.20, p < .001 [6-month follow-up]) but participants with minimal or mild depression did not (t31 = .20, p = .84 [post-treatment], t30 = .43, p = .67 [6-month follow-up]). There were no significant group × time interactions for diagnosis, psychosis status, or antidepressant medication use. Participants with minimal or mild depression had negligible nonsignificant improvements (< 1 point on the BDI-II). Reduction in depression in all other groups was larger (Range 1.7 to 6.5 points on the BDI-II).
Our results suggest that FOCUS can be deployed to treat moderate to severe depressive symptoms among people with schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder, in concert with antidepressant medications or without them, in both people with and without active psychotic symptoms. The study results are consistent with research on transdiagnostic models in psychotherapy and extend our knowledge about the potential of transdiagnostic mHealth. Clinical Trial: ClinicalTrials.gov NCT02421965