JMIR Publications

ABSTRACT

Background:

Depression is a serious, disabling mental disorder that severely affects the quality of life. Patients with depression often do not receive adequate treatment. App-based psychotherapy is considered to have great potential due to its reach and easy accessibility.

Objective:

To analyze the efficacy of app-based psychological interventions for reducing depressive symptoms in people with depression.

Methods:

We conducted a systematic literature review and meta-analysis. We searched Medline, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials from inception to 23 December 2020. We selected randomized trials examining the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Study selection, data extraction, and critical appraisal (using Cochrane Risk of Bias tool for randomized studies and the ROBINS-I tool for nonrandomized studies) were conducted by two reviewers independently. Where possible, we pooled data using random-effects meta-analyses to obtain estimates of the effect size of the intervention. We carried out post hoc meta-regression analyses to explore factors associated with intervention success.

Results:

After screening 3,468 unique references retrieved from the bibliographic searchers and evaluating the eligibility of 79 full texts, we identified 12 trials (2,859 participants) evaluating 14 different interventions. Seven trials were conducted in the US, three in Asia (Japan, South Korea, and China), one in Australia, and one in Germany. Five trials presented a low risk of bias. The mean (range) duration of the interventions was 6.5 (4 to 12) weeks. Two-thirds of the interventions were based on cognitive behavioral therapy alone or in combination with cognitive control therapy, positive psychology, brief behavioral activation, or mindfulness and acceptance-based therapy. A pooled analysis of ten trials and 12 interventions (1,916 patients) showed that app-based interventions, when compared with a control group receiving usual care or minimal intervention, produced a moderate reduction of depressive symptoms (standardized mean difference [SMD] = -0.51, 95%CI -0.67 to -0.33; 2,018 participants; I2 = 70%), with no evidence of publication bias. Our meta-regression analyses indicated a higher (P=.04) reduction of depression symptoms in trials including participants with moderate-to-severe depression (-0.67, 95%CI, -0.79 to -0.55), compared with trials with mild-to-moderate depression participants (-0.16, -0.43 to 0.12).

Conclusions:

App-based interventions targeted to people with depression produce moderate reductions in depression symptoms. More methodologically robust trials are needed to confirm our findings, to determine which intervention features are associated with larger improvements, and to identify those populations more likely to benefit from this type of intervention. Clinical Trial: PROSPERO (registration number CRD42019145689).