JMIR Publications

ABSTRACT

Background:

Mobile health (mHealth) applications (apps) offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews supported the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long is the minimum treatment “dose” for a mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness.

Objective:

Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose-effectiveness of app-based mHealth interventions for anxiety and depressive reduction.

Methods:

We conducted a literature search on seven databases, including Ovid-Medline, Em-base, PsycInfo, Scopus, Cochrane Library (including CENTRAL), ScienceDirect, and Clinicaltrials.gov, for publications between January 2012 and April 2020. We included randomized controlled trials evaluating app-based mHealth interventions on anxiety and/or depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We estimated the pooled effect size using Hedges’g and appraised study quality using the revised Cochrane risk of bias tool for randomized trials.

Results:

We included fifteen studies involving 2,627 participants for 18 app-based mHealth interventions. Participants in intervention groups showed significant effect on anx-iety (Hedge’s g = -0.10, 95% CI -0.14 to -0.06, I2 = 0%) but not on depression (Hedge’s g = -0.08, 95% CI -0.23 to 0.07, I2 = 4%). Interventions of as least seven weeks duration had larger effect sizes on anxiety.

Conclusions:

There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to non-significant effects of the intervention and study quality concerns. The recommended “dosage” of mHealth interventions and sustainability of intervention effectiveness remains unclear and requires further investigation.