Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 4, 2022
Open Peer Review Period: Aug 4, 2022 - Aug 11, 2022
Date Accepted: Sep 30, 2022
Date Submitted to PubMed: Oct 3, 2022
(closed for review but you can still tweet)
Effectiveness of Mental Health Apps for Distress during COVID-19 in U.S. Unemployed and Essential Workers: A Remote Pragmatic Clinical Trial
ABSTRACT
Background:
During the COVID-19 pandemic, the general public were concerned about the mental health impacts of unemployment due to COVID and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was very little evidence about the impact of these tools on mitigating distress.
Objective:
This study sought to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk.
Methods:
We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19 designated essential workers. Participants were randomized to one of four free commercial mobile applications for managing distress that were (1) highly rated by PsyberGuide and (2) met criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-weeks self-assessments of depression, anxiety emotional regulation and suicide risk.
Results:
We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (PHQ9: estimate= -1.5, SE 0.2, 95% CI -1.1--1.8; P < .001; GAD-7: estimate= -1.3, SE 0.2; 95% CI -1.0--1.6; P < .001). We found no significant changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate = -0.6; SE 0.2; 95% CI 1.0--0.2; P = .003) and anxiety (estimate= 0.1; SE 0.2; 95% CI 0.4-0.6; P = .78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (mean(Beautiful Mood) 72.9, SD 16.7; mean(Covid Coach) 71.2, SD 15.4; mean(Calm) 66.8, SD 17.3; mean(7 Cups) 65.2, SD 17.7). We found no significant differences on app acceptability or appropriateness.
Conclusions:
Few studies evaluate prospectively the utility and usability of commercial apps for mood. This study finds that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out. Clinical Trial: Mobile Mental Health Apps for Suicide Prevention, NCT04536935, https://clinicaltrials.gov/ct2/show/NCT04536935
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