JMIR Publications

ABSTRACT

Background:

Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited healthcare resources, within-person barriers contribute to the treatment-gap and impede early treatment seeking. These include a lack of trust in professionals, fear of stigmatization, or the desire to cope with problems without professional help.

Objective:

While unguided mental health apps are not designed to replace psychotherapy, they may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve self-management skills and contribute to symptom reduction and improvement of quality of life.

Methods:

1045 participants (recruited open, blinded and online) suffering from mild to moderate depressive, anxiety, sleep, eating, or somatization-related psychopathology were randomized to receive either access to an unguided transdiagnostic mental health app (MindDoc) in addition to care as usual (CAU), or CAU only. Core features of the app were regular self-monitoring and automated feedback and psychological courses and exercises. The (co-)primary outcomes were mental health literacy, mental health related patient empowerment and self-management skills, attitudes toward help seeking and actual mental health service use. Secondary outcomes were psychopathological symptom burden and quality of life. Data was collected at baseline as well as 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance including baseline variables as predictors applying multiple imputation.

Results:

We found small but robust between-group effects for mental health related patient empowerment and self-management skills (d = 0.29) as well as psychopathology (d = 0.28) and quality of life (d = 0.19) 8 weeks after randomization. Effects on patient empowerment and self-management skills were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy as well as preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher impairments in personality functioning.

Conclusions:

An unguided transdiagnostic mental health app can contribute to lasting improvements in both patient empowerment and self-management skills. Psychopathological symptoms and quality of life improved faster in the intervention group than in the control group. Such interventions may therefore support individuals with symptoms of one or Clinical Trial: Trial registeration: The trial has been registered in the DRKS trial register (DRKS00022531)