Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 25, 2023
Date Accepted: Jul 18, 2023
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Selective Prevention of Depression in Stressed Workers Using a Smartphone App: A Randomized Controlled Trial
ABSTRACT
Background:
Workplace stress is a risk factor for depression, but few interventions exist to prevent depression among stressed workers.
Objective:
This trial aimed to evaluate the efficacy of a smartphone-based intervention to reduce depression onset and improve related outcomes in stressed workers.
Methods:
A randomized controlled trial was conducted with employed participants who reported no clinically significant depression and at least moderate stress. The intervention group (n=1,053) used Anchored, a self-directed smartphone app-based cognitive behavioural and mindfulness intervention. The attention-control group (n=1,031) used a psychoeducation website. Assessment occurred via online self-report questionnaires at baseline and 30 days, 3 months, and 6 months post-baseline. The primary outcome was new depression caseness aggregated over the follow-up period.
Results:
There was no significant between-group difference in new depression caseness (z=0.69, P=.49), however those in the Anchored arm had significantly greater symptom reduction at 30 days (P=.049) and 6 months (P=.03). Notably, for Anchored participants completing at least two thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%–3.7%) compared to controls (9.0%, 95% CI 6.8%–12.3%) at post-intervention (z=4.50, P<.001). Significant small-to-medium effect sizes for most secondary outcomes were seen in these highly engaged Anchored users compared to controls, with effects maintained at 6-month follow-up.
Conclusions:
Amongst stressed workers, Anchored was associated with a small comparative reduction in depressive symptoms compared to controls, though selective prevention of case-level depression was not observed. Where users adequately engaged with the app, promising results were found highlighting the need for greater focus on engagement techniques in future research. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592
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