JMIR Publications

ABSTRACT

Background:

Patients with mental disorders often have difficulties maintaining a daily routine which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies.

Objective:

The aim of this study was to evaluate acceptability, usability, and feasibility of an app–based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic.

Methods:

Patients in a psychiatric outpatient department at a German university hospital were invited to use an app–based support service for four weeks, designed transdiagnostically for mental disorders. The app included seven relaxation modules, consisting of videos, audios, and psychoeducational texts, EMA (ecological momentary assessment)–like questionnaires on daily mood, answered via a visual smiley face scale, and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0, preintervention), end of intervention after 4 weeks (T2, postintervention) had been analyzed. Feedback via a smiley face scale was provided after using the app contents (T1, during the intervention). Measures included depressive symptoms, quality of life, treatment credibility/expectancy, and satisfaction. Further, participation rates, usage of app modules and the activity button as well as daily mood and given feedback were analyzed (T2).

Results:

In total, 57 patients participated in the study, of which 67% (38/57) participants’ data was analyzed, 30% (17/57) were drop outs. Satisfaction with the app was high, with 79% (30/38) of participants stating being rather satisfied or satisfied. Further, 79% (30/38) would more likely or definitely likely use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half of the participants (18/38, 47%) trying relaxation modules and 72% (27/38) regularly using the EMA-like approach between 15 and 28 times (mean 19.91, SD 7.57). The activity button was used on average 12 times (SD 15.72) per participant and 58% (22/38) definitely or rather felt encouraged to perform the respective activity. Depressive symptomatology improved significantly at postintervention (P=.021). Quality of life showed a nonsignificant increase in domains physical, psychological and social (P=.148, P=.015, P=.141.) and a significant improvement in domain environment (P=.010). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.015, P<.001). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=–0.36, P=.028).

Conclusions:

App–based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them to maintain daily routine, complementing existing (f2f) treatments and overall helping to respond to challenging situations like the COVID-19 pandemic and beyond. Clinical Trial: German Clinical Trials Register DRKS0027536; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027536