Accepted for/Published in: JMIR Formative Research
Date Submitted: Nov 13, 2024
Date Accepted: Aug 30, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Multi user App for the Detection and Treatment of Depression in Women’s Self Help Groups: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
Depression in women results in elevated morbidity rates, functional impairment, diminished quality of life, and an increased risk of suicide. Numerous obstacles impede access to mental health treatment for women in India. Digital mental health solutions can bridge the treatment gap; nevertheless, it is essential to tailor these solutions to the individual environment and consumers.
Objective:
We conducted a pilot RCT designed to test the feasibility, acceptability and preliminary effectiveness of a mental health app deployed at Community Based organizations (CBO) in improving depression outcomes.
Methods:
Multiuser Interactive Health Response Application (MITHRA) is a multiple-user, voice-response, mobile application used in CBO for screening, tracking, and supporting stepped-care treatment for depression. MITHRA is based on some of the modules of the Healthy Activity Program; a brief psychological intervention based on behavioral activation. It includes audio, video, and enhanced touchscreen capabilities; to overcome the barrier of illiteracy and lack of access. It was developed in collaboration with a Participatory Design Group consisting of primary and secondary end users and is available on tablets installed in Self Help Groups (SHGs) which as CBOs in India. The SHGs were randomized to MITHRA (n=3) or EUC (n=3). During SHG meetings, women completed the Patient Health Questionnaire-9 (PHQ-9). Based on the PHQ-9 scores, they were assigned different modules. MITHRA also tracks, and graphs PHQ-9 score change over time to inform the need to step up care. In the EUC SHGs, women received one module of education on symptoms of depression. Primary outcomes include feasibility and acceptability, and secondary outcomes include PHQ-9, Quick Inventory of Depressive Symptomatology (QIDS-SR) and WHO Disability Assessment Schedule (WHODAS). Feasibility is calculated using app usage rates. RMANOVA was performed to compare the change in the outcome scores over time between study groups. A p-value of < 0.05 was considered statistically significant.
Results:
MITHRA was found to be feasible and acceptable. NEED MORE HERE. A significant improvement in the depressive symptoms in MITHRA group from baseline compared to EUC (p=0.037) at 6 months was found. A significant reduction in the proportion of participants with mild/moderate depression from baseline to 6 months in the MITHRA group compared to EUC (p<0.001) was found. No significant difference in the BADS scores at 6 months. Change in WHODAS score was significantly different between study groups (p=0.005). Results of RMANOVA revealed a significant change in the PHQ-9, QIDS-SR, and BADS over time.
Conclusions:
MITHRA app is feasible and acceptable for use in women’s SHGS. Larger studies should examine the effectiveness of this approach in identifying and treating depression. Clinical Trial: NCT04480021
Citation
