Zhang R, Nicholas J, Knapp A, et al. (2019). Clinically meaningful use of mental health apps and its effects on depression: Mixed methods study. Journal of Medical Internet Research. 21(12): e15644. doi: 10.2196/15644
Researchers analyzed a previous randomized controlled trial of 301 adults with elevated symptoms of depression to determine the effect of app use behaviors on depression outcomes. Participants were randomized into 1 of 4 conditions within 2 intervention approaches (a coached vs. self-guided intervention and a weekly app recommendations vs. no recommendations intervention). Over the 8-week trial, all participants had access to IntelliCare, a suite of 12 clinical mental health apps. App content included cognitive restructuring, behavioral activation, social support, and relaxation. A hub app sent automated notifications and recommended apps to participants in the recommendation condition. Participants reported depression symptoms in web-based assessments at baseline, 4 weeks, and 8 weeks. To identify app use behaviors indicative of significant engagement, researchers drew on existing literature, a team of 5 psychologists, and qualitative interviews with 32 Intellicare users. Analysis of app use data revealed 67 significant app use behaviors. Among these significant behaviors, researchers identified 3 clusters of app use: self-tracking, learning, and goal-setting. Participants who engaged in self-tracking at any level of intensity (low, moderate, or high) experienced significant improvement of depression symptoms. Only moderate use of learning and goal-setting yielded significant reductions in depression severity. Total significant app use (self-tracking, learning, and goal-setting) was responsible for about the same amount of variation in depression outcomes as total number of app use sessions. This suggests that researchers accurately identified the app use behaviors associated with beneficial clinical outcomes. Incorporation of moderate-intensity learning, goal-setting, and self-tracking in mental health apps may improve short-term depression outcomes.