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January 27, 2022

Do mental health apps actually work? Here's what a new meta-review found.

Daily Briefing

    Researchers from the University of Wisconsin-Madison, Harvard Medical School, and Brown University last week published a meta-review in PLOS Digital Health that did not find any "convincing evidence" in support of mobile phone-based mental-health interventions.

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    Meta-review details

    For the meta-review, researchers examined 14 meta-analyses that focused specifically on randomized control trials for mental health interventions such as treatments for depression, anxiety, and smoking cessation. Overall, their review included 145 trials that collectively enrolled 47,940 patients. 

    In their analysis, researchers identified 34 different combinations of study criteria: the population targeted, the type of intervention, the control, and the outcome sought. They examined several types of phone-based interventions, including apps and text-based experiences.

    Then, researchers combined the effect sizes for the studies and graded the evidence based on the number of factors, including the statistical significance of the results and the consistency of findings across studies.

    Key findings

    Overall, the researchers said that while none of the interventions assessed demonstrated "convincing evidence"—meaning they were not able to meet a high standard that includes a lack of publication bias—at least eight interventions did meet a lower standard of having "highly suggestive evidence."

    In these cases, the research had large sample sizes and appeared to have some benefit—but the researchers noted that the strength of the evidence in these cases "tended to diminish as comparison conditions became more rigorous."

    Specifically, the researchers found that smartphone interventions performed better than inactive controls on measures of psychological symptoms such as anxiety, depression, stress, and quality of life. Mobile phone-based interventions and text message-based interventions both outperformed non-specific controls on smoking cessation.

    According to the research team, "[t]he only comparison with an active control condition that yielded highly suggestive evidence was text message-based interventions for smoking cessation," which suggested that many of the tools included in the study yielded better outcomes compared with not using any tools at all.

    "For me, this suggests that mobile phone-based interventions might not be uniquely effective, but still are effective relative to nothing or non-therapeutic interventions," said lead author Simon Goldberg, adding, "Given the scalability of these interventions, that's still good news."  

    Ultimately, however, the research team said that the study was limited by lack of available literature.   

    "It may well be that a body of literature exists pertaining [to] mobile phone-based [interventions'] effects on mental health outcomes that was simply not meta-analyzed," they wrote. "Likewise, it is possible that the strength of the evidence may have been underestimated due to lack of publication bias assessment."  

    Although the researchers were limited by a lack of existing literature, they said their findings could help encourage further research and grow the body of evidence for mobile phone-based mental-health interventions. "Mobile phone-based interventions may be worth considering as prevention tools, or as initial interventions within a stepped care model," they said.  

    "I would bet the farm that if you wait five years and people keep running these trials, there will be convincing evidence," Goldberg added. "Given how recent apps are in human history, there's a ton of research on them, and there's evidence that they're yielding benefits. To me, it's super encouraging." (Aguilar, STAT News, 1/19; Jercich, Healthcare IT News, 1/21)

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