Childhood Obesity News recently discussed the first meta analysis of smartphone psychological interventions. The same group of researchers, working from Harvard Medical School (USA), the University of Manchester (United Kingdom), the National Institute of Complementary Medicine and the Black Dog Institute (both Australia), published another paper late last year.
In it they reviewed 18 RTCs (randomized controlled trials) that encompassed 3,400 subjects, ages 18-59, of both sexes. The 22 mental health interventions were examined specifically for their efficacy in treating depression (mild, moderate, or major), anxiety, insomnia, and bipolar disorder. (Spoiler: They determined that major depression is probably best treated by some other modality.)
The same meta analysis was described by its authors in World Psychiatry. Among the many studies they reviewed, the smartphone interventions were of varying time periods, from four to 24 weeks. In other words, some were six times as long as others.
Other study-related challenges
In any study of studies, the difficulty of making the elements line up for legitimate, valid comparison can be enormous. To compensate for the discrepancies, all kinds of mathematical processes have to be employed. The possible variables include, but are not limited to: random sequence generation; allocation concealment; blinding of participants and personnel; blinding of outcome assessment; incomplete outcome data; and selective outcome reporting.
Among the 18 studies, many different measures of outcome were used, including the:
- Depression Anxiety Stress Scale
- Center for Epidemiological Studies Depression
- Beck Depression Inventory II
- Patient Health Questionnaire in six
- Hamilton Rating Scale for Depression
- Hospital Anxiety Depression Scale
- Montgomery-Asberg Depression Rating Scale
In other words, there are good reasons why psychology is called a “soft science.” When researchers announce findings they generally acknowledge that, despite their best efforts, nothing is yet engraved in stone. There is always a paragraph calling for further research.
In this case, the cumulative positive effect size was described as small to moderate. Coauthor Jennifer Nicholas told a journalist:
Given the multitude of apps available — many of them unregulated — it’s critical that we now unlock which specific app attributes reap the greatest benefits, to help ensure that all apps available to people with depression are effective.
Among the details that still need to be sorted out (also known as “new opportunities for further research“) are matters of “user engagement, feedback loops, expectancy effects and individual patient characteristics,” all of which can influence the outcome of the intervention. Also, says the report as published by the National Institutes of Health,
[…] results showed that those with more severe depression experienced greater benefits from the behavioral activation app, whereas those with mild depression benefitted more from the mindfulness app. Understanding both which psychological interventions are best delivered via a smartphone and which patient populations will most benefit from smartphone‐based interventions will require further research.
Your responses and feedback are welcome!
Source: “Smartphone apps can reduce depression,” ScienceDaily.com, 09/22/17
Source: “The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials,” NIH.gov, October 2017
Source: “Smartphone apps effective for depression,” Healio.com, 10/02/17
Photo credit: Mick Baker (rooster) on Visualhunt/CC BY-ND