Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
Top Cited Papers
Open Access
- 11 February 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in npj Digital Medicine
- Vol. 4 (1), 1-9
- https://doi.org/10.1038/s41746-021-00386-8
Abstract
Meta-analyses have shown that digital mental health apps can be efficacious in reducing symptoms of depression and anxiety. However, real-world usage of apps is typically not sustained over time, and no studies systematically examine which features increase sustained engagement with apps or the relationship between engagement features and clinical efficacy. We conducted a systematic search of the literature to identify empirical studies that (1) investigate standalone apps for depression and/or anxiety in symptomatic participants and (2) report at least one measure of engagement. Features intended to increase engagement were categorized using the persuasive system design (PSD) framework and principles of behavioral economics. Twenty-five studies with 4159 participants were included in the analysis. PSD features were commonly used, whereas behavioral economics techniques were not. Smartphone apps were efficacious in treating symptoms of anxiety and depression in randomized controlled trials, with overall small-to-medium effects (g = 0.2888, SE = 0.0999, z(15) = 2.89, p = 0.0119, Q(df = 14) = 41.93, p < 0.0001, I2 = 66.6%), and apps that employed a greater number of engagement features as compared to the control condition had larger effect sizes (β = 0.0450, SE = 0.0164, t(15) = 2.7344, p = 0.0161). We observed an unexpected negative association between PSD features and engagement, as measured by completion rate (β = −0.0293, SE = 0.0121, t(17) = 02.4142, p = 0.0281). Overall, PSD features show promise for augmenting app efficacy, though engagement, as reflected in study completion, may not be the primary factor driving this association. The results suggest that expanding the use of PSD features in mental health apps may increase clinical benefits and that other techniques, such as those informed by behavioral economics, are employed infrequently.Keywords
Funding Information
- Weill Cornell Medicine Children’s Health Council Investigator Fund
This publication has 65 references indexed in Scilit:
- Attention Bias Modification Training Via Smartphone to Reduce Social Anxiety: A Randomized, Controlled Multi-Session ExperimentCognitive Therapy and Research, 2014
- Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trialBMJ Open, 2014
- CBT for depression: a pilot RCT comparing mobile phone vs. computerBMC Psychiatry, 2013
- Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based InterventionsJournal of Medical Internet Research, 2012
- A Systematic Review of the Impact of Adherence on the Effectiveness of e-TherapiesJournal of Medical Internet Research, 2011
- Effect of Immunoglobulin Therapy on the Rate of Infections in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation and or treated with immunomodulatory agentsMediterranean Journal of Hematology and Infectious Diseases, 2010
- A Randomized, Controlled Trial of Financial Incentives for Smoking CessationThe New England Journal of Medicine, 2009
- Maps of Bounded Rationality: Psychology for Behavioral EconomicsAmerican Economic Review, 2003
- Measuring inconsistency in meta-analysesBMJ, 2003
- A Psychological Perspective on EconomicsAmerican Economic Review, 2003