Abstract
Background: It is uncertain whether app-based interventions add value to existing mental health care. Objective: To examine the incremental effects of app-based interventions when used as adjunct to mental health interventions. Methods: We searched PubMed, PsycINFO, Scopus, Web of Science, and Cochrane Library databases on September 15th, 2023, for randomised controlled trials (RCTs) on mental health interventions with an adjunct app-based intervention compared to the same intervention-only arm for adults with mental disorders or respective clinically relevant symptomatology. We conducted meta-analyses on symptoms of different mental disorders at postintervention. PROSPERO, CRD42018098545. Results: We identified 46 RCTs (4869 participants). Thirty-two adjunctive app-based interventions passively or actively monitored symptoms and behaviour, and in 13 interventions, the monitored data were sent to a therapist. We found additive effects on symptoms of depression (g = 0.17; 95 % CI 0.02 to 0.33; k = 7 comparisons), anxiety (g = 0.80; 95 % CI 0.06 to 1.54; k = 3), mania (g = 0.2; 95 % CI 0.02 to 0.38; k = 4), smoking cessation (g = 0.43; 95 % CI 0.29 to 0.58; k = 10), and alcohol use (g = 0.23; 95 % CI 0.08 to 0.39; k = 7). No significant effects were found on symptoms of depression within a bipolar disorder (g = -0.07; 95 % CI -0.37 to 0.23, k = 4) and eating disorders (g = -0.02; 95 % CI -0.44 to 0.4, k = 3). Studies on depression, mania, smoking, and alcohol use had a low heterogeneity between the trials. For other mental disorders, only single studies were identified. Only ten studies had a low risk of bias, and 25 studies reported insufficient statistical power. Discussion: App-based interventions may be used to enhance mental health interventions to further reduce symptoms of depression, anxiety, mania, smoking, and alcohol use. However, the effects were small, except for anxiety, and limited due to study quality. Further high-quality research with larger sample sizes is warranted to better understand how app-based interventions can be most effectively combined with established interventions to improve outcomes.
| Original language | English |
|---|---|
| Article number | 100703 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | Internet Interventions |
| Volume | 35 |
| Early online date | 18 Dec 2023 |
| DOIs | |
| Publication status | Published - Mar 2024 |
Bibliographical note
Funding Information:We express our gratitude to Katharina Roth, M.Sc. (Friedrich-Alexander Universität Erlangen-Nürnberg) and Simon Schmelzle, M.Sc. (Friedrich-Alexander Universität Erlangen-Nürnberg) for their work in extracting the characteristics and conducting the risk of bias assessment. We also extend our thanks to all the authors of the included studies, especially those who responded to our requests and provided additional data. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. “D.D.E. L.M.F. and K.K.W. conceived and designed the study, including the literature search strategy. K.K.W. L.M.F. and research assistants independently searched, screened, selected the articles, and extracted the data. J.K.K. and L.M.F. independently conducted the risk of bias assessment.” L.M.F. and K.K.W. had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. L.M.F. wrote the first draft of the manuscript under the supervision of M.B. All authors contributed to interpreting the findings and revising the manuscript. All authors reviewed and approved the final manuscript.
Publisher Copyright:
© 2023 The Authors
Keywords
- Adjunct
- App-based interventions
- Blended
- E-mental health
- Mental disorder
- Meta-analysis
- Mobile