Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement

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...

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Autores principales:	Ashley Wu, Matthew A. Scult, Emily D. Barnes, Jessica A. Betancourt, Avital Falk, Faith M. Gunning
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Computer applications to medicine. Medical informatics R858-859.7
Acceso en línea:	https://doaj.org/article/15da20b25340450b8446d05187109872
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spelling	oai:doaj.org-article:15da20b25340450b8446d051871098722021-12-02T14:23:50ZSmartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement10.1038/s41746-021-00386-82398-6352https://doaj.org/article/15da20b25340450b8446d051871098722021-02-01T00:00:00Zhttps://doi.org/10.1038/s41746-021-00386-8https://doaj.org/toc/2398-6352Abstract 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, I 2 = 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.Ashley WuMatthew A. ScultEmily D. BarnesJessica A. BetancourtAvital FalkFaith M. GunningNature PortfolioarticleComputer applications to medicine. Medical informaticsR858-859.7ENnpj Digital Medicine, Vol 4, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Computer applications to medicine. Medical informatics R858-859.7
spellingShingle	Computer applications to medicine. Medical informatics R858-859.7 Ashley Wu Matthew A. Scult Emily D. Barnes Jessica A. Betancourt Avital Falk Faith M. Gunning Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
description	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, I 2 = 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.
format	article
author	Ashley Wu Matthew A. Scult Emily D. Barnes Jessica A. Betancourt Avital Falk Faith M. Gunning
author_facet	Ashley Wu Matthew A. Scult Emily D. Barnes Jessica A. Betancourt Avital Falk Faith M. Gunning
author_sort	Ashley Wu
title	Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
title_short	Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
title_full	Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
title_fullStr	Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
title_full_unstemmed	Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
title_sort	smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/15da20b25340450b8446d05187109872
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Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement

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