Additive effects of adjunctive app-based interventions for mental disorders - A systematic review and meta-analysis of randomised controlled trials

IF 3.6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Internet Interventions-The Application of Information Technology in Mental and Behavioural Health Pub Date : 2023-12-18 DOI:10.1016/j.invent.2023.100703

Lukas M. Fuhrmann , Kiona K. Weisel , Mathias Harrer , Jennifer K. Kulke , Harald Baumeister , Pim Cuijpers , David D. Ebert , Matthias Berking

{"title":"Additive effects of adjunctive app-based interventions for mental disorders - A systematic review and meta-analysis of randomised controlled trials","authors":"Lukas M. Fuhrmann , Kiona K. Weisel , Mathias Harrer , Jennifer K. Kulke , Harald Baumeister , Pim Cuijpers , David D. Ebert , Matthias Berking","doi":"10.1016/j.invent.2023.100703","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>It is uncertain whether app-based interventions add value to existing mental health care.</p></div><div><h3>Objective</h3><p>To examine the incremental effects of app-based interventions when used as adjunct to mental health interventions.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>g</em> = 0.17; 95 % CI 0.02 to 0.33; <em>k</em> = 7 comparisons), anxiety (<em>g</em> = 0.80; 95 % CI 0.06 to 1.54; <em>k</em> = 3), mania (<em>g</em> = 0.2; 95 % CI 0.02 to 0.38; <em>k</em> = 4), smoking cessation (<em>g</em> = 0.43; 95 % CI 0.29 to 0.58; <em>k</em> = 10), and alcohol use (<em>g</em> = 0.23; 95 % CI 0.08 to 0.39; <em>k</em> = 7). No significant effects were found on symptoms of depression within a bipolar disorder (<em>g</em> = -0.07; 95 % CI -0.37 to 0.23, <em>k</em> = 4) and eating disorders (<em>g</em> = -0.02; 95 % CI -0.44 to 0.4, <em>k</em> = 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.</p></div><div><h3>Discussion</h3><p>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.</p></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214782923001033/pdfft?md5=0b9572b9aa5c9b6d516150fc75f1e86d&pid=1-s2.0-S2214782923001033-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214782923001033","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

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.

查看原文本刊更多论文

基于应用程序的精神障碍辅助干预措施的增效作用--随机对照试验的系统回顾和荟萃分析

背景目前尚不确定基于应用程序的干预措施是否能为现有的心理健康护理增添价值。方法我们于 2023 年 9 月 15 日在 PubMed、PsycINFO、Scopus、Web of Science 和 Cochrane Library 数据库中检索了有关心理健康干预措施的随机对照试验 (RCT)，这些试验针对患有精神障碍或有各自临床相关症状的成年人，并将基于应用程序的辅助干预措施与仅使用相同干预措施的干预措施进行了比较。我们对干预后不同精神障碍的症状进行了荟萃分析。PROSPERO，CRD42018098545.结果我们确定了 46 项 RCT（4869 名参与者）。32项基于应用程序的辅助干预措施被动或主动监测症状和行为，13项干预措施将监测数据发送给治疗师。我们发现，对抑郁症状（g = 0.17；95 % CI 0.02 至 0.33；k = 7 项比较）、焦虑症（g = 0.8；95 % CI 0.06 至 1.54；k = 3）、躁狂症（g = 0.2; 95 % CI 0.02 to 0.38; k = 4）、戒烟（g = 0.43; 95 % CI 0.29 to 0.58; k = 10）和饮酒（g = 0.23; 95 % CI 0.08 to 0.39; k = 7）。对双相情感障碍中的抑郁症状（g = -0.07; 95 % CI -0.37 to 0.23; k = 4）和进食障碍（g = -0.02; 95 % CI -0.44 to 0.4; k = 3）没有发现明显的影响。关于抑郁症、躁狂症、吸烟和酗酒的研究，各试验之间的异质性较低。对于其他精神障碍，只发现了单项研究。只有 10 项研究的偏倚风险较低，25 项研究的统计能力不足。讨论基于应用程序的干预措施可用于加强心理健康干预，以进一步减少抑郁、焦虑、躁狂、吸烟和酗酒等症状。然而，除焦虑症外，其他症状的影响较小，而且由于研究质量的原因，影响有限。有必要进一步开展样本量更大的高质量研究，以更好地了解如何将基于应用程序的干预措施与既有干预措施最有效地结合起来，从而改善疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Internet Interventions-The Application of Information Technology in Mental and Behavioural Health Medicine-Health Informatics

CiteScore

6.50

自引率

9.30%

发文量

审稿时长

6 weeks

期刊介绍： Official Journal of the European Society for Research on Internet Interventions (ESRII) and the International Society for Research on Internet Interventions (ISRII). The aim of Internet Interventions is to publish scientific, peer-reviewed, high-impact research on Internet interventions and related areas. Internet Interventions welcomes papers on the following subjects: • Intervention studies targeting the promotion of mental health and featuring the Internet and/or technologies using the Internet as an underlying technology, e.g. computers, smartphone devices, tablets, sensors • Implementation and dissemination of Internet interventions • Integration of Internet interventions into existing systems of care • Descriptions of development and deployment infrastructures • Internet intervention methodology and theory papers • Internet-based epidemiology • Descriptions of new Internet-based technologies and experiments with clinical applications • Economics of internet interventions (cost-effectiveness) • Health care policy and Internet interventions • The role of culture in Internet intervention • Internet psychometrics • Ethical issues pertaining to Internet interventions and measurements • Human-computer interaction and usability research with clinical implications • Systematic reviews and meta-analysis on Internet interventions