The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials

Abstract

The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.

Keywords: Smartphone technology; apps; cognitive behavioral therapy; cognitive training; depression; e-health; mental health interventions; mhealth; mindfulness training; mood monitoring.

Figure 1

PRISMA flow chart of study selection

Figure 2

Meta‐analysis of the effects of smartphone interventions on depressive symptoms. Box size represents study weighting. Diamond represents overall effect size and 95% CI.

Figure 3

Meta‐analysis showing effects of smartphone interventions on depressive symptoms in comparison to active and inactive controls. Box size represents study weighting. Diamonds represent overall effect size and 95% CI.