A New Mental Health Mobile App for Well-Being and Stress Reduction in Working Women: Randomized Controlled Trial

Abstract

Background: Although the availability and use of mobile mental health apps has grown exponentially in recent years, little data are available regarding their efficacy.

Objective: This study aimed to evaluate the effectiveness of an app developed to promote stress management and well-being among working women compared with a control app.

Methods: Female employees at a private hospital were invited to participate in the study via mailing lists and intranet ads. A total of 653 individuals self-enrolled through the website. Eligible participants were randomized between control (n=240) and intervention (n=250) groups. The well-being mobile app provides an 8-week program with 4 classes per week (including a brief theoretical portion and a 15-min guided practice). The active control app also provided 4 assessments per week that encouraged participants to self-observe how they were feeling for 20 min. We also used the app to conduct Web-based questionnaires (10-item Perceived Stress Scale and 5-item World Health Organization Well-Being Index) and ask specific questions to assess subjective levels of stress and well-being at baseline (t₁), midintervention (t₄=4 weeks after t₁) and postintervention (t₈=8 weeks after t₁). Both apps were fully automated without any human involvement. Outcomes from the control and intervention conditions at the 3 time points were analyzed using a repeated measures analysis of variance.

Results: Among the randomized participants (n=490), 185 participants were excluded at the 4-week follow-up and another 79 at the 8-week follow-up because of noncompliance with the experimental protocol. Participants who did not complete t₄ and t₈ assessments were equally distributed between groups (t₄: control group=34.6% [83/240] and intervention group=40.8% [102/250]; P=.16; t₈: control group=29.9% [47/157] and intervention group=21.6% [32/148]; P=.10). Both groups showed a significant increase in general well-being as a function of time (F_2,426=5.27; P=.006), but only the intervention group presented a significant increase in work-related well-being (F_2,426=8.92; P<.001), as well as a significant reduction in work-related and overall stress (F_2,426=5.50; P=.004 and F_2,426=8.59; P<.001, respectively).

Conclusions: The well-being mobile app was effective in reducing employee stress and improving well-being.

Trial registration: Clinicaltrials.gov NCT02637414; https://clinicaltrials.gov/ct2/show/NCT02637414.

Keywords: behavioral medicine; behavioral symptoms; health promotion; meditation; mental health; mind-body therapies; mobile applications; psychology; stress, psychological; women’s health.

Figure 1

Consolidated Standards of Reporting Trials flow diagram. PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.

Figure 2

Baseline outcome score data by experimental group. Scatter plots showing bivariate analyses of 10-item Perceived Stress Scale (t₂₈₈=0.414; P=.68; d=0.045), 5-item World Health Organization Well-Being Index (U=10461; P=.96; r=−0.002), work-related stress (U=11078; P=.47; r=−0.041), general stress (U=11274; P=.64; r=−0.026), work-related well-being (U=11487; P=.86; r=−0.010), and general well-being (U=11060; P=.45; r=−0.043) for the control and intervention groups. Open circles show data for each participant. Red lines show group medians, except for PSS-10, which shows group means. PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.

Figure 3

Plot means with standard error bars showing all outcome data for the control (dashed black line) and intervention (solid black line) groups at pre intervention and mid intervention. Time × group interaction at 10-item Perceived Stress Scale (F_1,208=9.48; P=.002; η_p²=.044), 5-item World Health Organization Well-Being Index (F_1,208=8.54; P=.004; η_p²=.168), work-related stress (F_1,208=6.34; P=.01; η_p²=.022), work-related well-being (F_1,208=12.1; P=.001; η_p²=.041), general stress (F_1,208=6.46; P=.01; η_p²=.023), and general well-being (F_1,208=1.48; P=.22; η_p²=.005). PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.

Figure 4

Plot means with standard error bars showing all outcome data for the control (dashed black line) and intervention (solid black line) groups at preintervention, midintervention, and postintervention. A time × group interaction was observed at 10-item Perceived Stress Scale (F_2,326=7.19; P=.001; η_p²=.042), 5-item World Health Organization Well-Being Index (F_2,326=7.97; P<.001; η_p²=.047), work-related stress (F_2,426=5.50; P=.004; η_p²=.025), work-related well-being (F_2,426=8.92; P<.001; η_p²=.040), general stress (F_2,426=8.59; P<.001; η_p²=.039), and general well-being (F_2,426=0.74; P=.47; η_p²=.003). PSS-10: 10-item Perceived Stress Scale; WHO-5: 5-item World Health Organization Well-Being Index.