Two studies – one on each side of the Atlantic – are throwing some shade over the idea that mHealth can help those with depression.
A two-year study by the Oregon Health and Science University in Portland of some 11,000 Americans age 50 and older has found that face-to-face interactions work better at staving off depression than regular contact by phone, e-mail or text. In the UK, meanwhile, a report in the journal Evidence Based Mental Health found that most of the 14 depression treatment apps endorsed by the National Health Service haven't proven effective.
"Mobile health apps are increasing at an amazing rate, and most don't have any empirical validation," Stephen Schueller, a clinical psychologist at Northwestern University who specializes in Internet and mobile interventions for depression and was not involved in the NHS study, told IEEE Spectrum. "The last time I looked at the literature, there were five or six randomized controlled trials of an app for depression, and none of those apps were available on a public app store, and none ran on an iPhone or Android operating system. So anything that I would want to touch as a consumer has not been validated in a randomized controlled trial."
Simon Leigh, a senior health economist for Liverpool-based Lifecode Solutions and author of the paper, faults the NHS for endorsing the 14 apps, even though only two – Big White Wall and Moodscope – have been clinically validated. The paper follows several other recent reports in the UK charging that apps that purport to treat PTSD, eating disorders and bipolar disorder aren't being tested properly.
The OHSU study, meanwhile, focuses on the value of in-person communication compared to electronic communication – a different measurement for validation than the UK studies, but a persistent issue. According to that study, those who maintained regular, in-person interactions with family and friends were 5 percent less likely to face depression than those who interacted via phone, text or e-mail.
The two studies point to the disconnect between consumer-facing platforms and those used by clinicians, who've been hesitant to embrace the technology until they have proof that it will give them the data they need and be effective in helping with clinical outcomes. In fact, a recent study by the IMS Institute for Healthcare Informatics noted that half of the estimated 165,000 mHealth apps now available to consumers are of "limited" value.
That's not to say mHealth is ineffective in treating people with behavioral issues. In August, researchers at the University of Missouri unveiled an app that allows users to track their moods, while also linking to their Fitbit to collect activity and sleep data and automatically sending all that information to a Cerner EMR. And last June, researchers at the University of California at San Francisco launched a project that uses Apple's ResearchKit platform to collect information – including mental health data – from the LGBT community.
In an analysis for mHealth News, Ken Cahill, CEO of SilverCloud Health, said such interventions can be effective if they combine mobility with real-time access to clinical support.
"Years of clinical research have shown that mobile and online mental health interventions and testing are effective in conjunction with traditional in-person therapy, improving both short- and long-term patient engagement," Cahill wrote. "This approach could cost-effectively unite mental and physical care if integrated into chronic care programs, including in areas where there is a shortage of mental health providers."
