Researchers are finding some early successes in using digital health techniques to treat depression.
Depression is a global health problem: More than 300 million people struggle with clinical depression world-wide. Barriers to treatment for these patients include cost, time, stigma, and access. In many areas of behavioral health, the relationship between the patient and the therapist is seen as essential to effective care. But a growing body of research, including a meta-analysis of studies involving internet-based cognitive behavioral therapy (CBT), is demonstrating that digital therapies – combined with coaches who are available by text or phone – might be as effective as evidence-based traditional face-to-face therapy in treating some people with depression.
One study funded by the National Institutes of Health (NIH) tracked 99 patients with moderate depression and found that 90 of them completed an eight-week study that included access to treatment apps plus text support from trained coaches. Those who completed the course experienced a significant decrease in their symptoms, with 75 percent categorized as being in full remission. Most participants interacted regularly with the app over the eight-week period, and on average interacted with the coach twice a week.
A study by the UK National Health Service involving 1.2 million referrals for depression and anxiety showed that computerized CBT administered to people with depression yielded a recovery rate of 58 percent, compared with 54 percent for those who received face-to-face therapy.
Some of the researchers involved in these studies note that stepped care approaches may help build the evidence base for new tools and identify patients who could benefit from them. Stepped care might start with a brief in-person assessment of a patient who shows signs of depression, so that therapists can identify any behavioral or health concerns. Then, depending on severity, the therapist could provide patients with a self-help book or access to web-based education. The next step could be a computer-assisted intervention. Patients who do not feel they are being helped could move toward in-person treatment.
Analysis: Mobile apps for depression have evolved over the past few years to be more tailored to the individual. Individuals typically enter information about their moods and behaviors into the app, which then offers suggestions or prompts alternative ways to think through a situation or perspective, and health tips. Stakeholders expect that in the future, apps will continue to be more tailored, and incorporate augmented reality, virtual reality, and gaming. Crowdsourcing is also a strategy some apps use. A new app called Koko uses a messaging chatbox combined with machine learning that allows the user to put in a negative thought or scenario, such as a perceived failure, and send it out to other people experiencing similar situations. The crowd can provide different ideas, solutions, and support much like a therapist could.
Though new digital health apps are coming onto the market rapidly, researchers have only systematically evaluated a few. These tools have great potential to help improve health of individuals and communities. However, data and evidence on safety and efficacy are needed before health plans will pay for them and physicians will recommend them to their patients and integrate them into their practice. For consumers, with the many apps on the market, the challenge is knowing which ones work best. Standardized quality rating systems that can help consumers start to make sense of the options might help build use.
(Source: David C. Mohr et al, IntelliCare: An eclectic, skills-based app suite for the treatment of depression and anxiety, Journal of Medical Internet Research, January 5, 2017)
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