Mobile Health App Effective for Serious Mental Illness

Megan Brooks

June 01, 2018

Patients with serious mental illness were more open to starting treatment using a mobile health (mHealth) app than to attending traditional sessions at a clinic in a randomized controlled trial.

In addition, patients who used the mHealth app experienced reductions in symptoms comparable to those experienced by their peers who attended group therapy sessions.

"It is now time to try and integrate this approach into real-world practice," Dror Ben-Zeev, PhD, professor of psychiatry and behavioral sciences and director of the mHealth for Mental Health Program at the University of Washington in Seattle, told Medscape Medical News.

The study was published online May 25 in Psychiatric Services.

Effective, Acceptable

The study included 163 patients with long-standing, serious mental illnesses, including schizophrenia or schizoaffective disorder (49%), bipolar disorder, (28%) and major depressive disorder (23%). The mean age of the patients was 49 years, 59% were men, and 65% were African American.

Eighty-one participants were randomly allocated to receive the Wellness Recovery Action Plan (WRAP), a widely used clinic-based group intervention; 82 received the FOCUS evidence-based smartphone-delivered intervention.

The FOCUS system includes daily self-assessment prompts and on-demand functions that can be accessed anytime. Self-management content targets five broad domains: voices, which involves coping with auditory hallucinations via cognitive restructuring, distraction, and guided hypothesis testing; mood, which involves managing depression and anxiety with behavioral activation, relaxation techniques, and supportive content; sleep, which involves sleep hygiene, relaxation, and health and wellness psychoeducation; social functioning, which involves cognitive restructuring of persecutory ideation, anger management, activity scheduling, and skills training; and medication, which involves behavioral tailoring and receiving reminders.

The FOCUS content can be accessed as either brief video or audio clips or through sequences of digital screens with written material coupled with images. FOCUS users' responses to daily self-assessments are displayed on a digital dashboard. Users receive brief weekly calls from an mHealth support specialist who helps with all technical and clinical aspects of the intervention

Outcomes for the study were engagement in treatment throughout the 12-week intervention period; satisfaction 3 months after the intervention; and improvement in clinical symptoms, recovery, and quality of life, assessed at baseline and 3 and 6 months after treatment.

Patients who used the FOCUS mHealth tool were more likely than those assigned to WRAP clinic sessions to start treatment (90% vs 58%; P < .001) and to remain fully engaged in treatment for at least 8 weeks (56% vs 40%; P = .03).

With the FOCUS mobile app, patients were exposed to treatment content more often and over a longer period than with clinic-based sessions, the authors note.

Patients in both groups experienced "significant and comparable" reductions in general psychopathology (assessed with the Symptom Checklist–9) and depression (assessed with the Beck Depression Inventory, Second Edition). Significant improvements in recovery, as determined on the basis of scores on the Recovery Assessment Scale, were seen for the WRAP group at the end of treatment (3 months) and in the FOCUS group at 6-month follow-up.

Both groups reported equally high satisfaction ratings for FOCUS and WRAP. Patients in both groups reported that it was enjoyable and interactive and helped them feel better, the authors report.

Psychiatrists on Board

These findings "support the notion that mHealth can play an important role in 21st century mental health care," the authors write.

Ben-Zeev led the research team that developed the FOCUS smartphone mobile app.

"The app was developed through research dollars and until now was only available through involvement in our studies. We are looking to change that and have it broadly available. We may do that through the University of Washington Department of Psychiatry and Behavioral Sciences," he told Medscape Medical News.

Digital tools for mental health are in active use by clinicians today. Dr Adam Powell

The findings of this study are "consistent with the literature on digital tools for mental health," Adam C. Powell, PhD, president of Payer+Provider Syndicate, a Boston, Massachusetts–based consulting firm specializing in operational challenges faced by health insurance companies and hospitals, told Medscape Medical News.

"Prior researchers have repeatedly shown that digital therapies are an efficacious means of improving mental well-being," said Powell, adding, "Digital tools for mental health are in active use by clinicians today.

"While the FOCUS app performed well in the study, it is possible that its benefits would be even greater in real-world use," said Powell. "Outside the context of a trial, it might be possible to encourage people that did not commence a live intervention to consider a digital intervention as an alternative. In real-world use, it might be possible to assign people that identify as unlikely to engage with a digital tool, or that become disengaged with the tool to the live intervention," said Powell.

The study was supported by the Patient-Centered Outcomes Research Institute. Dr Ben-Zeev has an intervention content licensing and consulting agreement with Pear Therapeutics. Dr Powell has disclosed no relevant financial relationships.

Psychiatr Serv. Published online May 25, 2018. Abstract

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