Combining smartphone apps with wearable devices can support people as they wait to start psychiatric treatment, trial findings suggest.
The findings indicate that digital interventions can be used as supplemental tools within healthcare systems to support patients during waiting-list delays in psychiatric care.
Effective evidence-based apps that offered mindfulness and cognitive behavioral therapy (CBT) and Fitbits or smartwatches that tracked sleep and activity and offered positive messages were all beneficial.
The results ran contrary to the researchers’ hypothesis that adding CBT or mindfulness apps to the Fitbit/smartwatch messages would offer extra benefits, except in the case of mindfulness reducing suicide risk.
Depression, anxiety, and the risk of suicide all dropped in people scheduled for outpatient psychiatric care who used the digital interventions, according to results published in the journal JAMA Network Open.
“Having this type of option, especially for people who are motivated enough to seek an appointment and wait for it, could be very valuable when providers have long wait lists,” said researcher Adam Horwitz, PhD, an assistant professor at the University of Michigan.
“These individuals want to be doing something about their mental health but don’t yet have access, so this suggests that providing them with some sort of digital option when their motivation is already high, and they are ready to do something, could begin to make a difference.”
The study included 2079 patients, 68.4% of whom self-identified as women, who were scheduled to receive care over the coming weeks from several mental and behavioral health clinics within the University of Michigan Health System.
Five interventions were assessed. The first was passive enhanced personalized feedback based on physical activity, sleep and mood assessed using a Fitbit or smartwatch. Notifications were delivered twice a day through the study app MyDataHelps and, for example, offered congratulations for walking or getting a good amount of sleep or suggested a simple act such as giving to others to improve their mood.
The mobile apps Headspace, which trains in mindfulness, and Silvercloud, which delivers CBT, were also assessed with and without the enhanced personalized feedback. Participants were randomized using a 2:1:1:1:1 allocation, with the arm including only enhanced personalized feedback being twice the size of other groups.
The primary outcome was change in depressive symptoms using the Patient Health Questionnaire (PHQ)-9, which ranged in score from 0 to 27, where higher numbers indicated greater depression symptoms. Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms.
The mean baseline PHQ-9 score of 12.7 significantly decreased for all five intervention arms at 6 weeks similarly, with marginal mean differences in mean change ranging from -2.1 to -2.9. Anxiety scores on a 21-point scale also dropped similarly across the groups.
Abstinence from substance use such as smoking or alcohol did not significantly change during the study period overall and also between the intervention groups.
However, the Headspace arms reported significantly greater improvements on a suicidality subscale compared with the Silvercloud arms.
“If we can use apps to give the patient a bit of momentum on understanding and managing their symptoms, even before they get to clinic, then perhaps that will help them get more out of therapy once they get to clinic and pass the baton from the app to a professional provider,” said Horwitz.
“The apps don’t have the same effect as therapy, but doing something while waiting is still important.”
