'Convincing evidence' of efficacy still lacking for mobile mental health interventions

Scientists from the University of Wisconsin, Madison, Harvard Medical School and Brown University published a meta-review in PLOS Digital Health this week seeking to examine the efficacy of apps and other mobile health interventions for mental illness.

After examining results from 14 meta-analyses representing 145 randomized controlled trials, researchers said they failed to find convincing evidence of efficacy.

That said, the team noted their work could act as a jumping-off point for further inquiries in this regard.  

“Taken together, these results suggest that mobile phone-based interventions may hold promise for modestly reducing common psychological symptoms … although effect sizes are generally small and rarely do these interventions outperform other interventions intended to be therapeutic,” they wrote in the study.  


The studies comprising the meta-analyses represented 47,940 participants, said the researchers.  

The groups examined a variety of phone-based interventions, including apps and text-based experiences. They noted that one reason evidence couldn’t be graded as convincing was that meta-analyses rarely assessed publication bias, which would be necessary to rule out small sample bias influence.  

Still, some of the interventions had “highly suggestive” evidence, based on large sample sizes.   

Smartphone interventions outperformed inactive controls on measures of psychological symptoms such anxiety, depression, stress and quality of life with small magnitude effects, said the research team.  

And mobile phone-based interventions and text message-based interventions outperformed non-specific controls on smoking cessation.  

“The only comparison with an active control condition that yielded highly suggestive evidence was text message-based interventions for smoking cessation,” they continued.  

In other words, many of these tools could be better than nothing.  

Or, as lead author Simon Goldberg explained to STAT’s Mario Aguilar, “For me, this suggests that mobile phone-based interventions might not be uniquely effective, but still are effective relative to nothing or non-therapeutic interventions.”  

“Given the scalability of these interventions, that’s still good news,” he said.  

The scientists note that the study was limited by the available literature.   

“It may well be that a body of literature exists pertaining [to] mobile phone-based interventions effects on mental health outcomes that was simply not meta-analyzed,” they wrote. “Likewise, it is possible that the strength of the evidence may have been underestimated due to lack of publication bias assessment.”  

They also note that the quality of apps and tools varies in important ways, with some designed in collaboration with researchers.  

Still, they say their findings could encourage further research in the area of smartphone interventions on some outcomes.   

“Mobile phone-based interventions may be worth considering as prevention tools, or as initial interventions within a stepped care model,” they noted.  


Apps and other mobile tools aimed at addressing behavioral health needs are big business, especially in the context of a pandemic that has strained provider and patient well-being.  

This past October, digital mental health giants Headspace and Ginger finalized their merger, aiming to target the consumer, employer and health plan markets.   Meanwhile, the year before, mental health benefits provider Lyra Health partnered with stress and wellness app Calm.  


“Eventually, standardized and transparent formal evaluation of these interventions’ clinical efficacy … may help guide consumers and providers,” observed the scientists in the PLOS Digital Health study.  

“These possibilities are, however, dependent on future primary studies and meta-analytic research continuing to establish under what circumstances these approaches are most effective, acceptable and safe,” they continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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