Smartphones have become an indispensible part of our lives. We use them for just about anything and in just about every setting imaginable — classrooms, cars, gyms and workplaces. For the amount of time we spend on our phones each day, researchers have started to recognize the potential usefulness of mobile technology in delivering treatment interventions and conducting research trials.
Major depressive disorder (i.e., clinical depression) is one of the most common mental illnesses in the United States and is a leading cause of disability worldwide. As such, it is often difficult to enroll people who have depression into clinical trials. Advances in mobile technology may be particularly advantageous to use for improving patients’ access to care for mental health issues such as depression — one of the major barriers preventing people from receiving the treatment they need — as well as for reducing expenses related to running randomized controlled trials (RTCs) to determine whether an intervention is effective for treating a specific mental disorder.
The BRIGHTEN study
Patricia A. Areán, Ph.D., a licensed clinical psychologist and professor of psychiatry and behavioral sciences at the University of Washington, and her colleagues from the University of California, San Francisco (UCSF), investigated the feasibility of using a new and potentially easier way to track and manage the symptoms of cognition and mood in individuals over the age of 18 who were diagnosed with depressive disorders — the use of mobile technology. The BRIGHTEN study aimed to determine whether a remote RCT could help to improve sample representativeness (or access to people with depressive disorders), study engagement and reduce costs.
Three methods were used to recruit participants. Each method linked participants to the researchers’ custom study website. The recruitment approaches utilized in the study included:
In total, 2,923 participants from eight rural states were recruited through five two-week advertising waves. Of these, 89 percent were recruited through traditional approaches, less than 1 percent were recruited using social networking, less than 1 percent came from search engine-based methods and 10.3 percent came from unanticipated means, such as referrals or through their own search. The BRIGHTEN study easily recruited participants from all over the country in a cost-effective way, including participants in underserved populations who are not able to be reached for their inclusion in RTCs. While recruiting participants was a benefit of using mobile technology, keeping people engaged in the study was much more challenging.
The Patient Health Questionnaire (PHQ-9), a brief measure of the severity of depression, was used to screen potential participants to determine whether they exhibited depressive symptoms. A score of 5 or greater (minimal symptoms of depression) on the PHQ-9 was required for enrollment in the study. The final sample consisted primarily of young adults who were moderately depressed at baseline with a PHQ-9 score of 13.9 (scores of 10 to 14 indicated a provisional diagnosis of minor depression, dysthymia or a mild major depressive episode).
Fifty-one percent of participants had co-occurring anxiety and 53 percent misused alcohol, while 16 percent had a history of psychosis or mania. Only half of the sample was receiving mental health treatment for depression. The participants were randomized to one of three treatment arms and asked to use their assigned app daily for one month. The three treatment arms included:
There were two apps that were used to collect data for the study. The first was Ginger.io, which collected self-reported mood, function and passive analytics (i.e., communication and mobility data). The other was Adaptive Cognition Evaluation (ACE), which is a mobile cognitive assessment app that evaluated cognitive function at baseline and follow-ups at four, eight and 12 weeks. Sixty-six percent of the sample completed the four-week assessment, 50 percent completed the eight-week assessment and 41 percent completed the 12-week assessment. Participants who were younger, less educated and had higher scores of depression were more likely to drop out of the study early.
The biggest limitation of the study was the high dropout percentage of participants during the study. Although participants were paid a total of $75 for completing all assessments and some participants were even given a $75 bonus for completing additional assessments during the 12 weeks, participants lost interest over time, which the researchers attributed to a lack of direct contact during the study. The participants who received bonus pay were more likely to participate for a longer time.
RTCs are often very expensive, costing millions of dollars to complete, and time-consuming, which limits researchers’ ability to obtain samples that are representative of the overall population. It cost much less to conduct the BRIGHTEN study compared to typical RTCs, which are often much more expensive. In addition, the data collected during the study was collected in several weeks, which is a relatively short time period compared to the average RTC that takes about four to five years to complete.
Overall, the results of the BRIGHTEN study found that mobile technology could be used to rapidly recruit study participants who are more representative of the U.S. population and those who are often challenging to recruit (e.g., people living in rural areas, racial or ethnic minority populations, people with mental illnesses). The use of mobile technology could potentially be used to investigate treatment outcomes in a faster time period, which would allow researchers to more quickly move effective treatments into practice and identify treatments that are unsafe or not effective. Lastly, the costs of conducting a mobile study were much lower than conducting typical RTCs. Despite the benefits of using mobile technology to conduct research, the dropout rate was higher due to the lack of direct contact between the research team and participants, and future studies should aim to find different methods to keep participants interested in using the interventions.
In summary, mobile technology can be useful for reaching typically underserved populations and for substantially reducing the time and costs to determine intervention effectiveness. There are also multiple benefits of utilizing technology for RTCs, including expanding the ability to collect greater amounts of data in a shorter amount of time as well as a reduction in the costs of conducting a research study. While many of the mobile applications utilized in the study were relatively new, results indicated that all three apps are useful for improving mood and reducing disability over time for people with depressive disorders.
Sovereign Health Rancho San Diego offers behavioral health treatment services to adolescents ages 12 through 17 with emotional and behavioral problems. For more information about the programs offered at our adolescent facility, please contact our 24/7 helpline for further assistance.
About the author
Amanda Habermann is a writer for the Sovereign Health Group. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques. For more information and other inquiries about this article, contact the author at email@example.com.