TY  - JOUR
AU  - Nagamitsu, Shinichiro
AU  - Okada, Ayumi
AU  - Sakuta, Ryoichi
AU  - Ishii, Ryuta
AU  - Koyanagi, Kenshi
AU  - Habukawa, Chizu
AU  - Katayama, Takashi
AU  - Ito, Masaya
AU  - Kanie, Ayako
AU  - Otani, Ryoko
AU  - Inoue, Takeshi
AU  - Kitajima, Tasuku
AU  - Matsubara, Naoki
AU  - Tanaka, Chie
AU  - Fujii, Chikako
AU  - Shigeyasu, Yoshie
AU  - Matsuoka, Michiko
AU  - Kakuma, Tatsuyuki
AU  - Horikoshi, Masaru
PY  - 2025
DA  - 2025/7/29
TI  - Usefulness of Interventions Using a Smartphone Cognitive Behavior Therapy Application for Children With Mental Health Disorders: Prospective, Single-Arm, Uncontrolled Clinical Trial
JO  - JMIR Form Res
SP  - e60943
VL  - 9
KW  - smartphone
KW  - cognitive behavioral therapy
KW  - application
KW  - adolescent
KW  - youth
KW  - teen
KW  - pediatric
KW  - mental health
KW  - psychoeducation
KW  - self-monitoring
KW  - questionnaire
KW  - depressive symptoms
KW  - effectiveness
KW  - Japan
KW  - statistical analysis
KW  - single-arm uncontrolled study
KW  - mobile phone
AB  - Background: The prevalence of mental health disorders among children in Japan has increased rapidly, and these children often show depressive symptoms and reduced quality of life (QOL). We previously developed a smartphone-based self-monitoring app to deliver cognitive behavioral therapy (CBT), implemented it in healthy children, and reported its effectiveness for health promotion. Objective: This study aims to examine the usefulness of the CBT app for improvement in depressive symptoms and QOL in children with mental health disorders. Methods: The participants were 115 children with mental health disorders (eg, school refusal, orthostatic hypotension, eating disorders, developmental disorders, among others) and aged 12‐18 years. The CBT app–based program comprised 1 week of psychoeducation followed by 1 week of self-monitoring. After reading story-like scenarios, participants created a self-monitoring sheet with 5 panels: events, thoughts, feelings, body responses, and actions. All participants received regular mental health care from physicians in addition to the app-based program. To evaluate the participants’ depressive symptoms and QOL, Patient Health Questionnaire for Adolescents (PHQ-9A), Depression Self-Rating Scale for Children (DSRS-C), and Pediatric Quality of Life Inventory (PedsQL) were measured at the beginning of the intervention, and at 2 and 6 months thereafter. Questionnaire for Triage and Assessment with 30 items (QTA30), and Rosenberg Self-Esteem Scale (RSES) were also used to measure their health and self-esteem. Participants were divided into 4 groups on the basis of the PHQ-9A score (above or below the cutoff; PHQ-9A≥5 or PHQ-9A<5) and completion or noncompletion of the CBT app–based program (app [+] or app [-]). The primary outcome was improvement in the DSRS-C score, and secondary outcomes were improvement in other psychometric scales including PedsQL, QTA30, and RSE. A paired-samples t test was used for statistical analysis. The Medical Ethics Committee of Fukuoka University Faculty of Medicine (approval U22-05-002) approved the study design. Results: There were 48, 18, 18, and 7 participants in the PHQ-9A≥5 app (+), PHQ-9A≥5 app (-), PHQ-9A<5 app (+), and PHQ-9A<5 app (-) groups, respectively. A total of 24 participants dropped out. No improvement in the DSRS-C score was observed in all groups. However, PedsQL scores improved significantly at 2 and 6 months in the PHQ-9A<5 app (+) group (t17=6.62; P<.001 and t17=6.11; P<.001, respectively). There was a significant positive correlation between the PHQ-9A scores and the number of self-monitoring sheets completed. Conclusions: The CBT app was useful for improving PedsQL scores of children with mental health disorders. However, a higher-intensity CBT program is necessary for more severely depressed children. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000046775; center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053360 
SN  - 2561-326X
UR  - https://formative.jmir.org/2025/1/e60943
UR  - https://doi.org/10.2196/60943
DO  - 10.2196/60943
ID  - info:doi/10.2196/60943
ER  -