Currently submitted to: JMIR Formative Research
Date Submitted: Oct 1, 2020
Open Peer Review Period: Oct 1, 2020 - Nov 26, 2020
(currently open for review)
Effectiveness of smartphone-based cognitive behavioral therapy among patients with major depression: A systematic review
Depression is often associated with rapid changes in mood and quality of life that persist for a period of two weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for the health care systems. At the same time, comprehensive limitations in physical, psychological and social dimensions are observed for patients with depression, which significantly reduce the quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care can be determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential, because of their reach and easy accessibility. Low socioeconomic groups, which are always hard to reach for public health intervention, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and the mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison to standard care.
The objective of this review was: (1) to identify and summarize existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and (2) to present health implications of smartphone-based cognitive behavioral therapy of considered endpoints.
A systematic literature review was conducted which identified relevant studies by means of inclusion and exclusion criteria. For this purpose, the databases PubMed and Psyndex were systematically searched using a search syntax. The endpoints depressive symptoms, depression-related anxiety, self-efficacy or self-esteem and quality of life were analyzed. Identified studies were evaluated concerning study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified.
The examined studies reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50 % (n=4) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem and quality of life. In conclusion, no clear implications of the smartphone-based cognitive behavioral therapy could be established.
Evidence for the treatment of depression by smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mHealth intervention studies.
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