Feasibility of a Therapist-Supported, Mobile Phone-Delivered Online Intervention for Depression: Longitudinal Observational Study

Philippe R Goldin, Riku Lindholm, Kristian Ranta, Outi Hilgert, Tiia Helteenvuori, Anu Raevuori, Philippe R Goldin, Riku Lindholm, Kristian Ranta, Outi Hilgert, Tiia Helteenvuori, Anu Raevuori

Abstract

Background: Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone-delivered 8-week intervention administered at the Meru Health Online Clinic in Finland.

Objective: We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms.

Methods: A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models.

Results: For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ∆R2=.38, P=.004 and ∆R2=.38, P=.002, respectively; Study 2: ∆R2=.16, P<.001 and ∆R2=.08, P=.002, respectively).

Conclusions: This therapist-supported, mobile phone-delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention.

Keywords: cognitive therapy; depression; digital health; digital therapeutics; mindfulness; online intervention.

Conflict of interest statement

Conflicts of Interest: PRG owns options of Meru Health Inc. RL serves as the chief operating officer of Meru Health Inc, owns a large share of the company’s stocks, and receives a salary from the company. KR serves as the chief executive officer of Meru Health Inc, owns a large share of the company's stocks, and receives a salary from the company. OH is employed as a chief therapist by Meru Health Inc, owns stocks and options, and receives a salary from the company. At the time of the study, TH was employed as a therapist by Meru Health Inc and received a salary from the company. AR is employed as a medical director by Meru Health Inc, owns stocks and options, and receives a salary from the company.

©Philippe R Goldin, Riku Lindholm, Kristian Ranta, Outi Hilgert, Tiia Helteenvuori, Anu Raevuori. Originally published in JMIR Formative Research (http://formative.jmir.org), 22.01.2019.

Figures

Figure 1
Figure 1
Number of days per week of mobile phone–delivered practices completed during the 8-week Ascend intervention during study 1. Error bars indicate standard error of the mean.
Figure 2
Figure 2
Depression symptoms during study 1 of the Ascend intervention. Error bars indicate standard error of the mean.
Figure 3
Figure 3
Daily practice and weekly group chat use during Ascend intervention predict pre-to-post change in depression symptoms in Ascend in study 1.
Figure 4
Figure 4
Number of days per week of mobile phone–delivered practices completed during the 8-week Ascend intervention during study 2. Error bars indicate standard error of the mean.
Figure 5
Figure 5
Depression symptoms during study 2 of the Ascend intervention. Error bars indicate standard error of the mean.
Figure 6
Figure 6
Daily practice and weekly group chat use during Ascend intervention predict pre-to-post change in depression symptoms in Ascend in study 2.

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