For Patients With Depression, Engagement in Digital Interventions Appears Limited

Participants in studies involving digital interventions for depression used the interventions an average of just 3.9 hours in total, according to a systematic literature review published online in the Journal of Medical Internet Research.

“Thus, it would be prudent for developers to front-load the most important content in the beginning modules,” wrote first author Ainslie Forbes of Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, and coauthors. “For mental health care providers, it may be helpful to conceive of digital interventions as short-term rather than long-term treatments, particularly for patients on waitlists.”

The review was comprehensive, spanning 94 studies including 20,111 participants with depression or major depressive disorder. Digital therapeutics for depression included 47 unique web-based interventions (as well as 10 unnamed web-based interventions), 15 mobile app interventions, 5 app-based interventions also available on the internet, and 1 CD-ROM.

Among 55 studies that compared a digital intervention to a control intervention such as waitlist, care as usual, or an active control, 78% found greater improvement for at least 1 efficacy outcome with the digital intervention.

However, researchers found wide variation in how studies defined and measured participant adherence and engagement. Adherence was mostly measured as the percent of participants who finished all digital intervention modules. According to the study, just 44.2% of participants completed all modules. Meanwhile, engagement was mostly measured as the number of modules completed. The average was 6.4 modules.

Participants used the digital interventions an average 3.9 hours total. App-based interventions garnered even less use: an average 2.0 hours in all, researchers reported.

Nearly two-thirds of studies that investigated the association found that increased engagement was significantly related to improved patient outcomes.

“The relationship between engagement and efficacy is complex. As reviewed here, it is not a unanimous finding in the existing literature that the more patients engage with the intervention, the better their outcomes,” researchers wrote. “Therefore, it is difficult to determine the extent of engagement necessary to improve depressive symptoms.”

Reference

Forbes A, Keleher MR, Venditto M, DiBiasi F. Assessing patient adherence to and engagement with digital interventions for depression in clinical trials: systematic literature review. J Med Internet Res. 2023;25:e43727. doi:10.2196/43727