Leading journal publishes new methodological study of randomised clinical trials that concludes there has been little improvement in quality
How effective are mobile health apps for depression and anxiety? Over more than a decade, a lot of academic work has been done to assess them. However, a new study in a leading journal suggests that major issues with such assessments continue to persist.
Photo by Daria Nepriakhina 🇺🇦 / Unsplash
The new study, published in the latest issue of BMJ Mental Health, analysed the way 176 randomised control trials (RCTS) of mental health apps for depression and anxiety were carried out between 2011 and 2023.
- Read the full paper: Methodological quality in randomised clinical trials of mental health apps: systematic review and longitudinal analysis
As we’ve reported before, a wide range of mental health apps are available. These can provide 24/7 personalised support and interventions not possible with in-person care. They seem to be popular with users.
There has been a corresponding rise in scientific interest in the efficacy of such apps in reducing symptoms of anxiety and depression. Hundreds of RCTS have been undertaken, many suggesting positive impacts. But concerns have also long been voiced about the methodological quality of some of these assessments.
Some early RCTs of mental health apps were criticised for issues that had the potential to lead to efficacy being overestimated. That could include the overuse of inactive/passive controls rather than active/placebo controls, risks of bias, high dropout rates, small sampling sizes and lack of longer follow-ups. In addition, adverse effects of interventions may not always have been adequately reported.
The new study, led by Jake Linardon of the SEED Lifespan Strategic Research Centre at Deakin University, Australia, aimed to see whether things had improved over time. The researchers applied 20 indicators of study quality including risk of bias, participant diversity, study design features and app accessibility measures. By tracking that against year of publication, they were able to show whether the quality of such studies has got better or worse since 2011.
Sadly, the team conclude that there is ‘minimal evidence of improvements in the quality of clinical trials of mental health apps.’ They observed some positive movement in such factors as preregistration, adverse event reporting and – at least potentially – in the handling of missing data. But generally they conclude that ‘other key indicators of trial quality showed no significant improvement over time.’
The study outlines a series of areas for improvement that the authors hope will be taken on. ‘Doing so,’ they conclude, ‘can expedite the safe and ethical integration and dissemination of digital health tools into clinical practice and broader society, ensuring they effectively reach and benefit those who need mental health support.’
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