Mental health app shown to prevent depression in the young
Study demonstrates that cost-effective new cognitive behavioural therapy (CBT) app can significantly prevent increases in depression in young people at high risk
There’s growing concern around the world about high and increasing rates of anxiety and depression among young people. We need ways of preventing poor mental health that are both effective and scalable. A range of digital solutions such as mobile apps have been proposed – we’ve reported on several – but a four-year research project led by the University of Exeter offers good evidence that these apps can be highly effective.
Photo by Tommy Tong
The £3.3m study, funded by Horizon 2020, assessed two emotional competence and well-being apps, ECo-WeB-PREVENT and ECo-WeB-PROMOTE, one focused on preventing depression and the other on promoting well-being. A total of 3,700 young people took part, aged 16 to 22 and based in the UK, Belgium, Germany and Spain. Indeed, this is the first such project to test a mental health app rigorously on such a large scale. The findings have now been published in two linked papers in Lancet Digital Health.
Of those taking part, 1,200 young people were found to have reduced emotional competency scores, an indicator of increased risk of depression. They were placed in the trial aimed at prevention. The 2,500 young people not found to be at such risk were put in the trial aimed at promoting well-being.
Having been divided in this way, the two groups were then randomly assigned to three different apps developed for the study. These were: a self-monitoring app in which participants can report their emotions each day; a self-help app providing personalised training in emotional competence skills; and a self-help app based on CBT principles. Each participant was followed up after three and then 12 months to see how their symptoms had changed.
The CBT app was found to prevent an increase of levels of depression relative to self-monitoring in the high-risk sample – a significant result, given the urgent need for such interventions. However, there was no variance between any of the three apps on those in the low-risk sample group.
Read the full research papers in Digital Lancet Health:
Support for the project was provided by the Exeter Clinical Trials Unit. Thirteen partner organisations were involved, including two commercial companies: German voice analysis company audEERING and Danish app creator Monsenso. The University of Exeter, LMU Munich (Germany), Ghent University (Belgium), and Universitat Jaume I (Spain) were the main treatment development and trial sites. The University of Oxford led on the qualitative analysis of the project.
Professor Ed Watkins, Project Leader at the University of Exeter, says: ‘For young people with elevated risk, our findings suggest the CBT app does have a preventative effect on depression and could have a public health benefit. Participants’ quality-of-life measures were better, and their reported work and social functioning was better.
‘However, we also found that it’s hard to make improvements in young people who are basically doing okay. Our findings add to the evidence that prevention for depression works best when we identify and select individuals who are more at risk, rather than take a more universal approach. This identification could be done by an online self-screening process or through professional referral.
‘Our results suggest that even when young people used the self-help app just a few times, there was a small but meaningful benefit. Because the app is scalable to large numbers of people in a cost-effective way, these effects have potential value as a public health intervention, within a broader portfolio of digital and in-person services and interventions. Next steps are to identify the active ingredients of the app that were beneficial and to improve engagement and ongoing use of these elements.’
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