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Mobile intervention as effective as clinic-based approach for serious mental illness

A mobile health approach that uses an intervention delivered by smartphones was as effective as a clinic-based group intervention for managing serious mental illness, according to research findings published in Psychiatric Services.

“Early [mobile health] efforts have produced promising outcomes in terms of feasibility, acceptability and preliminary efficacy in this population,” Dror Ben-Zeev, PhD, professor of psychiatry and behavioral sciences at the University of Washington, and colleagues wrote. “Whether [mobile health] interventions can serve as stand-alone treatments, effectively engage individuals with serious mental illness in remote care and produce clinical outcomes that are comparable to those of clinic-based interventions is unknown.”

The investigators conducted a 3-month randomized controlled trial to evaluate how a mobile health approach — FOCUS — performed compared with a clinic-based, group self-management intervention — the Wellness Recovery Action Plan (WRAP) — among 163 participants with long-term, serious mental illness. Specifically, FOCUS is a multimodal, smartphone-delivered intervention that includes an app, clinician dashboard and mobile health support specialist. It allows users to access preprogrammed daily self-assessment prompts at any time that target voices, mood, sleep, social functioning and medication.

Most of the participants were from racial minority groups, 49% had schizophrenia or schizoaffective disorder, 28% had bipolar disorder and 23% had major depression. Ben-Zeev and colleagues assessed participants’ engagement throughout the interventions, satisfaction after treatment and improvement in clinical symptoms, recovery and quality of life at baseline, 3 months and 6 months.

Overall, 90% of participants assigned to FOCUS (n = 74) started using the mobile health app, whereas only 58% of those assigned to WRAP (n = 47) attended at least one group session. FOCUS group participants were also more likely than WRAP participants to fully engage in treatment for at least 8 weeks (56% vs. 40%; P = .03). Post-treatment satisfaction ratings were similarly high for both groups.

Participants in both groups did not differ in clinical outcomes. The authors observed improvement in general psychopathology between baseline and 3 months among patients in the FOCUS (P < .001) and WRAP groups (P = .005) and between baseline and 6 months. They also noticed improvement in depression scores for both groups. Those in the WRAP group showed significant improvement in recovery post-treatment, and those in the FOCUS group showed significant improvement in recovery and quality of life at 6 months.

“The FOCUS [mobile health] intervention produced clinical outcomes and patient satisfaction ratings that were comparable to those of WRAP,” the authors wrote. “As more [mobile health] interventions prove to be engaging and clinically useful to patients with serious mental illness, enthusiasm for their use in clinical practice will grow. In the future, it will be important to ensure that these [mobile health] technologies are deployed ethically and responsibly.” – by Savannah Demko

Disclosure: Ben-Zeev reports an intervention content licensing and consulting agreement with Pear Therapeutics.