Depression imposes a very high societal burden in terms of cost, morbidity, suffering, and mortality. It is the leading cause of disability in the Unted States and the fourth leading cause worldwide. Current methods of treatment are insufficient to combat such a widespread health problem. Therefore, addressing this mental health epidemic requires significant changes in intervention strategies. A growing body of research is examining the use of behavioral intervention technologies (BITs), such as mobile phones to deliver behavioral and mental health interventions. The delivery of interventions via mobile phones offers the potential to provide a near continuous connection between a care system and the patient. However, currently available mobile applications (apps) for depression lack evidence regarding their efficacy. App stores currently offer apps for depression that are designed based on cognitive therapy (CT) interventions, some with behavioral activation (BA), some with mood monitoring only, and many with no discernable psychological approach. Even when based on psychological theory, there is no evidence that the translation of these theories, developed for face- to-face treatment, work the same way for people with depression when delivered through an app. Given the quickly evolving nature of mobile apps, conducting research on every available app will never be possible, nor very useful. The proposed research plan takes an innovative approach to investigating BITs for depression by incorporating principles from psychology, engineering, and design to examine two primary psychological principles, CT and BA, delivered by mobile apps. The project will include two stages. First, the most usable elements of existing apps will be identified to create two apps, one using CT and the other BA, targeting depressive symptoms. This usability process will use a clear, model-driven approach to identify the most usable and useful characteristics for three app elements: information delivery, tools, and visual feedback. Following usability testing and improvements, the two apps will be subjected to a small comparative trial. Secondary aims will include an examination of usage of the apps, defined as how many times the apps are opened on the mobile devices. Results will provide information that can be broadly used by developers of apps for depression and may also have implications for apps aimed at treating other mental health disorders.

Public Health Relevance

Twelve-month prevalence rates indicate that 21-30 million Americans will require treatment for depression each year, needs that will never be able to be met with standard one-on-one intensive treatments. The proposed research takes an innovative approach to extending care capacity and informing design of future interventions though usability testing on existing mobile application (app) features and evaluating the comparative outcomes of two treatments for depression delivered via mobile apps. Knowledge gained from this project has immense potential to extend care capacity to millions of individuals with empirically supported treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
5F31MH106321-02
Application #
8974741
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
Hill, Lauren D
Project Start
2014-11-16
Project End
2016-06-30
Budget Start
2015-11-16
Budget End
2016-06-30
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Northwestern University at Chicago
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
005436803
City
Chicago
State
IL
Country
United States
Zip Code
60611
Stiles-Shields, Colleen; Montague, Enid; Kwasny, Mary J et al. (2018) Behavioral and cognitive intervention strategies delivered via coached apps for depression: Pilot trial. Psychol Serv :
Stiles-Shields, Colleen; Montague, Enid; Lattie, Emily G et al. (2017) Exploring User Learnability and Learning Performance in an App for Depression: Usability Study. JMIR Hum Factors 4:e18
Schueller, Stephen M; Stiles-Shields, Colleen; Yarosh, Lana (2017) Online Treatment and Virtual Therapists in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am 26:1-12
Stiles-Shields, Colleen; Bamford, Bryony H; Touyz, Stephen et al. (2016) Predictors of therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa. J Eat Disord 4:13
Lattie, Emily G; Schueller, Stephen M; Sargent, Elizabeth et al. (2016) Uptake and Usage of IntelliCare: A Publicly Available Suite of Mental Health and Well-Being Apps. Internet Interv 4:152-158
Mohr, David C; Schueller, Stephen M; Riley, William T et al. (2015) Trials of Intervention Principles: Evaluation Methods for Evolving Behavioral Intervention Technologies. J Med Internet Res 17:e166
Stiles-Shields, C; Corden, M E; Kwasny, M J et al. (2015) Predictors of outcome for telephone and face-to-face administered cognitive behavioral therapy for depression. Psychol Med 45:3205-15
Mohr, David C; Stiles-Shields, Colleen; Brenner, Christopher et al. (2015) MedLink: A Mobile Intervention to Address Failure Points in the Treatment of Depression in General Medicine. Int Conf Pervasive Comput Technol Healthc 2015:100-107
Stiles-Shields, Colleen; Keefer, Laurie (2015) Web-based interventions for ulcerative colitis and Crohn's disease: systematic review and future directions. Clin Exp Gastroenterol 8:149-57