The use of mobile devices and technology extends to all areas of life and mental health could not be left out. Just as there are applications that help control diseases such as hypertension or diabetes, there are those that help deal with depression and its symptoms. A meta-analysis published in the journal JAMA Network Open has found “significant reductions in severity” in patients with this disease, who had used 16 of them. The researchers, from the University of Seoul (South Korea), believe that these apps can lead to an improvement in the treatment of depressive disorder.
The functions of these applications are to evaluate the mood of the patients through a test and send them guidelines and messages to help them improve their symptoms (such as negativity, apathy or demotivation…), says Luis Gutiérrez, member of the Spanish Society. of Psychiatry and Mental Health (SEPSM). In addition, some apps also have tools that allow teleconsultations with the therapist, adds Carme Carrión, principal researcher of the eHealth Lab group at the Open University of Catalonia (UOC).
The authors affirm that these types of applications offer more freedom, with respect to time and patient movements. However, they also advocate the need to further develop and refine these mobile device-based treatments, to “adapt them to socially disadvantaged populations.”
3.8% of the world's population (about 280 million people) suffer from depression, according to the World Health Organization (WHO). In low- and middle-income countries, more than 75% does not receive any treatment, despite the fact that there are numerous effective therapies. The authors of the work attribute this fact to the high cost of therapies, fear of stigmatization and lack of awareness about the effectiveness of the treatment, among others.
The interventions analyzed lasted between three and 24 weeks and included both people who were receiving treatment and those who were not. After the study, the authors of the work concluded that, for mobile depression treatment to be as effective as possible, it should not be prolonged for more than eight weeks. In addition, this also reduced the patient's “financial and psychological burdens,” the text adds. They also observed that severity was reduced more in those who did not follow other treatment for depression. Gutiérrez believes that more time is needed, “at least nine months or a year, to see the patient fully recover.”
It is easy to notice improvement in depressive symptoms in eight weeks if a person has moderate and severe depression, says the psychiatrist. “If I am very depressed, with little I do the symptoms will immediately improve,” adds Gutiérrez. Although what is truly interesting for him would be to follow the patients long term, “to prevent relapses and ensure that the initial improvement is maintained over time.”
They are not worth replacing psychologists
Carme Carrión and Luis Gutiérrez state that these types of applications can never replace therapists. The app provides value, but what is really important is “how the therapeutic process is designed and this tool is included so that it is effective,” adds the UOC researcher. The SEPSM member highlights its capacity as a complement when the patient does not see his or her psychiatrist or psychologist: “These applications can give you, on a daily basis, a guideline or a recommendation.”
Miguel Ángel López, clinical psychologist at the Jaén hospital and member of the steering committee of the Spanish Society of Clinical and Health Psychology (SEPCyS), explains that the therapeutic approach for depression is multidisciplinary and personalized for each patient. This specialist doubts the effectiveness of apps to cure depression, as research from the University of Seoul says, and believes that the idea that depression can be “addressed and cured by entering an application” can be confusing and frustrating for users. patients.
This research is an analysis of 13 studies that evaluated 16 apps and a total of 1,470 participants between 20 and 40 years old. Gutiérrez (from the SEPSM) and López (from the SEPCyS) agree that the sample is too small and homogeneous to be able to generalize the results to the entire population, something that the authors also recognize in the text itself. A UOC study published last September in JMR Publications, in which Carrión participated, concluded that hybrid interventions that combined the use of these applications and traditional therapy were more effective. According to its authors, this modality can be more economical for the patient and expand the therapists' ability to treat more people.
Trust an app for therapy
The UOC researcher considers that an appropriate mobile application to treat depression must be based on scientific evidence, have health professionals behind its development and specify very well everything that has to do with the use of patient data. Furthermore, it would be interesting if there was an app that could be integrated with the information systems of the public health system. Thus, the data would be transferred directly to the patient's medical history, Carrión emphasizes.
These types of applications do not only exist for the treatment of depression, but there are also some for bipolar disorder and schizophrenia, indicates Gutiérrez, member of the SEPSM. One way to distinguish an effective application with evidence from one that does not have it is to know if it has the hallmark of a health institution. For example, the Andalusian Health Quality Agency has healthy app stamp and Catalonia has AppSalut, a catalog with accredited and safe applications for use in therapy. In the United States, the American Psychological Association (APA) has developed a model to evaluate them into five levels, taking into account issues such as data processing, usability or whether there are clinical trials that prove its effectiveness.
Studies like this make it clear that the transformation of the health system does not just involve having more people working. Everything must be more efficient, and that includes the use of these tools, which accompany people in real time between visits to their therapist, according to Carme Carrión. The UOC researcher emphasizes the importance of investing in mental health: “We are not only talking about many new people in the health system, but we are talking about tools that can help these people,” concludes Carrión.
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