Smartphone Apps Not Ensuring Patient Engagement for Depression-focused Studies

Smartphone Apps Not Ensuring Patient Engagement for Depression-focused Studies

Clinical trials assessing the treatment of depression increasingly can capitalize on highly accessible smartphone applications to support and facilitate engagement and seamless trial data capture. However, there is one problem: increasing dropout rates evidence low engagement and considerable attrition rates raise the question, why aren’t these apps working as contemplated?

The Study

Led by John Torous, MD department of psychiatry with Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, and others from Boston and the UK—a study was conducted involving a systematic review and associated meta-analysis of 3,336 adult participants (median age, 39 years; range 19 to 50 years) randomly assigned to either A) mobile app interventions (n=1,786) or B) control conditions (n=1,550). As part of this study, the team identified a number of data sources and from there found 18 randomized clinical trials that fit the study criteria—which involved utilization of mobile device app for depression-related symptoms and reported retention during post-treatment, reported Anna Bella Zawahir with Psychiatry Advisor.


The team found that for those studies where participants utilized mobile app interventions, the pooled dropout rate totaled 26.2% (95% CI, 18.12-36.34) and significant heterogeneity (12=93.4) and a “strong indication of publication bias, reported Psychiatry Advisor. Apparently, the team found that the intervention group (those using the apps) rates were higher than control group rates in studies involving large samples but actually lower in clinical studies involving participant feedback and in-app mood monitoring, reported Ms. Bella Zawahir.

The investigators observed that actual study retention rates failed to show differentiation between depression and placebo apps, cognitive behavioral therapy and non-cognitive behavioral therapy apps, mindfulness and non-mindfulness apps, clinically diagnosed and self-reported depression or paid and unpaid assessments.


The study team reported, “Study dropout in existing mental health app trials offers a standardized and practical proxy for beginning to better understand clinical engagement” and these findings lead to the concern centering on high dropout rates when using apps. Hence, comprehensive planning should occur upfront to determine how to mitigate risk and secure greater engagement.

Lead Research/Investigators

John Torous, Beth Israel Deaconess Medical Center, Harvard Medical School

Jessica Lipschitz, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Michelle Ng, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Joseph Firth, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom