There has been increasing interest in the use of digital interventions and apps to provide mental health support to patients. Long before the COVID-19 pandemic, there has been a shortage of mental health providers and significant barriers to accessing care. With the pandemic, the crisis has worsened, with a steadily increasing number of individuals experiencing depression, anxiety, stress and trauma. At the same time, we face limited availability of in-person therapeutic services.
About one out of every five women experience depression or anxiety during pregnancy or the postpartum period. Women with perinatal mood and anxiety disorders face unique challenges in accessing mental health services, given the small number of specialized mental health providers and logistical limitations related to childcare.
Mental health apps have the potential to increase access to care in a cost-effective and scalable way; however, despite the enthusiasm around, and proliferation of, mental health apps, a recent systematic review and meta-analysis (Weisel et al, 2021) concluded that while some trials demonstrated the potential of some apps to target mental health symptoms, using smartphone apps as standalone psychological interventions cannot be recommended based on the current level of evidence.
A significant factor limiting the impact of digital interventions is their ability to engage users, which appears to be a challenge for many apps. A systematic review of 93 mental health apps from Baumel and colleagues (2019) examined usage patterns. The findings revealed strikingly low engagement levels; the median percentage of daily active users (open rate) was 4.0%. Only 3.3% of the users continued to use the app after 30 days.
MIT’s Affective Computing group in the Media Lab is using innovative strategies to specifically address the issue of low long-term engagement among mental health apps. They developed The Guardians: Unite the Realms; this is not only a game but “a unique tool created using the power of mobile gaming to reward and encourage healthy habit formation” and to provide skills promoting wellness and reducing risk for depression. The design of the mental health intervention in the game is informed by behavioral activation theory – an evidence-based framework that helps individuals reduce depressive symptoms by encouraging them to engage in adaptive and pleasant behaviors (Lejuez et al, 2001). The game incentivizes players to regularly complete “real-world“ tasks in exchange for “in-game” rewards that have immediate and intrinsic value in the game. And importantly, preliminary research indicates that this app has double the retention rate of conventional mental health apps.
Rachel Vanderkruik, PhD and colleagues from the MGH Center for Women’s Mental Health have teamed up with collaborators at the MIT Affective Computing group to explore how this novel app could benefit women experiencing depression during pregnancy. You can learn more about this study HERE.
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Baumel A, Muench F, Edan S, Kane JM. Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis. J Med Internet Res 2019;21(9):e14567.
doi: 10.2196/14567
Lejuez CW, Hopko DR, and Hopko SD, “A Brief Behavioral Activation,” Behavior Modification, vol. 25, no. 2, pp. 255–286, 2001.
Weisel KK, Fuhrmann LM, Berking M, et al. Standalone smartphone apps for mental health—a systematic review and meta-analysis. npj Digit Med 2, 118 (2019).
A Behavioral Activation App for Depression During Pregnancy
Rachel Vanderkruik, PhD
Rachel Vanderkruik, PhD MSc is a Staff Psychologist with the Center for Women’s Mental Health at Massachusetts General Hospital (MGH). She has been trained in evidence-based psychotherapies, including CBT, Acceptance and Commitment Therapy (ACT), and Mindfulness Based Cognitive Therapy (MBCT). Her work focuses on the promotion of women’s mental health and wellbeing; she is passionate about increasing access to evidence-based interventions and services through novel delivery methods (e.g., online platforms, peer delivery, and integrated care) and addressing disparities in mental health access and outcomes nationally and on a global scale.
