Lipschitz Jessica, Miller Christopher J, Hogan Timothy P, Burdick Katherine E, Lippin-Foster Rachel, Simon Steven R, Burgess James
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.
Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
JMIR Ment Health. 2019 Jan 25;6(1):e11334. doi: 10.2196/11334.
Emerging research suggests that mobile apps can be used to effectively treat common mental illnesses like depression and anxiety. Despite promising efficacy results and ease of access to these interventions, adoption of mobile health (mHealth; mobile device-delivered) interventions for mental illness has been limited. More insight into patients' perspectives on mHealth interventions is required to create effective implementation strategies and to adapt existing interventions to facilitate higher rates of adoption.
The aim of this study was to examine, from the patient perspective, current use and factors that may impact the use of mHealth interventions for mental illness.
This was a cross-sectional survey study of veterans who had attended an appointment at a single Veterans Health Administration facility in early 2016 that was associated with one of the following mental health concerns: unipolar depression, any anxiety disorder, or posttraumatic stress disorder. We used the Veteran Affairs Corporate Data Warehouse to create subsets of eligible participants demographically stratified by gender (male or female) and minority status (white or nonwhite). From each subset, 100 participants were selected at random and mailed a paper survey with items addressing the demographics, overall health, mental health, technology ownership or use, interest in mobile app interventions for mental illness, reasons for use or nonuse, and interest in specific features of mobile apps for mental illness.
Of the 400 potential participants, 149 (37.3%, 149/400) completed and returned a survey. Most participants (79.9%, 119/149) reported that they owned a smart device and that they use apps in general (71.1%, 106/149). Most participants (73.1%, 87/149) reported interest in using an app for mental illness, but only 10.7% (16/149) had done so. Paired samples t tests indicated that ratings of interest in using an app recommended by a clinician were significantly greater than general interest ratings and even greater when the recommending clinician was a specialty mental health provider. The most frequent concerns related to using an app for mental illness were lacking proof of efficacy (71.8%, 107/149), concerns about data privacy (59.1%, 88/149), and not knowing where to find such an app (51.0%, 76/149). Participants expressed interest in a number of app features with particularly high-interest ratings for context-sensitive apps (85.2%, 127/149), and apps focused on the following areas: increasing exercise (75.8%, 113/149), improving sleep (73.2%, 109/149), changing negative thinking (70.5%, 105/149), and increasing involvement in activities (67.1%, 100/149).
Most respondents had access to devices to use mobile apps for mental illness, already used apps for other purposes, and were interested in mobile apps for mental illness. Key factors that may improve adoption include provider endorsement, greater publicity of efficacious apps, and clear messaging about efficacy and privacy of information. Finally, multifaceted apps that address a range of concerns, from sleep to negative thought patterns, may be best received.
新兴研究表明，移动应用程序可用于有效治疗抑郁症和焦虑症等常见精神疾病。尽管这些干预措施取得了有前景的疗效结果且易于获取，但用于精神疾病的移动健康（mHealth；通过移动设备提供）干预措施的采用率一直有限。需要更深入了解患者对移动健康干预措施的看法，以制定有效的实施策略，并调整现有干预措施以促进更高的采用率。
本研究的目的是从患者角度考察当前用于精神疾病的移动健康干预措施的使用情况以及可能影响其使用的因素。
这是一项对退伍军人的横断面调查研究，这些退伍军人于2016年初在单一退伍军人健康管理机构就诊，患有以下心理健康问题之一：单相抑郁症、任何焦虑症或创伤后应激障碍。我们使用退伍军人事务部企业数据仓库创建符合条件的参与者子集，按性别（男性或女性）和少数族裔身份（白人或非白人）进行人口统计学分层。从每个子集中随机选择100名参与者，并邮寄一份纸质调查问卷，其中包含有关人口统计学、整体健康、心理健康、技术拥有或使用情况、对用于精神疾病的移动应用程序干预措施的兴趣、使用或不使用的原因以及对用于精神疾病的移动应用程序特定功能的兴趣等项目。
在400名潜在参与者中，149名（37.3%，149/400）完成并返回了调查问卷。大多数参与者（79.9%，119/149）报告称他们拥有智能设备且一般会使用应用程序（71.1%，106/149）。大多数参与者（73.1%，87/149）表示有兴趣使用用于精神疾病的应用程序，但只有10.7%（16/149）的人使用过。配对样本t检验表明，对临床医生推荐的应用程序的使用兴趣评分显著高于一般兴趣评分，当推荐临床医生是专业心理健康提供者时，评分更高。与使用用于精神疾病的应用程序相关的最常见担忧包括缺乏疗效证据（71.8%，107/149）、对数据隐私的担忧（59.1%，88/149）以及不知道在哪里可以找到此类应用程序（51.0%，76/149）。参与者对许多应用程序功能表示感兴趣，对情境敏感应用程序（85.2%，127/149）以及专注于以下领域的应用程序的兴趣评分特别高：增加锻炼（75.8%，113/149）、改善睡眠（73.2%，109/149）、改变消极思维（70.5%，105/149）以及增加活动参与度（67.1%，100/149）。
大多数受访者能够使用设备来使用用于精神疾病的移动应用程序，已经将应用程序用于其他目的，并且对用于精神疾病的移动应用程序感兴趣。可能提高采用率的关键因素包括提供者认可、对有效应用程序的更多宣传以及关于疗效和信息隐私的明确信息。最后，解决从睡眠到消极思维模式等一系列问题的多方面应用程序可能最受欢迎。
