Using Mobile Apps to Assess and Treat Depression in Hispanics and Latinos: A Fully Remote, Randomized Clinical Trial (Preprint)
Authors: Pratap Abhishek , Renn Brenna N. , Volponi Joshua , Mooney Sean D. , Gazzaley Adam , Areán Patricia A. , Anguera Joaquin A. 
Published: February 2018

BACKGROUND

Most people with mental health disorders fail to receive timely access to adequate care. In the U.S., Hispanic/Latino individuals are particularly underrepresented in mental health care and are historically a very difficult population to recruit into clinical trials. However, U.S. Hispanic/Latinos have increasing access to mobile technology, with over 75% owning a smartphone. This technology has the potential to overcome known barriers to accessing and utilizing traditional assessment and treatment approaches.

OBJECTIVE

This is a feasibility clinical trial comparing three different types of mental health apps for the treatment of mild to moderate depression in Hispanic/Latino adults in the U.S. The primary aim of this study was to to compare recruitment and engagement in a fully remote trial of individuals with depression who either self-identify as Hispanic/Latino or not. A secondary aim was to assess treatment outcomes from three different self-guided mobile apps (iPST (based on evidence-based therapeutic principles from problem-solving therapy [PST])); Project: Evolution™ (EVO; a cognitive training app based on cognitive neuroscience principles); and Health Tips (health information app that served as an information control).

METHODS

Spanish- and English-speaking participants were recruited through social media platforms, internet-based advertisements, and traditional fliers in select locations in each state across the United States. Assessment and self-guided treatment was conducted on each participant's smartphone or tablet. We enrolled 389 Hispanic/Latino and 637 non-Hispanic/Latino adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5 or an endorsement of impaired functioning. Participants were first asked their preferences among the three apps available to them, and then randomized to their top two choices. Outcomes were depressive symptom severity (measured using PHQ-9) and functional impairment (assessed with Sheehan Disability Scale) and collected over 3 months. Engagement in the study was assessed based on the number of times participants completed active surveys

RESULTS

We screened 4,502 participants and enrolled 1,040 participants from throughout the U.S. over 6 months, yielding a sample of 348 active users. The majority of the participants were recruited via posts on craigslist.org, with significant acquisition costs for recruiting Spanish-speaking Hispanic/Latinos participants ($31/ participant) compared to their English-speaking non-Hispanic/Latino counterparts ($1.49/participant). Long-term engagement surfaced as a key issue among Hispanic/Latino participants, who dropped from the study two weeks earlier than their non-Hispanic/Latino counterparts ( p<0.016). There were no significant differences observed for treatment outcomes between those identifying as Hispanic/Latino or not. Although depressive symptoms improved over the course of treatment, outcomes did not vary by type of treatment app.

CONCLUSIONS

The findings from this study suggest that fully remote mobile-based studies can attract a diverse participant pool including people from traditionally underserved communities in mental health care and research (in this case, Hispanic/Latino individuals). However, keeping participants engaged in this type of ‘low-touch’ research study remains challenging. Hispanic/Latino populations may be less willing to use mobile apps for assessing and managing depression. We recommend that future research endeavors include the use of user-centered design to determine the role of mobile apps in assessment and treatment of depression for this population, app features they would be interested in using, and strategies for long-term engagement.

CLINICALTRIAL

Clinicaltrials.gov Identifier: NCT01808976