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Cited by 38Digital Mental Health InterventionsMobile Health and mHealth ApplicationsTreatment of Major Depression

Digital health technologies and major depressive disorder

Open access
McIntyre, Roger S., Greenleaf, Walter, Bulaj, Grzegorz, Taylor, Steven T., Mitsi, Georgia, Saliu, Dylan, Czysz, Andy, Silvesti, Greg +2 more·2023·CNS Spectrums
DOI 10.1017/s1092852923002225
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Abstract

There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review argues that digital health technologies—telepsychiatry, apps, digital therapeutics, biomarkers, and VR—can help close gaps in awareness, screening, treatment, and monitoring of major depressive disorder (MDD). It highlights current evidence and implementation challenges, concluding that validation and optimization are still needed for personalized depression care.

Key findings

  • MDD management gaps remain substantial: approximately 1 in 5 US adults will experience MDD in their lifetime; US depressive symptom prevalence increased approximately threefold from 2017 to 2020; depression screening occurred in only 1.4% of all US primary care visits in 2012; and 41% of 789 primary care patients with depressive symptoms were undertreated with antidepressants when an antidepressant was indicated.
  • Nonpharmacologic treatment barriers are common: 51%–58% of primary care patients with depression preferred nonpharmacologic therapy, but only about 20% initiated it, and about 40%–60% of initiators did not complete treatment.
  • Digital uptake expanded during COVID-19: patients with depression were three times more likely to use telehealth than those without; surveys of more than 3000 telepsychiatry patients and more than 100 mental health clinicians found support, satisfaction, and willingness to use telepsychiatry in the future.
  • Evidence for specific digital tools is mixed but promising: SuperBetter (n=190) reduced depressive symptoms more than waiting list (n=93) over 6 weeks; MoodHacker showed significant 6-week effects versus depression websites in 300 employed adults but attenuated effects at 10 weeks; SPARX (n=94) was noninferior to treatment as usual (n=93) at 3 months; MoodGYM had adherence rates of 10%–27%; Sonde Health voice biomarker sensitivity/specificity was 0.60/0.70; and CT-152 pilot trial in 51 participants with MDD showed greater symptom reduction.

Methods

  • Narrative review synthesizing published literature, FDA clearances, surveys, randomized controlled trials, and examples of digital health technologies for MDD.
  • Organizes findings around gaps in awareness, screening/diagnosis, and treatment/monitoring, then discusses currently available and future digital technologies.
  • No systematic search strategy, inclusion criteria, meta-analysis, or formal quality appraisal is described.

Limitations

  • Stated in the paper: implementation challenges include patient engagement hindered by depression symptoms, privacy mistrust, correlation-not-causation in smartphone monitoring, generalizability/selection bias, dropout in app trials, high implementation/training/maintenance costs, digital divide, temporary pandemic-era regulatory/reimbursement changes, and many unevaluated or inconsistently evaluated apps.
  • Stated for cited RCTs: SuperBetter had high attrition and possible non-generalizability from self-help website recruitment; MoodHacker used a convenience sample, self-report surveys, and compensation; SPARX was limited by clinical service setting, limited adherence data, and heterogeneous treatment as usual.
  • Evident from the text: as a narrative review, it lacks systematic search and risk-of-bias assessment; funding by Sage Therapeutics and Biogen and author disclosures—including employment/stock at Biogen and Sage—raise potential conflict-of-interest concerns.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s1092852923002225

Cites

116 of 116 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Interpretationreasoning

    Iterative efforts to validate and optimize digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD.

    “Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    There have been few specific guidelines to support health system implementation of universal depression screening in primary care.

    “and there have been few specific guidelines to support health system implementation of universal depression screening in primary care.25”
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    The COVID-19 pandemic exacerbated many risk factors for depression across countries of disparate economic status.

    “The COVID-19 pandemic exacerbated many risk factors for depression across countries of disparate economic status 5,6 ;”
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  • Premisecitation

    About 40% to 60% of those who initiated nonpharmacologic therapy did not complete the treatment.

    “and about 40% to 60% of those who initiated nonpharmacologic therapy did not complete the treatment, 50”
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  • Premisecitation

    In a study involving more than 50,000 individuals across 21 countries, the vast majority of those affected by depression did not seek treatment due to stigma or lack of knowledge of the disorder.

    “In a study involving more than 50 000 individuals across 21 countries, the vast majority of those affected by depression did not seek treatment due to stigma or lack of knowledge of the disorder.20”
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    Interpretationreasoning

    Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD.

    “Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately 1 in 5 adults in the US will experience major depressive disorder (MDD) at some point in their lifetime.

    “approximately 1 in 5 adults in the US will experience major depressive disorder (MDD) at some point in their lifetime.2”
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    Premisenone given

    Digital health technologies have demonstrated utility in relation to various health conditions, including MDD.

    “Digital health technologies have demonstrated utility in relation to various health conditions, including MDD.”
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    Premisenone given

    Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed.

    “Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD.

    “Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Depression was one of the top 10 causes of disability globally in 2019 and is associated with significant direct and indirect economic and societal burdens.

    “Depression was one of the top 10 causes of disability globally in 2019 and is associated with significant direct and indirect economic and societal burdens.3,4”
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    The global prevalence of depression has steadily increased from 1990 to 2019.

    “The global prevalence of depression has steadily increased from 1990 to 2019, 1”
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    Premisecitation

    Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care.

    “Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care.”
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    Interpretationcitation

    Digital health technology is rapidly evolving the delivery of mental health care and holds promise for improving access to and quality of mental health care, thus improving the clinical management of depression.

    “Digital health technology is rapidly evolving the delivery of mental health care and holds promise for improving access to and quality of mental health care, thus improving the clinical management of depression.10”
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    Premisecitation

    Patients with depression may be undertreated with antidepressant therapies (ADTs); in a longitudinal study involving 789 primary care patients with depressive symptoms, 41% were undertreated.

    “Patients with depression may be undertreated with antidepressant therapies (ADTs), as observed in a longitudinal study involving 789 primary care patients with depressive symptoms, in which 41% were undertreated (ie, did not receive ADTs even though an ADT was indicated).35,36”
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    Patients may discontinue chronic treatment due to lack of rapid and consistent treatment benefits, treatment-related adverse events, and expectations of treatment that are misaligned with the treatment goals of HCPs.

    “Patients may discontinue chronic treatment due to lack of rapid and consistent treatment benefits, 37 treatmentrelated adverse events (AEs), [37][38][39][40] and expectations of treatment that are misaligned with the treatment goals of HCPs.41,42”
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    Premisecitation

    Telepsychiatry has been adopted in direct patient care, telepsychiatry-enhanced referral, and collaborative or integrated care models.

    “Telepsychiatry, the use of electronic information and telecommunication technologies to provide mental health services, has been adopted in direct patient care, telepsychiatry-enhanced referral, and collaborative or integrated care models.16”
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    Premisecitation

    Men tend to experience higher levels of stigma regarding help-seeking and having depression than women, which may result in higher rates of suicide.

    “Men tend to experience higher levels of stigma regarding help-seeking and having depression than women, 21 which may result in higher rates of suicide.22”
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    Health equity challenges and stigma associated with depression, including racialized framing on the part of the healthcare provider, may limit access and quality of care.

    “Furthermore, health equity challenges and stigma associated with depression, including racialized framing on the part of the healthcare provider (HCP), may limit access and quality of care.28,29”
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    The US Preventive Services Task Force and Agency for Healthcare Research and Quality guidelines have recommended routine screening for depression in healthcare settings to address the under-recognition of depression.

    “Over the last two decades, the US Preventive Services Task Force and Agency for Healthcare Research and Quality guidelines have recommended routine screening for depression in healthcare settings to address the under-recognition of depression.23”
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    Premisecitation

    The prevalence of depressive symptoms in the US increased approximately threefold from 2017 to 2020.

    “the prevalence of depressive symptoms in the US increased approximately threefold from 2017 to 2020, 7”
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    Premisecitation

    These barriers may be structural (eg, transportation problems, time constraints, and cost) or emotional (eg, social stigma and discomfort talking about problems with a therapist).

    “These barriers may be structural (eg, transportation problems, time constraints, and cost) or emotional (eg, social stigma and discomfort talking about problems with a therapist).52”
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    Interpretationcitation

    During the COVID-19 pandemic, telepsychiatry has transformed the mental health care landscape and may continue to help improve the clinical management of depression.

    “During the COVID-19 pandemic, telepsychiatry has transformed the mental health care landscape and may continue to help improve the clinical management of depression.17”
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    Premisecitation

    Both the American Psychiatric Association and the American Psychological Association practice guidelines recommend that HCPs consider appropriate treatments (including both pharmacologic and nonpharmacologic therapy options) for preventing relapse in patients with depression who have achieved remission.

    “Both the American Psychiatric Association and the American Psychological Association practice guidelines recommend that HCPs consider appropriate treatments (including both pharmacologic and nonpharmacologic therapy options) for preventing relapse in patients with depression who have achieved remission.45,46”
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    Premisenone given

    Gaps and challenges currently faced in the clinical management of depression include those related to disease awareness, screening and diagnosis, and treatment and monitoring.

    “Gaps and challenges currently faced in the clinical management of depression include those related to disease awareness, screening and diagnosis, and treatment and monitoring (Figure 2).”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Barriers to depression screening and the lack of adequate follow-up in patients who screened positive for depression include lack of resources for treatment referrals, limited access to mental health services, and unequal geographical distribution of specialists.

    “Barriers to depression screening and the lack of adequate follow-up in patients who screened positive for depression include lack of resources for treatment referrals, limited access to mental health services, and unequal geographical distribution of specialists.26,27”
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    The COVID-19 pandemic was associated with increased economic burden of depression.

    “along with increased associated economic burden 8”
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    Premisecitation

    Poor awareness of depression may contribute to the stigma associated with the disorder that, in turn, diminishes treatment seeking and adherence to mental health services.

    “Poor awareness of depression may also contribute to the stigma associated with the disorder that, in turn, diminishes treatment seeking and adherence to mental health services.19”
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    Premisecitation

    Nonadherence to ADTs is associated with increased severity of depressive symptoms, risk of relapse and recurrence, and healthcare resource utilization, as well as significantly higher medical costs, inpatient admissions, and visits to the emergency department.

    “Nonadherence to ADTs is associated with increased severity of depressive symptoms, risk of relapse (ie, early return of symptoms within the expected duration of a current episode) and recurrence (ie, a new major depressive episode following a full-episode remission), and healthcare resource utilization, as well as significantly higher”
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    Premisecitation

    For adolescents, many reported moderate to high levels of stigma associated with depression and low levels of mental health literacy, which contributed to their early termination of treatment.

    “For adolescents, many reported moderate to high levels of stigma associated with depression and low levels of mental health literacy, which contributed to their early termination of treatment.19”
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    Premisecitation

    Substantial time is required for an accurate diagnosis of depression, which is often observed alongside other physical and psychiatric comorbidities that may obscure a diagnosis of depression.

    “Substantial time is required for an accurate diagnosis of depression, which is often observed alongside other physical and psychiatric comorbidities 32 that may obscure a diagnosis of depression.”
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    Interpretationcitation

    Digital biomarkers hold promise for enabling scalable, time-sensitive, and cost-effective assessment of depression by providing real-time psychological, behavioral, and physiological data, but further validation is required.

    “Digital biomarkers hold promise for enabling scalable, time-sensitive, and cost-effective assessment of depression 13,14 by providing real-time psychological, behavioral, and physiological data, 15 but further validation is required.”
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    Premisecitation

    There is an increasing need for more personalized approaches to monitor and treat depression, but this is associated with several challenges.

    “There is an increasing need for more personalized approaches to monitor and treat depression, but this is associated with several challenges.54”
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    Premisecitation

    There are various ethical concerns, including privacy and security issues and risks of social discrimination.

    “In addition, there are various ethical concerns, including privacy and security issues and risks of social discrimination.54”
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    Premisecitation

    There is also a lack of sufficient evidence for their effectiveness and cost-effectiveness in primary care settings.

    “There is also a lack of sufficient evidence for their effectiveness and cost-effectiveness in primary care settings.53”
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    Premisecitation

    The COVID-19 pandemic was associated with increased rates of suicidal ideation.

    “and rates of suicidal ideation.9”
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    Premisecitation

    There are substantial barriers both to initiating and to adhering to nonpharmacologic therapy in the real-world practice.

    “suggesting that there are substantial barriers both to initiating and to adhering to nonpharmacologic therapy in the real-world practice.51”
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  • May combine two claims.

    Interpretationreasoning

    Digital health technologies may help address barriers to the implementation of depression screening and provide objective assessment to facilitate diagnosis.

    “Digital health technologies may help address barriers to the implementation of depression screening and provide objective assessment to facilitate diagnosis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Unlike conditions such as diabetes, where significant adoption of digital technologies has been observed, depression is more complex due to the unique challenges associated with the clinical management of the disorder (eg, poor mental health literacy, stigma, and the lack of objective tools for assessment and diagnosis).

    “However, it should be noted that unlike conditions such as diabetes, where significant adoption of digital technologies has been observed, depression is more complex due to the unique challenges associated with the clinical management of the disorder (eg, poor mental health literacy, stigma, and the lack of objective tools for”
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    Premisecitation

    In 2017, the FDA cleared a PDT (Pear Therapeutic's reSET) that delivers a computerized version of cognitive behavioral therapy (CBT) and serves as an adjunct to clinician-supervised outpatient therapy programs in patients with substance use disorder.

    “In 2017, the FDA cleared a PDT (Pear Therapeutic's reSET) that delivers a computerized version of cognitive behavioral therapy (CBT) and serves as an adjunct to clinician-supervised outpatient therapy programs in patients with substance use disorder.57”
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    Premisecitation

    Telemedicine is already being implemented successfully to allow remote visits with HCPs, thus helping to overcome challenges associated with diagnosis (eg, limited access to mental health resources/services and stigma associated with seeking diagnosis and treatment).

    “Telemedicine is already being implemented successfully to allow remote visits with HCPs, thus helping to overcome challenges associated with diagnosis (eg, limited access to mental health resources/services and stigma associated with seeking diagnosis and treatment).81”
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    Interpretationcitation

    Digital technologies may support clinical management of depression by capturing longitudinal, temporally dense, and multimodal mental health data for use in diagnosis and monitoring; analyzing data using ML paradigms to generate personalized and clinically actionable insights and predictions; and supporting integrated care by facilitating connections to clinical care, peer support, personalized资源,

    “Besides therapeutic interventions, digital technologies may support clinical management of depression by: (a) capturing longitudinal, temporally dense, and multimodal mental health data for use in diagnosis and monitoring; (b) analyzing data using ML paradigms to generate personalized and clinically actionable insights and predictions; and (c) supporting integrated care by facilitating connections”
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    Interpretationnone given

    There are several categories of digital health technologies for depression, and each of these categories may play a role in addressing the gaps and challenges in the clinical management of depression.

    “There are several categories of digital health technologies for depression (Figure 2), and each of these categories may play a role in addressing the gaps and challenges in the clinical management of depression.”
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    Premisecitation

    Since then, the FDA has cleared more mobile medical apps, including those that help diagnose autism spectrum disorder: Cognoa's Canvas Dx and EarliTec's EarliPoint Evaluation.

    “Since then, the FDA has cleared more mobile medical apps, including those that help diagnose autism spectrum disorder: (a) Cognoa's Canvas Dx is a software that uses a machine learning (ML) algorithm to receive input from parents or caregivers, video analysts, and HCPs to help clinicians evaluate a patient's risk of the disorder, and (b) EarliTec's EarliPoint Evaluation is a device that uses AI to”
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    Premisecitation

    The VitalSign 6 software can be augmented by other models of care (eg, mental health navigation and behavioral activation teletherapy) and offers the potential to add-on research and quality improvement projects.

    “The software can be augmented by other models of care (eg, mental health navigation and behavioral activation teletherapy) and offers the potential to add-on research and quality improvement projects.23”
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    Premisecitation

    Several studies have demonstrated the effectiveness of MoodGYM (a CBT-based intervention for depression that has been available since 2001 and used by over three-quarters of a million people) in reducing depressive symptoms, but in some of these studies, adherence rates were low (10%-27%).

    “Several studies have demonstrated the effectiveness of MoodGYM (a CBT-based intervention for depression that has been available since 2001 and used by over three-quarters of a million people) 83 in reducing depressive symptoms, but in some of these studies, adherence rates were low (10%-27%).84,85”
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    Premisecitation

    The SuperBetter study was limited by a high rate of attrition and may not be generalizable due to recruitment from a self-help website, which may have captured a particularly motivated and/or hopeful segment of patients with depression.

    “This study was limited by a high rate of attrition and may not be generalizable due to recruitment from a self-help website, which may have captured a particularly motivated and/or hopeful segment of patients with depression.75”
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    Premisecitation

    The majority of telehealth-related literature published during the COVID-19 pandemic (92.3%) reported provision of telehealth services for conditions not related to COVID-19, with the most common being integrated clinical care (49.7%).

    “The majority of telehealth-related literature published during the COVID-19 pandemic (92.3%) reported provision of telehealth services for conditions not related to COVID-19, 65 with the most common being integrated clinical care (49.7%), including a combination of triage, diagnosis, treatment, follow-up, and rehabilitation services.65”
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    Premisecitation

    Limitations of the MoodHacker study included the use of a convenience sample of interested individuals, the use of self-report surveys, and the use of compensation for completing assessments, which may reduce generalizability of results.

    “Limitations of this study included the use of a convenience sample of interested individuals, the use of self-report surveys, and the use of compensation for completing assessments, which may reduce generalizability of results.76”
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    Premisecitation

    Digital health technologies for depression gained broad public attention after the release of the SuperBetter app, MoodHacker app, and SPARX, which are self-management tools to reduce depressive symptoms supported by randomized controlled trial data.

    “Digital health technologies for depression gained broad public attention after the release of the SuperBetter app, 75 MoodHacker app, 76 and SPARX, 77 which are self-management tools to reduce depressive symptoms supported by randomized controlled trial data.”
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    Premisecitation

    The use of social media platforms can help increase awareness of depression and encourage patients to actively seek treatment and connect with physicians.

    “The use of social media platforms can help increase awareness of depression and encourage patients to actively seek treatment and connect with physicians.18”
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    Premisecitation

    A 2020 survey of more than 3000 patients treated with telepsychiatry during the COVID-19 pandemic and a separate survey of more than 100 mental health clinicians during the COVID-19 pandemic revealed that both patients and clinicians were supportive of telepsychiatry, were satisfied with the quality of care, and would consider using this modality in the future.

    “A 2020 survey of more than 3000 patients treated with telepsychiatry during the COVID-19 pandemic 66 and a separate survey of more than 100 mental health clinicians 67 during the COVID-19 pandemic revealed that both patients and clinicians were supportive of telepsychiatry, were satisfied with the quality of care, and would consider using this modality in the future.”
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    • cites [67] source

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  • May combine two claims.

    Premisecitation

    Although mobile apps targeting treatment adherence have been understudied, several recent examples have shown promise: AiCure uses a HIPAA-compliant and scalable AI platform to monitor treatment adherence; Mango Health and Health Prize are incentive-based apps to improve access and adherence to prescribed treatments; Medisafe is an app that provides reminders and alerts for users to take theirpres

    “Although mobile apps targeting treatment adherence have been understudied, several recent examples have shown promise: AiCure uses a HIPAA-compliant and scalable AI platform to monitor treatment adherence 86,87 ; Mango Health and Health Prize are incentive-based apps to improve access and adherence to prescribed treatments 88,89 ; Medisafe is an app that provides reminders and alerts for users to”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [86] source

      Not checked in the free run.

    • cites [87] source

      Not checked in the free run.

    • cites [88]

      Not checked in the free run.

    • cites [89] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recently, the FDA also issued marketing authorization for a virtual reality (VR)-based app, EaseVRx, as an adjunctive treatment for chronic low back pain.

    “Recently, the FDA also issued marketing authorization for a virtual reality (VR)-based app, EaseVRx, as an adjunctive treatment for chronic low back pain.60”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The rapid growth in digital health technologies globally presents opportunities toward bridging the current gaps in the clinical management of depression.

    “The rapid growth in digital health technologies globally presents opportunities toward bridging the current gaps in the clinical management of depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Digital technologies may also help guide treatment planning and medical decision-making and monitor or promote treatment adherence in patients with depression.

    “Digital technologies may also help guide treatment planning and medical decision-making and monitor or promote treatment adherence in patients with depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The use of digital technologies for depression, including telehealth and telemedicine, also increased during the pandemic; patients with depression were three times more likely to use telehealth than those without.

    “The use of digital technologies for depression, including telehealth and telemedicine, also increased during the pandemic; patients with depression were three times more likely to use telehealth than those without.68,69”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [68] source

      Not checked in the free run.

    • cites [69] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A 2021 global survey involving 293 HCPs showed that various subsegments of digital health saw considerable growth (up to 36%) from 2020 to 2021, with telehealth and telemedicine emerging as key digital approaches to disease management.

    “A 2021 global survey involving 293 HCPs showed that various subsegments of digital health saw considerable growth (up to 36%) from 2020 to 2021, 64 with telehealth and telemedicine emerging as key digital approaches to disease management.63”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [64]

      Not checked in the free run.

    • cites [63]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Despite limitations, these types of digital health technology are rapidly evolving the delivery of care for depression and hold promise for improving the clinical management of depression.

    “Despite limitations, these types of digital health technology are rapidly evolving the delivery of care for depression and hold promise for improving the clinical management of depression.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    There are also opportunities to develop online and mobile apps for the prevention of depression.

    “There are also opportunities to develop online and mobile apps for the prevention of depression.74”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2013, a mobile medical app (WellDoc's BlueStar Rx) was cleared by the FDA as a prescription digital therapeutic (PDT) to support the management of type 2 diabetes by analyzing patient data, formulating personalized guidance, and summarizing data analytics to the healthcare team for clinical decision support.

    “In 2013, a mobile medical app (WellDoc's BlueStar Rx) was cleared by the FDA as a prescription digital therapeutic (PDT) to support the management of type 2 diabetes by analyzing patient data, formulating personalized guidance, and summarizing data analytics to the healthcare team for clinical decision support.56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Digital health technologies may help address privacy and security issues, as well as structural or emotional barriers (including stigma) associated with personalized approaches to treating depression.

    “Digital health technologies may help address privacy and security issues, as well as the structural or emotional barriers (including stigma) associated with personalized approaches to treating depression.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Whilst there exists a wealth of mobile apps aimed at the treatment of depression, most are not backed by robust scientific evidence, and there are few ongoing studies evaluating the use of mobile apps as interventions for MDD.

    “Whilst there exists a wealth of mobile apps aimed at the treatment of depression, most are not backed by robust scientific evidence, and there are few ongoing studies evaluating the use of mobile apps as interventions for MDD, highlighting a need for further clinically oriented and systematic validation and testing of such mobile apps.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [124]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sonde Health is a voice-based technology that can be used as a digital biomarker for depression, with a sensitivity and specificity of 0.60 and 0.70, respectively.

    “Sonde Health is a voice-based technology that can be used as a digital biomarker for depression, with a sensitivity and specificity of 0.60 and 0.70, respectively.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [119] source

      Not checked in the free run.

    • cites [120] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Deprexis uses CBT-based techniques and AI to personalize treatment and help patients with depression learn how to overcome negative thoughts and behavior patterns.

    “Deprexis (developed by Orexo and GAIA) is a software platform that uses CBT-based techniques and AI to personalize treatment and help patients with depression learn how to overcome negative thoughts and behavior patterns”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [94] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In addition to limitations on generalizability and possible selection bias, user engagement challenges and considerable dropout rates have presented challenges in clinical trials of smartphone apps.

    “In addition to limitations on generalizability and possible selection bias, user engagement challenges 148 and considerable dropout rates have presented challenges in clinical trials of smartphone apps.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [148] source

      Not checked in the free run.

    • cites [149] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ellipsis Health is an ML-based mobile app that detects depression using speech analysis of smartphone audio, potentially allowing accessible screening and monitoring of depression.

    “Ellipsis Health is an ML-based mobile app that detects depression using speech analysis of smartphone audio, which can be easily recorded and transmitted, potentially allowing accessible screening and monitoring of depression.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Remote measurement technologies can allow tracking of current depression status and identification of behavioral markers related to depression in a continuous and effortless manner for long-term passive monitoring.

    “Remote measurement technologies can allow tracking of current depression status and identification of behavioral markers related to depression in a continuous and effortless manner for long-term passive monitoring.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [135] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    VitalSign 6 is an EHR-integrated web-based iPad app designed for use in clinics that facilitates screening and diagnosis in patients with depression using the PHQ-2.

    “VitalSign 6 is an EHR-integrated web-based iPad app designed for use in clinics that facilitates screening and diagnosis in patients with depression using the two-item version of the Patient Health Questionnaire (PHQ-2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness of the mobile apps highlights the need for further research, especially in real-world applications.

    “However, the lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness of the mobile apps highlights the need for further research, especially in real-world applications.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Screening efforts in VitalSign 6 are focused on identifying patients with depression, and there are no additional screening assessments for those who screen negative on the PHQ-2; thus, patients with current suicidality who do not have significant depressive symptoms may be missed.

    “Screening efforts are focused on identifying patients with depression, and there are no additional screening assessments for those who screen negative on the PHQ-2; thus, patients with current suicidality who do not have significant depressive symptoms may be missed.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Abilify MyCite combines pharmacologic therapy with a wearable sensor and a mobile app that help monitor treatment and enhance collaboration between patients and their providers.

    “One example is Otsuka Pharmaceutical's Abilify MyCite that combines pharmacologic therapy with a wearable sensor and a mobile app that help monitor treatment and enhance collaboration between patients and their providers.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telemedicine or care coordination platforms can help provide remote care to rural areas or hard-to-reach communities, thereby enhancing patient-provider collaboration.

    “Telemedicine or care coordination platforms can help provide remote care to rural areas or hard-to-reach communities, thereby enhancing patient-provider collaboration.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The use of digital therapeutics may help provide consistent treatment benefits, reduce treatment-related AEs, and align treatment expectations and goals of patients and HCPs.

    “The use of digital therapeutics may help provide consistent treatment benefits, reduce treatment-related AEs, and align the treatment expectations and goals of patients and HCPs”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [95] source

      Not checked in the free run.

    • cites [96] source

      Not checked in the free run.

    • cites [97] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent scoping review revealed that the use of CBT in a VR environment or the use of VR therapy in addition to CBT was an effective adjunct to the treatment of depression.

    “A recent scoping review revealed that the use of CBT in a VR environment or the use of VR therapy in addition to CBT was an effective adjunct to the treatment of depression.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [141]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    VitalSign 6 data are stored securely, and access to the data is closely monitored to ensure confidentiality.

    “For VitalSign, 6 data are stored securely, and access to the data is closely monitored to ensure the confidentiality of these records.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ecological momentary assessment can enable the collection and integration of multimodal data passively, continuously, and objectively and may be useful in assessing how depressive symptoms, including suicidal thoughts and behaviors, unfold in real-world contexts.

    “Ecological momentary assessment can enable the collection and integration of multimodal data passively, continuously, and objectively and may be useful in assessing how depressive symptoms, including suicidal thoughts and behaviors, unfold in real-world contexts.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [136] source

      Not checked in the free run.

    • cites [137] source

      Not checked in the free run.

    • cites [138] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The remote patient assessment feature of VitalSign 6 allows patients to complete assessment at home using their own electronic devices, potentially facilitating access to important and timely health data for resource-poor clinics that care for underserved and minority populations.

    “In addition, the remote patient assessment feature allows patients to complete the assessment at home using their own electronic devices; this potentially facilitates access to important and timely health data for resource-poor clinics that care for underserved and minority populations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multivariable prognostic models may aid in better prediction of relapse and remission of depression at the individual patient level, which in turn can support precision medicine and allow resources to be better targeted toward relapse prevention.

    “Multivariable prognostic models may aid in better prediction of relapse and remission of depression at the individual patient level, which in turn can support precision medicine and allow resources to be better targeted toward relapse prevention”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [139] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Ongoing efforts to optimize and validate the use of digital health technology should provide a personalized medicine approach in detecting, treating, and monitoring depression.

    “Ongoing efforts to optimize and validate the use of digital health technology should provide a personalized medicine approach in detecting, treating, and monitoring depression.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the EU, reimbursement processes for digital health technologies are beginning to take shape; Germany, Belgium, and France have standardized reimbursement processes in place or soon to be launched, while other EU countries have expressed interest in implementing standardized reimbursement processes for digital health technologies.

    “In the EU, reimbursement processes for digital health technologies are beginning to take shape; Germany, Belgium, and France have standardized reimbursement processes in place or soon to be launched, while other EU countries have expressed interest in implementing standardized reimbursement processes for digital health technologies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [162] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The availability of digital health platforms and online health communities may facilitate cocreation by encouraging transparent communication with patients, improving health literacy, providing informational and social support to patients, and empowering patient self-management.

    “The availability of digital health platforms and online health communities may facilitate cocreation by encouraging transparent communication with patients, improving health literacy (in patients and healthcare organizations), providing informational and social support to patients, and empowering patient self-management.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [159] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationnone given

    Digital technologies may soon facilitate long-term monitoring that in turn may help prevent the relapse and recurrence of depression.

    “Digital technologies may soon facilitate long-term monitoring that in turn may help prevent the relapse and recurrence of depression.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    There is a need to address the major gaps that exist between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions.

    “There is a need to address the major gaps that exist between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [133] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the US, the Centers for Medicare and Medicaid Services has recently approved a new category of digital health services-Remote Therapeutic Monitoring-to complement the existing suite of Remote Physiological Monitoring codes covered under Medicare.

    “In the US, the Centers for Medicare and Medicaid Services has recently approved a new category of digital health services-Remote Therapeutic Monitoring-to complement the existing suite of Remote Physiological Monitoring codes covered under Medicare.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [160] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    How payors in general would cover costs associated with digital health services could greatly impact the uptake of digital health technologies in mental health care.

    “Whilst this was an important milestone, how payors in general would cover costs associated with digital health services could greatly impact the uptake of digital health technologies in mental health care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Digital health technology has facilitated the clinical management of depression and will likely have future growth with continued expansion and integration in patient care.

    “Digital health technology has facilitated the clinical management of depression and will likely have future growth with continued expansion and integration in patient care.”
    Quote in the paperSubstantial claim
82 of 82

  • The paper relies on this without support.

    Many behavioral health apps are either unevaluated in clinical trials or claim evidential support by using an evidence-based foundation, such as CBT.

    “Many behavioral health apps are either unevaluated in clinical trials or claim evidential support by using an evidencebased foundation, such as CBT.”

  • The paper relies on this without support.

    The value of cocreation has been well studied in other sectors, but there are few examples of effective cocreation within the digital mental health landscape.

    “The value of cocreation has been well studied in other sectors, but there are few examples of effective cocreation within the digital mental health landscape.”

  • The paper relies on this without support.

    There is a paucity of high-quality studies examining the effectiveness of online peer support groups.

    “While there is a paucity of high-quality studies examining the effectiveness of online peer support groups, they remain promising for depression management.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • SuperBetter trial is cited as a SPARX study

    Minor

    The text cites reference 75 for the SuperBetter trial, but reference 75 is a study of SPARX. The references list the SuperBetter trial under reference 73.

1 of 1

Cites

Flagged first, then by citations

2 of the 118 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Ferguson, 2001, SSRI antidepressant medications: adverse effects and tolerability, Prim Care Companion J Clin Psychiatry., 3, 22
  2. Mehrotra, 2016, Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing: Adjunct; ; Heidelberg, Germany
  3. 45. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, third edition. Published 2010. Accessed October 6, 2022.

Cited by

Sorted by citations

Related

Authors
McIntyre, R. S., Greenleaf, W., Bulaj, G., Taylor, S. T., Mitsi, G., Saliu, D., Czysz, A., Silvesti, G., Garcia, M., & Jain, R.
Affiliations
  • University of Toronto (CA)
  • Stanford University (US)
  • University of Utah (US)
  • Harvard University (US)
  • Biogen (United States) (US)
  • Sage Therapeutics (United States) (US)
  • Texas Tech University (US)
Corresponding author
Jain, Rakesh
ORCID
McIntyre, Roger S.
Venue
CNS Spectrums
Publisher
Cambridge University Press (CUP)
Published
2023-04-12
Volume
28
Issue
6
Pages
662-673
ISSN
  • 1092-8529 (ISSN-L)
  • 2165-6509
DOI
10.1017/s1092852923002225
OpenAlex
W4365136404
Cited by
38
References
118
Citations by year
2026: 8 · 2025: 11 · 2024: 16 · 2023: 3
FWCI
1.29
Type
journal article
Language
en
Open access
Licence
Locations
  • CNS Spectrums (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • Biogen
  • Sage Therapeutics
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
major depressive disorder, digital health technologies, telemedicine, mobile health apps, virtual reality, digital therapeutics, digital biomarkers, depression detection, depression treatment, depression monitoring, COVID-19 pandemic, access to mental health care
MeSH terms
Major Depressive Disorder, Depressive Disorder, Major, Humans, Telemedicine, Pandemics, Mobile Applications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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