A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial
Open accessAbstract
BACKGROUND: Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. METHODS: We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes. CONCLUSIONS: Monitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.
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An EMI using self-monitoring on mobile phones was not effective relative to an attention control in reducing stress (d = −0.08 at post-test).
“an EMI using self-monitoring on mobile phones 38 was not effective relative to an attention control in reducing stress ( d = −0.08 at post-test).”
From Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: A systematic review (2016) · cites this paper as [38]
The Results (Outcome–Intention to Treat; page not specified) report no significant group-by-time effect for stress, supporting the claim that the intervention was not more effective than the attention comparison. But Table 3 gives a post-test between-group effect size of d = 0.14, not −0.08. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe study by Reid et al. was the only study evaluating an interactive EMI using mobile phones which failed to yield significant effects in reducing stress relative to an attention control.
“In the present research, the study conducted by Reid et al.38 was the only study evaluating an interactive EMI using mobile phones which failed to yield significant effects in reducing stress relative to an attention control.”
From Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: A systematic review (2016) · cites this paper as [38]
Mobile BITs have not been effective at treating depression.
“Trials of mobile BITs have found some positive short-term benefits for anxiety disorders (39), eating disorders (40), bipolar disorder (41), and schizophrenia (42), although others have not been effective at treating depression (43).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [43]
Mobile self-monitoring is a useful tool.
“and that mobile self-monitoring is a useful tool [41-43].”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [43]
The effect size for depression was moderate though smaller than the four published studies that describe three other mobile app interventions targeting depression.
“The effect size for depression was moderate though smaller than the four published studies [23-26] that describe three other mobile app interventions targeting depression.”
Kauer et al and Reid et al found no differences in Depression, Anxiety, and Stress Scale scores between a mobile app with ecological momentary assessment (EMA)-based emotional self-awareness training and feedback and an attention control condition.
“Kauer et al [53] and Reid et al [54] found no differences in the Depression, Anxiety, and Stress Scale scores between a mobile app with ecological momentary assessment (EMA)-based emotional self-awareness training and feedback and an attention control condition.”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [54]
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“Multimedia mobile phone programs and smart phone apps show promise for early intervention and monitoring (Reid et al. 2011; Kauer et al. 2012; Whittaker et al. 2012).”
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- Authors
- Reid, S. C., Kauer, S. D., Hearps, S. J., Crooke, A. H., Khor, A. S., Sanci, L. A., & Patton, G. C.
- Affiliations
- The University of Melbourne (AU)
- Royal Children's Hospital (AU)
- Corresponding author
- Reid, Sophie C
- Venue
- BMC Family Practice
- Published
- 2011-11-29
- Volume
- 12
- Issue
- 1
- Pages
- 131-131
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC3247177
- OpenAlex
- W2154306466
- Cited by
- 192
- References
- 63
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 8 · 2023: 3 · 2022: 22 · 2021: 17 · 2020: 14 · 2019: 17 · 2018: 26 · 2017: 18 · 2016: 14 · 2015: 9 · 2014: 13 · 2013: 13 · 2012: 3
- FWCI
- 12.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Telstra Foundation
- Australian Rotary Health
- State Government of Victoria
- Shepherd Foundation
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- mobile application, youth mental health, adolescent mental health, primary care, self-monitoring, mood tracking, stress, coping strategies, emotional self-awareness, depression, anxiety, general practitioners, general practitioner referral, mobile health intervention
- MeSH terms
- Adolescent, Mental Disorders, Female, Humans, Male, Primary Health Care, Single-Blind Method, Cell Phone, Young Adult
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