Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru

Menezes, Paulo; Quayle, Julieta; Garcia Claro, Heloísa; da Silva, Simone; Brandt, Lena R; Diez-Canseco, Francisco; Miranda, J Jaime; Price, LeShawndra N; Mohr, David C; Araya, Ricardo

doi:10.2196/11698

Cited by 71Digital Mental Health InterventionsMobile Health and mHealth ApplicationsMental Health Treatment and Access

Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru

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Menezes, Paulo, Quayle, Julieta, Garcia Claro, Heloísa, da Silva, Simone, Brandt, Lena R, Diez-Canseco, Francisco, Miranda, J Jaime, Price, LeShawndra N +2 more·2019·JMIR Mental Health

DOI 10.2196/11698PMC PMC6658291

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Abstract

Background: Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. Objective: This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). Methods: Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. Results: The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. Conclusions: The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants’ depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings.

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Mental health apps provide a potential way to reduce symptoms and increase adherence by dispensing psychoeducation and therapeutic skills through an accessible electronic format.
“Mental health apps provide a potential way to reduce symptoms and increase adherence by dispensing psychoeducation and other therapeutic skills through an electronic, easily accessible format [26-34].”
From Examining the effectiveness of gamification in mental health apps for depression: Systematic review and meta-analysis (2021) · cites this paper as [28]
The Introduction (Background) describes CONEMO as a mobile-phone psychoeducational intervention intended to reduce depressive symptoms, and the Methods (Emotional Control Intervention) describe its behavioral-activation and self-care content. But the Discussion (Principal Findings) reports that adherence to app sessions decreased over time; it does not establish that the app increased adherence. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Wider access to digital technology and mobile phones offers the possibility of delivering digital mental health interventions in a more scalable and convenient way.
“In recent years, wider access to digital technology and mobile phones has presented new opportunities for overcoming these barriers, by offering the possibility of delivering digital mental health interventions in a more scalable and convenient way [10,11].”
From Engagement and effectiveness of a healthy-coping intervention via chatbot for university students during the COVID-19 pandemic: Mixed methods proof-of-concept study (2021) · cites this paper as [11]
The Introduction (Background; page not provided) says app-based care can simplify coordination and provide a more scalable process. The Abstract (Background; page not provided) says mobile phones are widely used in LMICs, and the Discussion (Principal Findings; page not provided) says participants found the app easy to use. The copy does not establish that access has widened in recent years or that digital delivery is more convenient than other approaches. (LLM, conf=0.82)
Experimental — accuracy not yet measured
There was a trend in all CONEMO pilot studies for a reduction in depressive symptoms over time.
“However, there was a trend in all pilot studies for a reduction in depressive symptoms over time.”
From Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review (2019) · cites this paper as [36]
Participants were satisfied with the CONEMO intervention.
“and participants were satisfied with the intervention.”
From Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review (2019) · cites this paper as [36]
The samples in the CONEMO pilot studies were small to test the efficacy of the intervention.
“The samples were small to test the efficacy of the intervention.”
From Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review (2019) · cites this paper as [36]

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[22]Diez-Canseco F Ipince A Toyama M Benate-Galvez Y Galán-Rodas E Medina-Verástegui JC Sánchez-Moreno D Araya R Miranda JJ [Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings] Rev Peru Med Exp Salud Publica 2014 31 1 131 6 24718538 S1726-46342014000100019 24718538
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Additional file 2 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659921
Additional file 15 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659960
Additional file 4 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659927
Additional file 8 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659939
Additional file 9 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659942
Additional file 11 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659948
Additional file 10 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659945
Additional file 12 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659951
Additional file 14 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659957
Additional file 5 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659930
Additional file 3 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659924
Additional file 13 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659954
Additional file 1 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659918
Additional file 7 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659936
Additional file 6 of The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review
Mudiyanselage, K. W. W., Santis, K. K. D., Jörg, F., Saleem, M., Stewart, R. E., Zeeb, H., & Busse, H. (2024) · Figshare · doi:10.6084/m9.figshare.26659933
PsyAPP: The Development of a Mobile Application for Effective Health Management in Mentally Ill Patients
Llorente-Alonso, M., García‐Ael, C., Topa, G., Fernández-Araque, A., Jiménez‐Navascués, L., Martínez-Casado, M. Á., Carretero, I. G., & Tejedor, A. C. M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020894
mHealth and Digital Technologies for Community-Based Hypertension Screening, Monitoring, Treatment, and Long-Term Management: A Scoping Review and Evidence Gap MapPreprint
Boatemaa, A., Osei, B., Yaw, O. R., & Forkuo, G. O. (2026) · Research Square · doi:10.21203/rs.3.rs-10434622/v1

Addressing Depression Comorbid With Diabetes or Hypertension in Resource-Poor Settings: A Qualitative Study About User Perception of a Nurse-Supported Smartphone App in Peru
Brandt, L. R., Hidalgo, L., Diez-Canseco, F., Araya, R., Mohr, D. C., Menezes, P. R., & Miranda, J. J. (2019) · JMIR Mental Health · doi:10.2196/11701 · Cited by 32 · see citing works
Self-citation
Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru
Araya, R., Menezes, P. R., Claro, H. G., Brandt, L. R., Daley, K., Quayle, J., Diez‐Canseco, F., Peters, T. J., Cruz, D. V., Toyama, M., et al. (2021) · JAMA · doi:10.1001/jama.2021.4348 · Cited by 98 · see citing works
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Mobile phone and web-based cognitive behavior therapy for depressive symptoms and mental health comorbidities in people living with diabetes: results of a feasibility study
Clarke, J., Proudfoot, J., & Ma, H. (2016) · JMIR Mental Health · doi:10.2196/mental.5131 · Cited by 26 · see citing works
Participants’ and Nurses’ Experiences With a Digital Intervention for Patients With Depressive Symptoms and Comorbid Hypertension or Diabetes in Peru: Qualitative Post–Randomized Controlled Trial Study
Toyama, M., Cavero, V., Araya, R., Menezes, P. R., Mohr, D. C., Miranda, J. J., & Diez‐Canseco, F. (2022) · JMIR Human Factors · doi:10.2196/35486 · Cited by 7 · see citing works
Self-citation
Barriers and facilitators to implementing a mobile intervention with task shifting in the treatment of depressive symptoms in people with diabetes and / or hypertension in Brazil: A study protocol using the CFIR.Preprint
Castro, H. C. M., Couto, M. T., Daley, K., Rocha, T. I. U., Aschar, S. C. D. A. L., dos Santos, D. V. C., Claro, H. G., Araya, R., & Menezes, P. R. (2020) · doi:10.21203/rs.3.rs-88770/v1
Self-citation

Authors: Menezes, P., Quayle, J., Garcia Claro, H., da Silva, S., Brandt, L. R., Diez-Canseco, F., Miranda, J. J., Price, L. N., Mohr, D. C., & Araya, R.
Affiliations: Universidade de São Paulo (BR)
Universidad Peruana Cayetano Heredia (PE)
National Institutes of Health (US)
Northwestern University (US)
King's College London (GB)
Corresponding author: Menezes, Paulo
ORCID: Menezes, Paulo
Quayle, Julieta
Garcia Claro, Heloísa
da Silva, Simone
Brandt, Lena R
Diez-Canseco, Francisco
Miranda, J Jaime
Price, LeShawndra N
Mohr, David C
Araya, Ricardo
Venue: JMIR Mental Health
Publisher: JMIR Publications Inc.
Published: 2019-04-26
Volume: 6
Issue: 4
Pages: e11698
ISSN: 2368-7959 (ISSN-L)
DOI: 10.2196/11698
PMC: PMC6658291
OpenAlex: W2913551388
Cited by: 71
References: 25
Citations by year: 2026: 3 · 2025: 7 · 2024: 20 · 2023: 5 · 2022: 8 · 2021: 22 · 2020: 4 · 2019: 2
FWCI: 10.17
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JMIR Mental Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
Research Portal (King's College London) (submittedVersion, cc-by)
Greater South Information System
Funders: Medical Research Council (MR/M007405/1)
National Institute of Mental Health (U19MH098780)
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 › Social Psychology › Mental Health Treatment and Access
Keywords: depression, mobile health, mobile health apps, hypertension, diabetes mellitus, psychoeducational intervention, feasibility, low- and middle-income countries, primary care, PHQ-9, depressive symptoms

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Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru

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