TOPLINE:

Use of a self-help smartphone application over 4 weeks in addition to usual care was associated with alleviated depressive symptoms, improved quality of life, and enhanced self-esteem vs usual care alone in adults with intellectual disabilities, a new study showed.

METHODOLOGY:

• In a randomized clinical trial conducted in 2023, 99 adults aged between 18 and 75 years (mean age, 35 years; 54.5% female) with self- or caregiver-reported intellectual disabilities and depressive symptoms were enrolled.
• Participants were randomly assigned to use of “Happy,” a smartphone-based self-help application with cognitive-behavioral therapy-based exercises with audio, illustrations, and reminders for 4 weeks (n = 50) or to a waiting list (control group; n = 49). Usual care continued in both groups.
• The primary outcome was alleviation of depressive symptoms, as measured by the Glasgow Depression Scale for People with a Learning Disability (GDS-LD). Secondary outcome measures included the adapted Rosenberg Self-Esteem Scale (RSE), the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), and an 8-item Client Satisfaction Questionnaire (CSQ-8).
• Both intention-to-treat (ITT) and complete case approaches were used, and 94% of participants completed postintervention assessments.

TAKEAWAY:

• App users had significantly greater alleviation of depressive symptoms than the control group (ITT analysis: P = .007; complete case analysis: P = .02) and greater self-esteem (P < .001 for both analyses).
• Quality-of-life improvement was also greater for the app users in ITT analysis (P = .03), but the result just missed significance in the complete case analysis (P = .05).
• However, the researchers noted that the group differences in quality of life, self-esteem, and depressive symptoms were “primarily driven by deterioration of symptoms in the control group rather than significant improvement in the intervention group.”
• User satisfaction was high among app users, with at least 85% giving a good or excellent rating on the CSQ-8, 98% rating the quality as positive, 93.5% saying they would recommend the app to others, and 89% saying they would use it again. Test-retest reliability was satisfactory on the GDS-LD, WHOQOL-BREF, and RSE (P < .001 for all).

IN PRACTICE:

“This study contributes important evidence to address the treatment gap for individuals with IDs [intellectual disabilities]. The app may serve as interim support for those awaiting regular therapy or those with mild symptoms, or for preventive use,” the investigators of the study wrote.

“Given the increasing smartphone access in this group, app-based interventions represent a promising strategy to improve access to mental health care,” they added.

SOURCE:

The study was led by Swantje Borsutzky, PhD, and Lina Hannah Paul, MD, both of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany. It was published online on October 9 in JAMA Network Open.

LIMITATIONS:

The reliance on self-report and proxy report data may have introduced social desirability bias. The self- and caregiver-reported status of intellectual disability and recruitment through specialized networks may have limited diagnostic precision and generalizability. The waiting list design of the control group constrained drawing conclusions about mechanisms of change. Relying on self-reported use of the app may have limited the accuracy of assessing adherence to the intervention. The brief intervention period and absence of long-term follow-up restricted gaining insights into sustained effects.

DISCLOSURES:

The study was funded by Lebenshilfe and Techniker Krankenkasse. Paul reported receiving nonfinancial support from the study’s funders for self-service promotion during the conduct of the study. Another investigator reported receiving honoraria and serving on the advisory board of Boehringer Ingelheim. The others reported having no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.