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

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

doi:10.2196/11698

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

JMIR Ment Health. 2019 Apr 26;6(4):e11698. doi: 10.2196/11698.

Authors

Paulo Menezes^#^{1

2}, Julieta Quayle^#¹, Heloísa Garcia Claro^#¹, Simone da Silva^#^{1

3}, Lena R Brandt^#⁴, Francisco Diez-Canseco^#⁴, J Jaime Miranda^#^{4

5}, LeShawndra N Price^#⁶, David C Mohr^#⁷, Ricardo Araya^#⁸

Affiliations

¹ Population Mental Health Research Centre, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil.
² Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil.
³ Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.
⁴ Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁵ Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁶ National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.
⁷ Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States.
⁸ Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

^# Contributed equally.

PMID: 31025949
PMCID: PMC6658291
DOI: 10.2196/11698

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.

Keywords: PHQ-9; depression; feasibility study; mHealth; pilot study.

©Paulo Menezes, Julieta Quayle, Heloísa Garcia Claro, Simone da Silva, Lena R Brandt, Francisco Diez-Canseco, J Jaime Miranda, LeShawndra N Price, David C Mohr, Ricardo Araya. Originally published in JMIR Mental Health (http://mental.jmir.org), 26.04.2019.

Abstract

Grants and funding