Mobile Health Applications for Depression in China: A Systematic Review

Leping Huang; Victor W Li; Tao Yang; Jing Liu; Jill Murphy; Erin E Michalak; Zuowei Wang; Chee Ng; Lakshmi Yatham; Jun Chen; Raymond W Lam

doi:10.7759/cureus.27299

Mobile Health Applications for Depression in China: A Systematic Review

Cureus. 2022 Jul 26;14(7):e27299. doi: 10.7759/cureus.27299. eCollection 2022 Jul.

Authors

Leping Huang¹, Victor W Li², Tao Yang³, Jing Liu², Jill Murphy², Erin E Michalak⁴, Zuowei Wang¹, Chee Ng⁵, Lakshmi Yatham², Jun Chen⁶, Raymond W Lam⁴

Affiliations

¹ Psychiatry, Hongkou Mental Health Centre, Shanghai, CHN.
² Department of Psychiatry, University of British Columbia, Faculty of Medicine, Vancouver, CAN.
³ Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, CHN.
⁴ Psychiatry, University of British Columbia, Vancouver, CAN.
⁵ Department of Psychiatry, University of Melbourne, Melbourne, AUS.
⁶ Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, CHN.

Abstract

Mobile health (mHealth) applications (apps) have the potential to increase access to mental health care. In China, there is growing interest in mHealth apps for depression. Our objective was to systematically review research on mHealth for depression in China to identify benefits and challenges. A systematic literature search was conducted using Chinese and English databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized and nonrandomized clinical studies on mHealth apps and depression in China were included. Study quality was assessed using the Cochrane Risk of Bias tool. Seven studies met the inclusion criteria with three randomized trials, two quasi-randomized trials, one clinical trial with an uncertain grouping method, and one study with a single-group design. All studies used the WeChat platform and included activities such as psychoeducation, self-management, supervised group chats, and/or remote contact with a healthcare team, in comparison to usual care. All studies reported significant and large benefits for outcomes, but the risk of bias was high. There are few rigorous evaluations of mHealth apps for depression in China, with all included studies involving WeChat programs and most using WeChat to extend nursing discharge care for inpatients with depression. While these studies showed significant improvement in health outcomes as compared to usual care, the results remain inconclusive because of the high risk of bias. mHealth holds promise for increasing access to mental health care in China, but issues such as efficacy, scalability, patient and clinician acceptability, and data privacy must be addressed.

Keywords: china; depression; mhealth; mobile health; smartphones; systematic review; wechat.

Publication types

Review

Grants and funding

This study was supported by the Enhanced Measurement-Based Care Effectiveness for Depression (EMBED) study, funded by the Canadian Institutes of Health Research (CIHR) and the National Natural Sciences Foundation of China (81761128032) through the Global Alliance on Chronic Disease [CIHR Team Grant: GACD Mental Health, GAC-154985; Agreement #01709-000]. LH was supported by Shanghai Key Medicine Specialties Program (ZK2019A06) and Key Support Program for Clinical Specialty of Hongkou District Health Committee (HKZK2020A11). JKM was supported by a MITACS Elevate Postdoctoral Award. The sponsors had no role in the design, conduct, interpretation, or publication of this study.