Effectiveness of interventions using a smartphone cognitive behavior therapy application for children with mental health disorders: A single-arm uncontrolled study (Preprint)

Abstract

ince the coronavirus disease 2019 pandemic, the prevalence of mental health disorders among children in Japan has increased rapidly, and mental healthcare for children is an increasingly important part of pediatric healthcare delivery. We previously developed a smartphone-based self-monitoring application to deliver cognitive behavioral therapy (CBT app), implemented it in healthy children, and reported its effectiveness for health promotion.

This study sought to examine the effectiveness of the CBT app in children with mental health disorders.

The participants were 115 children with mental health disorders (e.g., school refusal, orthostatic hypotension, eating disorders, or developmental disorders, among others) aged 12–18 years. The CBT app-based program comprised 1 week of psychoeducation followed by 1 week of self-monitoring. After reading story-like scenarios, participants created a self-monitoring sheet with five panels: events, thoughts, feelings, body responses, and actions. All participants received regular mental healthcare from physicians in addition to the app-based program. Several psychometric scales, including the Patient Health Questionnaire for Adolescents, Questionnaire for Triage and Assessment with 30 items (QTA30), Depression Self-Rating Scale for Children, Pediatric Quality of Life Inventory (PedsQL), and Rosenberg Self-Esteem Scale, were completed at the beginning of the intervention and 2 and 6 months thereafter. Participants were divided into four groups on the basis of the presence or absence of depressive symptoms [Dep (+)/Dep (-)] and completion or non-completion of the CBT app-based program [App (+)/App (-)]. The primary and secondary outcomes were the improvements in the QTA30 total scores and the scores on the other psychometric scales, respectively. A paired-samples t-test was used for statistical analysis. The Medical Ethics Committee of Fukuoka University Faculty of Medicine (approval number: U22-05-002) approved the study design.

There were 48, 18, 18, and 7 participants in the Dep (+) App (+), Dep (+) App (-), Dep (-) App (+), and Dep (-) App (-) groups, respectively. Twenty-four participants dropped out. In the depressed participants, the QTA30 and PedsQL scores improved significantly at 6 months regardless of completion or non-completion of the CBT app-based program. However, among the non-depressed participants, the scores only showed significant improvements in those who completed the app-based program. There were no significant changes in the scores on the other scales in any group. There was a significant positive correlation between Patient Health Questionnaire for Adolescents scores and the number of self-monitoring sheets completed.

The CBT app was useful for improving QTA30 and PedsQL scores of children with mental health disorders. However, a higher-intensity CBT program is necessary for more severely depressed children.

University Hospital Medical Information Network Clinical Trials Registry (registration number: 000046775).