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Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis.

Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF - J. Med. Internet Res. (2016)

Bottom Line: Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70).In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57).Moreover, the effect was larger with additional support by an MHP.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands. a.versluis@fsw.leidenuniv.nl.

ABSTRACT

Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices.

Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance).

Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool.

Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low.

Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being.

No MeSH data available.


Related in: MedlinePlus

Funnel plot of standard error by Hedges’ g with imputed values based on Duval and Tweedie’s trim and fill method (between-subject studies).
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figure5: Funnel plot of standard error by Hedges’ g with imputed values based on Duval and Tweedie’s trim and fill method (between-subject studies).

Mentions: The effect for EMI in between-subject studies was g=0.40, 95% CI (0.22-0.57), P<.001 (see Figure 4). This effect can be considered small to medium. The funnel plot (see Figure 5) shows that there is indication for publication bias; the distribution of effects is asymmetrical as the sample size decreases. Specifically, effect sizes are more likely to fall to the right side of the mean when the sample size is small. Furthermore, the Egger’s test of intercept is significant, indicating that there is a risk for bias (intercept is 1.50, 95% CI: 0.28-2.72) with t (11)=2.708, 1-sided P=.01). The trim and fill method was used to account for the missing studies. Six studies were added to the left of the mean (black circles in Figure 5), and the corrected effect size was g=0.23, 95% CI (0.04-0.42). The corrected effect is considerably smaller than the uncorrected effect, which indicates that the uncorrected effect may be subject to publication bias and needs to be interpreted carefully. On the basis of the standardized residuals, no study was identified as an outlier.


Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis.

Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF - J. Med. Internet Res. (2016)

Funnel plot of standard error by Hedges’ g with imputed values based on Duval and Tweedie’s trim and fill method (between-subject studies).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940607&req=5

figure5: Funnel plot of standard error by Hedges’ g with imputed values based on Duval and Tweedie’s trim and fill method (between-subject studies).
Mentions: The effect for EMI in between-subject studies was g=0.40, 95% CI (0.22-0.57), P<.001 (see Figure 4). This effect can be considered small to medium. The funnel plot (see Figure 5) shows that there is indication for publication bias; the distribution of effects is asymmetrical as the sample size decreases. Specifically, effect sizes are more likely to fall to the right side of the mean when the sample size is small. Furthermore, the Egger’s test of intercept is significant, indicating that there is a risk for bias (intercept is 1.50, 95% CI: 0.28-2.72) with t (11)=2.708, 1-sided P=.01). The trim and fill method was used to account for the missing studies. Six studies were added to the left of the mean (black circles in Figure 5), and the corrected effect size was g=0.23, 95% CI (0.04-0.42). The corrected effect is considerably smaller than the uncorrected effect, which indicates that the uncorrected effect may be subject to publication bias and needs to be interpreted carefully. On the basis of the standardized residuals, no study was identified as an outlier.

Bottom Line: Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70).In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57).Moreover, the effect was larger with additional support by an MHP.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands. a.versluis@fsw.leidenuniv.nl.

ABSTRACT

Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices.

Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance).

Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool.

Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low.

Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being.

No MeSH data available.


Related in: MedlinePlus