Abstract
Pilot Study of a Behavioral Activation Gaming App for Depression in Pregnancy
APHA 2022 Annual Meeting and Expo
Background: Depression during pregnancy is not uncommon and, if untreated, can cause detrimental outcomes for mother and child. Effective depression treatments exist, such as Behavioral Activation (BA), yet most women do not receive treatment. The use of technology, including mobile apps, is an innovative approach to increase access to services. While many apps exist to improve wellbeing, the average retention rate on day 15 for digital mental health interventions is only 3.9%. Guardians: Unite the Realms is a novel gaming app grounded in BA principles that is free and publicly available, and which leverages mobile game mechanics and in-game rewards to encourage long-term user engagement. This study explores change in depressive symptoms associated with use of the Guardians app among pregnant women.
Methods: This pilot study consists of a single arm proof-of-concept trial to test app engagement among pregnant women (N=18) with elevated depressive symptoms. Their unpaid participation includes two study visits conducted over the phone: 1) a baseline assessment, and 2) a follow-up visit 10 weeks later to administer follow-up measures and explore user experience. Change in depression scores is assessed biweekly through an electronically-delivered depression scale (PHQ-9). Engagement with the Guardians app is captured with game interaction metric data.
Results: Data collection will be complete in June 2022. Preliminary analysis of data suggests average app-related task completion rate of 70.0% and a 15-day retention rate of 15%. Approximately 75% of completed tasks result in participants reporting feeling at least a little bit better with “harder tasks associated with greater mood improvement relative to “easier tasks. Average depression (PHQ-9) scores among participants decreased from 13.2 (SD=4.7) at baseline to 6.0 (SD=3.6) at study end. We also report on themes from the exit interviews regarding user experience and suggestions for future app improvements.
Conclusions: Retention rates among participants using Guardians in this study are over double the average retention levels of most digital mental health interventions. Engagement with Guardians appears to be associated with improvement in mood and decreased depressive symptom severity, suggesting that it may be an effective and scalable digital intervention to support women experiencing depression during pregnancy.