Association between user engagement and clinical outcomes in smartphone apps for depression and anxiety: A systematic review and meta-analysis

Abstract

Apps targeting symptoms of depression and anxiety have a growing evidence base for their efficacy, yet it remains unclear whether increased user engagement is necessary to enhance their benefits. This systematic review and meta-analysis examined the current evidence on the association between engagement and clinical outcomes in trials of depression and anxiety apps. We included original or secondary analyses of randomized trials of apps delivered to participants with elevated depression or anxiety that reported engagement-outcome relationships. Studies were identified through a previous systematic review and an updated search. Twenty-eight studies met inclusion criteria for the systematic re..