Use of Mobile Mindfulness Apps in Young Adults With Depression

A MMA, or Mobile Mindfulness Application, is a smartphone app designed to deliver mindfulness-based interventions. These apps typically offer guided meditation sessions, breathing exercises, and other mindfulness practices accessible through mobile devices.

Berg, D., & Perich, T. (2022). Use of mobile mindfulness apps in young adults with depression: Results from a cross-sectional survey. Professional Psychology: Research and Practice, 53(1), 42–49. https://doi.org/10.1037/pro0000411

Key Points

• Young adults with severe-extreme depression symptoms were most likely to use mobile mindfulness applications (MMAs), compared to those with mild-moderate or no depression.
• Participants with no depression rated MMAs as more helpful than those with mild-moderate or severe-extreme depression symptoms.
• Reasons for using MMAs differed across depression severity levels, with severely depressed individuals most likely to use them for mental wellbeing.
• Knowledge barriers and perceived lack of efficacy were cited as reasons for not using MMAs, particularly among those with severe depression.
• The study highlights the need for further research on MMA use and efficacy in young adults with varying levels of depression severity.
• While MMAs are perceived as a valid form of self-help by young adults with severe depression symptoms, their perceived helpfulness may be limited for this group.

Rationale

The increasing prevalence of smartphone ownership has led to growing interest in the potential of mobile mindfulness applications (MMAs) to reduce depression symptoms.

Previous research has demonstrated the efficacy of MMAs in reducing depressive symptoms in general populations (Flett et al., 2019; Bostock et al., 2019).

However, there is a lack of understanding regarding how real-world, self-directed MMA use may differ between depressed and non-depressed populations, particularly among young adults.

This study aimed to address this gap by examining MMA usage patterns, perceived helpfulness, and reasons for use or non-use across different levels of depression severity in young adults. Understanding these factors is crucial for developing more effective digital interventions and guiding clinical practice in the use of MMAs as complementary tools for managing depression.

The research builds upon previous findings suggesting that young adults may prefer online help-seeking for mental health issues (Pretorius et al., 2019) and that clinical populations, including those with depression, are willing to use mindfulness applications (Beard et al., 2019).

By focusing specifically on young adults and examining differences across depression severity levels, this study provides valuable insights into the real-world application and perception of MMAs in a population at high risk for depression.

Method

The study employed a cross-sectional online survey design to collect data on MMA use, perceived helpfulness, reasons for use or non-use, and depression symptoms among young adults aged 18-30 years.

Procedure

Participants completed an online survey that included demographic questions, inquiries about their use of mental health applications (particularly MMAs), and the Depression, Anxiety and Stress Scale (DASS-21) to assess depression symptom severity.

Sample

The final sample consisted of 726 participants (552 female, 151 male, 23 other) aged 18-30 years (M = 21.61, SD = 3.45).

Participants were recruited through various methods, including university research participation systems, MTurk, Facebook advertising, and social media.

Measures

1. Demographics: Questions about age, gender, marital status, country of birth, religious affiliation, employment status, and education level.
2. MMA Use: Questions about use of mental health applications, specific MMAs used, frequency and recency of use, reasons for use or non-use, and perceived helpfulness.
3. Depression, Anxiety and Stress Scale (DASS-21): A 21-item self-report measure assessing depression, anxiety, and stress symptoms over the past week. Only the depression subscale was used for this study.

Statistical measures

Chi-square tests of independence were used to assess differences in MMA use across demographic variables and depression severity categories.

Kruskal-Wallis and Mann-Whitney tests were employed to analyze differences in perceived helpfulness across depression severity categories.

Results

Hypothesis 1

Participants with severe-extreme depression symptomology will be more likely to use MMAs compared to those with mild-moderate depression and no depression.

Result: Supported

A significant difference was found across categories of depression severity (χ2(2, N = 726) = 8.08, p = .018, Cramer’s V = .11), with participants in the severe-extreme category (14.7%) most likely to use MMAs, followed by mild-moderate (8.7%), and no depression (8.3%).

Hypothesis 2

Participants with severe-extreme depression and mild-moderate depression symptoms will report higher levels of perceived helpfulness for MMAs compared to those with no depression.

Result: Not supported

A significant difference was found in helpfulness ratings across depression severity categories (χ2(2, N = 230) = 20.815, p < .001, η2 = .09).

Participants with no depression rated MMAs as more helpful (Mdn = 8) compared to those with severe-extreme depression (Mdn = 6) and mild-moderate depression (Mdn = 6).

Additional findings

• Participants with severe-extreme depression were more likely to use MMAs for mental wellbeing (43.9%) compared to other groups.
• Knowledge barriers and perceived lack of efficacy were more commonly cited as reasons for not using MMAs among those with severe-extreme depression.
• No significant differences were found in frequency or recency of MMA use across depression severity categories.

Insight

This study provides novel insights into the real-world use of mobile mindfulness applications (MMAs) among young adults with varying levels of depression severity.

The finding that young adults with severe-extreme depression symptoms were most likely to use MMAs suggests that this group views these applications as a viable self-help tool for managing their mental health.

This aligns with previous research indicating that young adults may more easily identify severe depression symptoms and be more motivated to improve their wellbeing (Klineberg et al., 2011; Tanielian et al., 2009).

However, the lower perceived helpfulness of MMAs among those with severe-extreme and mild-moderate depression symptoms compared to those with no depression is a critical finding.

This contrasts with some previous research on structured mindfulness interventions, which found greater symptom reductions for those with higher baseline depression scores (Chi et al., 2018; Kuyken et al., 2016).

The discrepancy may be due to differences in intervention duration, structure, or the self-directed nature of MMA use compared to more formal mindfulness programs.

The study extends previous research by specifically examining MMA use in young adults across different depression severity levels, providing a more nuanced understanding of how these applications are perceived and utilized in real-world settings.

The findings highlight the need for further investigation into why young adults with more severe depression symptoms find MMAs less helpful, despite being more likely to use them.

Future research should focus on:

1. Longitudinal studies to examine the long-term effects of MMA use on depression symptoms in young adults.
2. Qualitative research to explore the reasons behind lower perceived helpfulness among those with more severe depression.
3. Randomized controlled trials to assess the efficacy of MMAs specifically designed for young adults with severe depression symptoms.
4. Investigation of factors that might improve the perceived helpfulness and effectiveness of MMAs for those with more severe depression.

Strengths

1. A large sample size (N = 726) of young adults, allowing for robust statistical analyses.
2. The use of a validated measure (DASS-21) to assess depression symptom severity.
3. Examination of real-world MMA use patterns and perceptions, enhancing ecological validity.
4. Inclusion of participants with varying levels of depression severity, enabling comparisons across groups.
5. Assessment of multiple aspects of MMA use, including frequency, recency, reasons for use, and perceived helpfulness.

Limitations

1. The cross-sectional design limits causal inferences about the relationship between depression severity and MMA use.
2. The sample was predominantly female, limiting generalizability to male populations.
3. Self-report measures may be subject to response bias.
4. The study did not assess the overall duration of MMA use, which could influence perceived helpfulness.
5. The sample may have been biased towards individuals who are more technologically inclined, as recruitment occurred online.
6. The single-item measure of helpfulness may not capture the full complexity of participants’ experiences with MMAs.

Clinical Implications

The findings of this study have several important implications for clinical psychology practice and the development of digital mental health interventions:

1. Clinical awareness: Psychologists working with young adults should be aware that those with severe depression symptoms are likely to be using MMAs as a form of self-help. This knowledge can inform treatment planning and discussions about complementary interventions.
2. Tailored interventions: The lower perceived helpfulness of MMAs among those with more severe depression suggests a need for more tailored digital interventions for this group. App developers should consider the specific needs and challenges of severely depressed young adults when designing MMAs.
3. Education and guidance: Given the knowledge barriers reported by participants with severe depression, there is a need for better education about the appropriate use and potential benefits of MMAs. Clinicians could play a role in guiding patients on how to effectively incorporate MMAs into their overall treatment plan.
4. Integration with traditional therapy: The findings suggest that while young adults with severe depression are using MMAs, they may not find them sufficiently helpful on their own. This highlights the importance of integrating digital tools with traditional therapeutic approaches rather than relying on them as standalone interventions.
5. Addressing efficacy concerns: The perceived lack of efficacy reported by some participants with severe depression indicates a need for more research on the effectiveness of MMAs for this population. This could inform the development of evidence-based guidelines for MMA use in clinical practice.
6. Personalization: The variability in perceived helpfulness across depression severity levels suggests that a one-size-fits-all approach to MMAs may not be optimal. Future development of MMAs could focus on personalization features that adapt to the user’s depression severity and specific needs.
7. Monitoring and follow-up: Given that young adults with severe depression are using MMAs but finding them less helpful, clinicians should consider monitoring their patients’ use of these apps and following up on their experiences to ensure they are receiving appropriate support.

These implications underscore the importance of a nuanced approach to incorporating MMAs into mental health care for young adults, particularly those with more severe depression symptoms.

While MMAs show promise as accessible self-help tools, their integration into clinical practice should be done thoughtfully, with consideration for individual needs and in conjunction with other evidence-based treatments.

References

Primary reference

Berg, D., & Perich, T. (2022). Use of mobile mindfulness apps in young adults with depression: Results from a cross-sectional survey. Professional Psychology: Research and Practice, 53(1), 42–49. https://doi.org/10.1037/pro0000411

Other references

Beard, C., Silverman, A. L., Forgeard, M., Wilmer, M. T., Torous, J., & Björgvinsson, T. (2019). Smartphone, social media, and mental health app use in an acute transdiagnostic psychiatric sample. JMIR mHealth and uHealth, 7(6), e13364.

Bostock, S., Crosswell, A. D., Prather, A. A., & Steptoe, A. (2019). Mindfulness on-the-go: Effects of a mindfulness meditation app on work stress and well-being. Journal of Occupational Health Psychology, 24(1), 127-138.

Chi, X., Bo, A., Liu, T., Zhang, P., & Chi, I. (2018). Effects of Mindfulness-Based Stress Reduction on depression in adolescents and young adults: A systematic review and meta-analysis. Frontiers in Psychology, 9, 1034.

Flett, J., Hayne, H., Riordan, B., Thompson, L., & Conner, T. (2019). Mobile mindfulness meditation: A randomised controlled trial of the effect of two popular apps on mental health. Mindfulness, 10(5), 863-876.

Klineberg, E., Biddle, L., Donovan, J., & Gunnell, D. (2011). Symptom recognition and help seeking for depression in young adults: A vignette study. Social Psychiatry and Psychiatric Epidemiology, 46(6), 495-505.

Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., … & Dalgleish, T. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. JAMA Psychiatry, 73(6), 565-574.

Pretorius, C., Chambers, D., & Coyle, D. (2019). Young people’s online help-seeking and mental health difficulties: Systematic narrative review. Journal of Medical Internet Research, 21(11), e13873.

Tanielian, T., Jaycox, L. H., Paddock, S. M., Chandra, A., Meredith, L. S., & Burnam, M. A. (2009). Improving treatment seeking among adolescents with depression: Understanding readiness for treatment. Strengths(5), 490-498.

Keep Learning

Socratic questions for a college class to discuss this paper

1. How might the lower perceived helpfulness of MMAs among severely depressed young adults impact their long-term engagement with these tools?
2. What factors could contribute to the discrepancy between the higher likelihood of MMA use and lower perceived helpfulness among those with severe depression symptoms?
3. How might the design of MMAs be improved to better address the needs of young adults with varying levels of depression severity?
4. What ethical considerations should be taken into account when promoting MMAs as a self-help tool for young adults with severe depression symptoms?
5. How might cultural factors influence the use and perceived helpfulness of MMAs among young adults with depression?
6. In what ways could the integration of MMAs with traditional psychotherapy be optimized for young adults with severe depression?
7. How might the findings of this study inform public health initiatives aimed at improving mental health support for young adults?
8. What role should healthcare providers play in guiding young adults’ use of MMAs, especially for those with severe depression symptoms?
9. How might the reasons for using or not using MMAs differ across various age groups or populations beyond young adults?
10. What implications do these findings have for the development of evidence-based guidelines for digital mental health interventions?