Do baseline participant characteristics impact the effectiveness of a mobile health intervention for depressive symptoms? A post-hoc subgroup analysis of the CONEMO trials

TL;DR

This study examines if personal characteristics like age and income affect the success of a mobile health intervention for depression in two different countries.

Contribution

The study provides new evidence on how baseline characteristics may influence the effectiveness of digital mental health interventions.

Findings

Older and wealthier participants in Lima showed greater improvement in depressive symptoms from the intervention.

No significant differential effects were observed in São Paulo or for other secondary outcomes.

The study used mixed logistic regression to analyze interactions between treatment and baseline characteristics.

Abstract

To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO).

The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization – suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension – in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models.

Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively).

There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial.

NCT02846662 (São Paulo, Brazil – SP), NCT03026426 (Lima, Peru – LI). Funded by the U.S. National Institute of Mental Health (grant U19MH098780).