DNP Project Background
Over the past few years, mobile electronic devices have revolutionized the possibilities for therapy management to an unprecedented extent. The WHO lists depression as one of the most severe illnesses that cause disability, and the intense form is considered in the same category of disability as the last stages of cancer (Peng et al., 2020). Therefore, in recent years, there has been a rapid growth in online resources and mobile apps designed specifically to reduce the burden of depression.
The foremost question in this area is to what extent all these tools, attractive by their accessibility, anonymity, massiveness, economic feasibility, and other obvious promising characteristics, are effective in practical application. At the same time, when summarizing the results of numerous meta-analyses and carefully reviewing the quality of studies, no convincing data on the effectiveness of mobile applications in treating depression could be obtained (Peng et al., 2020). However, preliminary data analysis suggests that medication reminder apps may be effective in treating certain diseases.
The information obtained during the preliminary search has generated interest in researching the results and prospects of using Medisafe, one of the most highly rated and positively evaluated apps for treating depression. The historical context of the problem, along with a further analysis of its current impact, will be considered. Moreover, the evaluation of the financial aspects and the immediate results of implementing the app in the therapy process will form the basis of the study.
Informatization has generated enthusiasm in the medical-psychological environment regarding the prospects of utilizing this communication channel to provide psychological support to those who need it. Thus, testing the hypothesis of the possibility of improving the symptoms of depression by the use of Medisafe during treatment is the basis and the main purpose of the study.
History of the Question and Its Significance
In the era of information technology development, mobile applications have become an integral part of the everyday lives of most people. Mobile applications greatly simplify the existence of modern humans, saving time and bringing significant benefits. Numerous individuals use them to maintain and improve their health, such as counting the kilocalories of food eaten, estimating the distance covered during the day, and serving as a reminder diary for taking medication (Alhuwail et al., 2020).
The usefulness of this is obvious for both doctors and patients. Moreover, not long ago, researchers surveyed to assess the current state of healthcare worldwide. Most respondents noted the paramount importance of easy access to medical services and the ability to monitor their health (Alhuwail et al., 2020). It was not the first survey, and it appears that healthcare worldwide is gradually approaching a stage where a transition to a patient-centered, instrument-based healthcare model will follow.
It is essential to emphasize the existence of multiple cases in which the ineffectiveness of treatment is caused by patients’ irrational attitudes toward the treatment process. Moreover, numerous studies indicate an increase in medication nonadherence cases due to forgetfulness (Santo et al., 2019). There is a need for an outside source to track medication use. According to a 2029 randomized clinical trial conducted to test the effect of medication reminder apps on improving medication adherence in the Coronary Heart Disease Study, the improvement in adherence among app users was ~7.2% (Santo et al., 2019).
From this, it can be concluded that patients who used medication reminder apps had better medication adherence than patients who received usual care. Furthermore, a study on medication adherence interventions in older adults found that behavioral and educational interventions, as well as simple strategies, can improve medication adherence and satisfaction (Basit et al., 2020). Thus, mobile health is an integral part of public health, closely tied to mobile devices and their associated apps.
This technology has become a vast platform for encouraging and improving patient-led self-care, patient-centered care, and health literacy. Nowadays, there are a significant number of interactive and psychological education apps that address a wide range of health issues (Basit et al., 2020). Behavior modification apps have proven effective in reducing the risk of obesity, treating eating disorders, and reducing anxiety. However, one of the most significant problems in the world today is depression.
A recent study by Schramm and colleagues focused on developing and validating apps to improve mental health outcomes (Schramm et al., 2020). It aimed to examine existing applications to optimize future developments. That review made sixteen recommendations, among which the inclusion of cognitive behavioral therapy, automatic app customization, and coping skills training was particularly noteworthy (Schramm et al., 2020). The results likewise showed the effectiveness of apps in reducing symptoms of stress, depression, and substance abuse.
Moreover, another noteworthy study on this topic should be correspondingly considered. For example, Greenberg et al. (2021) reported that the Mindful Moods app is an effective tool for assessing symptoms of depression. In general, the studies found provide reliable evidence of the effectiveness of mobile apps in relation to mental health. There is evidence that receiving SMS messages containing medication reminders and links to useful information resources can also benefit a patient’s mental and physical well-being (Greenberg et al., 2021). It confirms the value of mobile apps as an adjunctive treatment tool and the effectiveness of the method in treating depression.
Problem Statement
Despite the facts discussed above, the situation remains unclear, and it is unknown whether all applications are suitable for symptom reduction. On the one hand, numerous authors have noted that SMS services used as reminders are highly effective in increasing adherence to prescribed medications (Teeng et al., 2021). It is also accurate for SMS services, which encourage patients to attend medical appointments by serving as a reminder of the time and place.
One of the most notable uses of SMS as an intervention is the spread of psychoeducation for mental illness. The app market is growing with the ever-increasing use and proliferation of cell phones. On the other hand, according to the literature, there are currently no strict guidelines for mobile health app developers to adhere to (Kujawa et al., 2020). Therefore, effectiveness has yet to be confirmed by repeated studies.
A review has shown that mobile health apps can improve outcomes in patients with chronic conditions who need to take their medications continuously. There is the possibility of using mobile apps to improve medication adherence (Peng et al., 2020). However, there is a need to test this method specifically on patients who are experiencing symptoms of depression. Depression is increasingly common in modern society, and not all patients are ready to admit their illness or follow their doctor’s recommendations. The Medisafe app is one of the most popular ways to improve the efficiency of the therapy process (Greenberg et al., 2021). From this, we can assume the rationality of its use to alleviate the symptoms of depression.
Every year in the U.S., numerous people suffer from its symptoms; statistical indicators of the disease will be provided subsequently in the paper. Moreover, the disease is costly economically, but the price of human suffering is impossible to measure. Depression often interferes with normal life activities and causes pain and suffering to those affected and their loved ones (Alhuwail et al., 2020). Most people suffering from it do not seek help, although many of them can be treated. Due to many years of fruitful research, medications and various types of psychosocial therapies are available today to relieve the pain of depression (Peng et al., 2020). Still, the most meaningful thing is patient compliance with the treatment regimen.
Assuming the wrong dose of the advised pills, taking them at the wrong time, or skipping medications are various forms of adherence disorder. It correspondingly includes the option of the patient taking more medications than recommended. It is comprehended that only 50% of patients with chronic diseases adhere to treatment recommendations; at the same time, high adherence to treatment significantly impacts the cure (Alhuwail et al., 2020). Commitment to treatment can significantly impact patient health, enhance the quality of the patient-physician relationship, and help alleviate the healthcare burden.
However, given the view of numerous authors, multiple influencing factors create barriers to full adherence to therapy in all patients. For example, there is evidence that many patients do not adhere to treatment during the first six months after initiating therapy (Basit et al., 2020). Nevertheless, it is the period when the maximum effect of the treatment can be expected.
Lack of adherence can be intentional or unintentional. Medical applications can change the symptomatology of depression by influencing adherence, resulting in improved health and favorable economic consequences. Depression is curable with the right therapy and adherence, and the promise of a health application proves the project’s significance.
Historical and Social Perspectives
Depression is an illness that has deep roots; its symptoms have always been about the same, but as a concern, it began to be considered relatively recently. People suffering from it have always had a difficult life, not only because of their ennui but also due to society’s attitude toward the problem. However, if in the past the patient was suspected of being possessed by the devil, nowadays depression is often seen as a manifestation of laziness and weakness (Schramm et al., 2020).
The term “depression” is relatively recent, having appeared only in the nineteenth century, but the disease has existed for more than a millennium. It is mentioned in ancient texts of Mesopotamia, Babylon, Egypt, and China, and in those days, the cause of depression was believed to be a man possessed by demons (Basit et al., 2020). The treatment, accordingly, was exorcism: the sick were beaten, bound, and starved.
The disease did not disappear over time, but attitudes toward it gradually changed. For example, in ancient Greece, during the time of Hippocrates, physicians, following the legendary doctor himself, believed that melancholy was caused by an excess of black bile, one of the body’s primary fluids (Schramm et al., 2020). The next important step forward was made in Plato’s time. Philosophers of that time concluded that the cause of mental illness could be childhood experiences and problems in the family.
However, this idea could not be advanced beyond that time, and half a millennium later, the Dark Ages came, which did not bode satisfactorily for the mentally ill. St. Augustine, who lived at the beginning of the Dark Ages, said that despondency and depression are punishment for sins, and the symptoms of severe clinical depression are signs of demonic possession (Teeng et al., 2021). Demons were treated the same way as in antiquity, with punishments with which the sick had to atone for their transgressions.
However, the gradual decrease in the church’s influence during the seventeenth and eighteenth centuries did not make the situation more favorable. The Age of Reason and Rationalism explained the illness as a lack of self-discipline and indulgence in laziness, which is still a common misbelief (Schramm et al., 2020). The problem began to globalize significantly at this stage, changing names and treatments, but no solution was found. Every year, the number of people experiencing symptoms of anxiety disorders has been growing.
In the 20th century, depression appeared more as a separate diagnosis in medical practice, but even today, the attitude towards it is ambiguous (Teeng et al., 2021). The myth that it is not a disease but a lack of motivation, connivance, and laziness is humming. This situation requires intervention because depression is the most common disease, the consequences of which destroy individuals and damage the healthcare system.
Several factors have contributed to the current scale of the problem, including large sociocultural transformations and the emotional dimension of people’s daily lives. The transition to a market economy, the gradual liberalization of social life, inclusion in a global context, and the rapid development of new media have all combined to create a fundamentally new horizon of citizens’ expectations.
One of the key effects of these processes has been the emergence and widespread diffusion of a new psychological culture (Schramm et al., 2020). It has served as a clear indicator of individualization as a new mode of establishing connections between the self and society. The rise of depression is an inevitable affective implication of this regime.
Nowadays, depression is a real social disease, but everyone still does not comprehend its seriousness. Instead of taking the symptoms of depression thoughtfully and taking preventive measures against it, in numerous cases, it is dismissed, attributed to bad moods, and not taken earnestly in the social environment (Peng et al., 2020). The embarrassment and fear that society does not consider depression a disease greatly affect those suffering from it. Scientific research and education about the disorder have made significant advances in recent decades.
Promising treatments are available, and the chances of recovery are high if the condition is diagnosed early in most cases. However, patients do not always take their treatment seriously due to societal influences. This, in turn, leads to the problem of low adherence and an inaccurate course of the treatment process (Peng et al., 2020). Thus, therapy often remains ineffective, and an increasing number of people cannot cope with depression symptoms.
Prevalence
Depression is considered the most common disease of the 21st century, and the number of those suffering from it is increasing daily. According to global statistics, on average, every eighth person worldwide suffered from depression in one form or another in 2020 (Alhuwail et al., 2020). This number is stunning and conveys the enormity of the crisis, which concerns many international organizations.
The WHO predicts that by 2030, the prevalence of depressive disorders will quadruple and rank first among all diseases globally, surpassing coronary heart disease (Greenberg et al., 2021). However, it is already in the lead among mental disorders, and it is possible that soon it will affect every second person in the world.
Moreover, numerous researchers believe that the real prevalence of depression is even higher. For example, according to a local study of institutionalized individuals with various somatic illnesses, 72% showed signs of unexpressed depression (Santo et al., 2019). The issue of inaccuracy in statistical data, in this case, stems from the fact that not everyone understands the essence of this illness and dismisses its symptoms.
Despite this, existing data is shocking; according to the WHO, about 50% of the world’s population, at some point in their lives, suffer from neuropsychiatric disorders (Alhuwail et al., 2020). It is alarming because if the rates rise or remain stable, depression will take second place among the causes of disability and mortality worldwide.
Although depression can lead to considerable suffering and poor functioning at work, school, and in family life, half of the people suffering from this disorder do not seek psychotherapeutic or psychiatric help, mistaking the symptoms for simple fatigue and overstrain. Especially if they experience mild depression, which accounts for about 40% of all depressive disorders, with mild depression, a person often does not notice the reduced mood (Santo et al., 2019). However, the quality of life is undoubtedly significantly impaired.
Moreover, the prevalence of depression has worsened during the pandemic, as isolation has left its mark on the psyche of almost every individual. Fifty-three million additional cases of major depressive disorder (MDD) and 76 million cases of anxiety disorders in 204 countries were reported in the first year of the virus alone (Santo et al., 2019). Of all populations, women and young people were most affected.
The former accounted for 35 million cases of clinical depression and nearly 52 million cases of anxiety disorders (Alhuwail et al., 2020). However, even after the pandemic subsides, the unstable global situation is causing the disease to spread more rapidly. At the same time, as already noted, people are increasingly neglecting quality treatment, thereby worsening the situation. All age categories are vulnerable to depression, necessitating a larger sample of project participants.
The Cost of Healthcare
An equally noteworthy aspect that supports the need for project implementation is the cost of health care. The treatment of depression and its effects places a heavy economic burden on patients and national health care systems. For example, Greenberg estimates that depression and anxiety cost the U.S. economy more than $210 billion annually (Greenberg et al., 2021). Almost half of this is the direct cost to patients and their employers for antidepressants and medical care.
The cost of treating someone without a depressive disorder is estimated at $4,782 per year, while twice that amount is spent on someone suffering from depression (Peng et al., 2020). At the same time, half of the total cost is borne by employers because of absenteeism and presenteeism. The total cost of absenteeism in the U.S. is estimated at nearly $24 billion, and the average American misses 11 days of work per year (Schramm et al., 2020). Nevertheless, presenteeism, in which an employee goes to work but is markedly less effective, costs employers up to six times as much as absenteeism.
Confirmation of Greenberg’s viewpoint can be found in a study by British economists Sarah Ivans-Laco and Martin Nappa. They have revealed that all countries lose between 0.1% and 4.9% of their GDP annually due to the depression (Schramm et al., 2020). The leader in the costs of presenteeism is the United States, with a prohibitively high rate of people suffering from depressive disorders. The country’s losses are estimated in this study to be $84.7 billion, and the total cost to employers across eight countries is $250 billion (Peng et al., 2020).
Thus, it is clear that the country and the parties involved bear high costs. Nevertheless, it is worth noting that patients allocate a significant portion of their budget to treatment. Although the exact number of expenses is strictly individual, one can already comprehend the scale. Medical services encompass the necessary clinical minimum, as well as several specific examinations and tests conducted by various specialists (Teeng et al., 2021). Much of the money goes directly to the medications themselves, and the problem of adherence failure only exacerbates it.
Introduction of PICOT
Thus, it can be concluded that depression is one of the most common diseases with deep roots and social consequences. Every year, the number of individuals of different age groups experiencing symptoms of the disorder is increasing, causing negative consequences for the economy and the healthcare system. At the same time, it is worth noting that one of the biggest challenges in the therapy process is low adherence to treatment. Numerous patients ignore the rules of taking medications, make mistakes in dosages, or stop treatment.
A promising approach to addressing this concern is through mobile apps, which are widely used in therapy to track calories and provide reminders. Therefore, it can be assumed that a mobile app, the most popular of which is Medisafe, can enhance the dynamics of treating depression. This assertion led to the formation of the PICOT question as follows. In adults with acute mental depression, as a medication reminder app, Medisafe improves symptoms of depression in adults aged 18-65 years with a diagnosis of depression.
References
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Basit, S. A., Mathews, N., & Kunik, M. E. (2020). Telemedicine interventions for medication adherence in mental illness: A systematic review. General hospital psychiatry, 62, 28-36.
Greenberg, P. E., Fournier, A. A., Sisitsky, T., Simes, M., Berman, R., Koenigsberg, S. H., & Kessler, R. C. (2021). The economic burden of adults with major depressive disorder in the United States (2010 and 2018). Pharmacoeconomics, 39(6), 653-665.
Kujawa, A., Green, H., Compas, B. E., Dickey, L., & Pegg, S. (2020). Exposure to COVIDā19 pandemic stress: Associations with depression and anxiety in emerging adults in the United States. Depression and anxiety, 37(12), 1280-1288.
Peng, Y., Wang, H., Fang, Q., Xie, L., Shu, L., Sun, W., & Liu, Q. (2020). Effectiveness of mobile applications on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. Journal of managed care & specialty pharmacy, 26(4), 550-561.
Santo, K., Singleton, A., Rogers, K., Thiagalingam, A., Chalmers, J., Chow, C. K., & Redfern, J. (2019). Medication reminder applications to improve adherence in coronary heart disease: a randomised clinical trial. Heart, 105(4), 323-329.
Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801-812.
Teeng, L. P., Guan, N. C., Kadir, M. S., & Ling, T. S. (2021). Reminder through mobile messaging application improves outpatient attendance and medication adherence among patients with depression: An open-label randomised controlled trial. Med J Malaysia, 76(5), 617.