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

• Published in: Revista brasileira de psiquiatria Vol. 46; p. e20233172
• Main Authors: Claro, Heloísa Garcia, Menezes, Paulo Rossi, Fernandes, Ivan Filipe, Seward, Nadine, Miranda, Juan Jaime, Saidel, Maria Giovana Borges, Baquete, Aline Geovanna de Lima, Daley, Kate L, Aschar, Suzana, Cruz, Daniela Vera, Castro, Hellen Carolina Martins, Rocha, Thais, Quayle, Julieta, Peters, Tim J, Araya, Ricardo
• Format: Journal Article
• Language: English
• Published: Brazil Associação Brasileira de Psiquiatria 2024; Associação Brasileira de Psiquiatria (ABP)
• Subjects: Adult; behavioral research; Brazil; depression; Depression - psychology; Depression - therapy; Digital technology; Female; Humans; Male; Middle Aged; mobile applications; Original; Peru; PSYCHIATRY; randomized controlled trial; Socioeconomic Factors; Telemedicine; Treatment Outcome; Young Adult; Brazil; Peru; behavioral research; Digital technology; depression; mobile applications; randomized controlled trial
• ISSN: 1809-452X; 1516-4446; 1809-452X
• DOI: 10.47626/1516-4446-2023-3172

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).