Mental Health Apps Research Articles

Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey.

The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment. This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers. A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence. Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect. These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health. RR2-10.2196/41040.

Ethical and legal aspects of cybersecurity in health

Background: With the emergence of eHealth and mHealth, the use of mental health apps has increased significantly as an accessible and convenient approach as an adjunct to promoting well-being and mental health. There are several apps available that can assist with mental health monitoring and management, each with specific features to meet different needs. The intersection of mental health and cyber technology presents a number of critical legal and ethical issues. As mental health monitoring apps and devices become more integrated into clinical practice, cybersecurity takes on paramount importance. Objective: To address the ethical and legal aspects of health cybersecurity related to applications in mental health monitoring and management. Methods: We carried out a thematic synthesis of the best scientific evidence. Results: These tools have the potential to significantly improve access to and quality of care for users with mental health conditions, but they also raise substantial concerns about privacy and informed consent. Cybersecurity in mental health is not only a matter of technology, but also of human rights. The protection of sensitive mental health information is critical, and legal and ethical measures to safeguard this information must be implemented in a robust and transparent manner. Conclusion: the use of information technologies and mobile devices is now part of the clinical reality and its future perspectives. It is important to mention that while these apps can be helpful for self-care and mental well-being management, they are not a substitute for the advice and support of a qualified mental health professional (psychologist or psychiatrist). As we move into the digital age, it is imperative that mental health monitoring and management apps are developed and used responsibly, ensuring the safety, dignity, and well-being of users.

The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care.

Background: Mental health apps offer scalable care, yet clinical adoption is hindered by low user engagement and integration challenges into clinic workflows. Human support staff called digital navigators, trained in mental health technology, could enhance care access and patient adherence and remove workflow burdens from clinicians. While the potential of this role is clear, training staff to become digital navigators and assessing their impact are primary challenges. Methods: We present a detailed manual/framework for implementation of the Digital Navigator within a short-term, cognitive-behavioral therapy-focused hybrid clinic. We analyze patient engagement, satisfaction, and digital phenotyping data quality outcomes. Data from 83 patients, for the period spanning September 2022 to September 2023, included Digital Navigator satisfaction, correlated with demographics, mindLAMP app satisfaction, engagement, and passive data quality. Additionally, average passive data across 33 clinic patients from November 2023 to January 2024 were assessed for missingness. Results: Digital Navigator satisfaction averaged 18.8/20. Satisfaction was not influenced by sex, race, gender, or education. Average passive data quality across 33 clinic patients was 0.82 at the time this article was written. Digital Navigator satisfaction scores had significant positive correlation with both clinic app engagement and perception of that app. Conclusions: Results demonstrate preliminary support and patient endorsement for the Digital Navigator role and positive outcomes around digital engagement and digital phenotyping data quality. Through sharing training resources and standardizing the role, we aim to enable clinicians and researchers to adapt and utilize the Digital Navigator for their own needs.

Increasing access to mental health supports for 12–17-year-old Indigenous youth with the JoyPop mobile mental health app: study protocol for a randomized controlled trial

BackgroundIndigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12–17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app’s broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs.MethodsA pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks.DiscussionThis trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways.Trial registrationhttps://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].

A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands.

MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability. This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands. Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the "Problem Areas in Diabetes" (PAID-11) questionnaire (diabetes distress), the "World Health Organization Well-being Index" (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the "Checklist Individual Strength" (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback. In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization. Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial.

Psychiatrists’ Readiness for Digital Psychiatry in Pakistan: A Multicenter CrossSectional Study with Regression Analysis

IntroductionThe concept of digital psychiatry, encompassing technologies such as mental health apps, Virtual Reality (VR), Artificial Intelligence (AI), and telepsychiatry, emerges as a potential solution to bridge the existing gaps in the mental health system of Pakistan. However, one of the major barriers to the implementation of these technologies is hesitancy to adopt digital tools by psychiatrists.ObjectivesThis study aims to explore the current understanding of digital psychiatry, the barriers faced by psychiatrists in its’ widespread implementation, and their willingness to adopt these services in clinical practice.MethodsThis cross-sectional study surveyed psychiatrists’ knowledge, attitudes, and practices on digital psychiatry from 39 public hospitals across Pakistan using an online validated questionnaire from January to July 2023. Participants included psychiatry residents, fellows, and consultants practicing in Pakistan. Responses were analyzed with Raosoft software, Quirkos, and SPSS 26 using thematic analysis and correlation.ResultsA total of 200 participants responded to the questionnaire, primarily in the age range of 20-30 years (56%). The gender distribution was 55% male (N = 111) and 45% female (N = 89). Among the professional roles, 23% were consultants, 7% were registrars, 54% were psychiatry residents, and 17% were medical officers. Respondents came from both rural (N = 148, 74%) and urban (N = 52, 26%) practice settings. Regarding telepsychiatry, 46% strongly agreed that they are familiar with telepsychiatry, while 58% agreed that telepsychiatry can save time and money. Additionally, 22% strongly agreed that it’s a viable approach for patient care. Concerning perspectives on Artificial Intelligence (AI) in digital psychiatry readiness, only 40% of participants had received AI training. However, 55% expressed interest in collaborating with international centers on AI-related projects. In terms of mental health apps, 62% of respondents reported limited familiarity with them. Nevertheless, 65% believed that these apps could potentially save time and money for psychiatric health systems. Lastly, concerning Virtual Reality (VR) in psychiatric care, 57% of participants were familiar with VR technology, but only 43% were acquainted with its applications in psychiatry. Notably, 71% did not view VR as a viable replacement for in-person psychiatric management.Conclusions This is the first study conducted on understanding digital psychiatry in Pakistan’s healthcare system, which revealed multiple challenges to digital health competency among psychiatrists. This emphasizes on the need for formal training and funding towards resources to overcome obstacles in utilizing mental health technologies.Disclosure of InterestNone Declared

The Wired Couch: Untangling the Promise and Peril of Telepsychiatry and Mental Health Apps

The Wired Couch: Untangling the Promise and Peril of Telepsychiatry and Mental Health Apps

Navigating Mental Health Support in Tunisia’s Digital Age: Preferences, Challenges, and Paradoxes-An online survey

IntroductionThe digital age has transformed mental health support in Tunisia. This study explores how individuals seek assistance for mental health concerns online, considering their comfort levels, preferences, and decision-making factors.ObjectivesThis study aims to: Investigate the comfort levels of Tunisians when discussing mental health concerns online Identify preferred online sources for mental health support Explore factors influencing the choice between online sources and mental health professionalsMethods To unearth these insights, an exhaustive online survey was meticulously conducted. This survey was posted online on different social media platforms and cast a wide net, drawing responses from an eclectic cross-section of Tunisian society. The survey methodically gathered data on participants’ demographics, their inclinations towards online avenues for seeking assistance, and the multifaceted factors that sway their choices in this digital age.ResultsIntriguingly, the results of this study illuminate several key findings:Comfort Levels: A striking 47% of respondents expressed their unease about discussing their mental health concerns online. This statistic vividly underscores the intricate interplay between digital platforms and the persistent social stigma surrounding mental health issues.Preferences for Online Sources: The study notably revealed that mental health apps and online counseling websites are emerging as the favored choices among those seeking support. This underscores the surging significance of digital mental health solutions tailored to individual needs.Factors Influencing Preferences: An array of factors sways the preference for online sources. Among them, the allure of anonymity, the appeal of convenience, and the perception of limited access to in-person mental health professionals were prevalent. Additionally, financial constraints emerged as a notable consideration in the decision-making process.Trust in Online Information: In contrast, individuals who leaned toward seeking assistance from mental health professionals stressed the pivotal importance of professional expertise, personalized guidance, and a comprehensive understanding of their concerns. Importantly, 38% expressed reservations about the reliability of online mental health information, underscoring the critical role of trust in the process.ConclusionsThis study sheds light on the nuanced process of seeking mental health assistance in the digital age. It emphasizes the need to address mental health stigma and improve online resource credibility. The findings highlight the importance of comprehensive mental health strategies that integrate digital solutions and traditional professional care, catering to diverse preferences and needs in Tunisia.Disclosure of InterestNone Declared

Enhancing outpatient anxiety treatment with mobile technology: A quality improvement study

IntroductionMobile mental health applications are a novel treatment method with unique qualities and capabilities for enhancing existing psychiatric treatments. Outpatient settings such as Mile Square Health Clinic have identified a need to leverage this new technology into their routine care. BackgroundIn the U.S., over 40 million people suffer from an anxiety disorder, however, only 1 in 4 responds to pharmacological treatment. Preliminary research indicates mental health apps are acceptable, feasible, and can improve patient outcomes for those with anxiety. MethodsParticipants from two different outpatient psychiatric clinics locations with generalized anxiety disorder were identified and recruited by participating nurse practitioners. Participants were instructed on how to download and use IntelliCare by the Project Lead. The Project Lead administered a semi-structured interview to collect qualitative data at three weeks and six weeks follow-up. Results and conclusionsSurvey responses at three and six weeks showed relevant themes of increased journaling, increased feelings of connectedness, positive associations with gamification, and IntelliCare being most useful for a moderate to severe level of anxiety. RecommendationsThe results of this QI project demonstrate the clinical utility of incorporating the IntelliCare app into regular outpatient practice. IntelliCare should be used with those with moderate to severe anxiety and journaling features should follow research developments to incorporate best-practice guidelines.

Predicting determinants influencing user satisfaction with mental health app: An explainable machine learning approach based on unstructured data

In the contemporary digital landscape, the rising concern for mental health has sparked a surge in the use of mental health apps (MHAs) as accessible tools for addressing psychological well-being. Maintaining a high level of user satisfaction (USAT) is important for MHAs in the highly competitive app market. Leveraging BERT (Bidirectional Encoder Representations from Transformers), a state-of-the-art deep learning (DL) model, we perform topic modeling and sentiment analysis on 17,717 user online reviews. Specifically, we employ the BERTopic model to identify the determinants of USAT with MHAs. Utilizing a BERT-base-multilingual-uncase-sentiment model, we perform sentiment analysis to distinguish determinants that elicit satisfaction from those causing dissatisfaction. Also, this study tests and compares six machine learning (ML) algorithms to predict the influence of determinants on USAT with MHAs. The Light Gradient Boosting Machine (LightGBM) emerges as the top performer, showcasing its efficacy in predicting USAT determinants. By using SHAP (Shapley Additive exPlanations), an explainable ML model with cross-validation, we visualize the results of the LightGBM. The SHAP values show that the five most influential determinants of USAT with MHAs include soothing audio experience, smoking cessation support, payment and subscription management, tracking progress and mindful meditation experience. This study facilitates a deeper understanding of user experiences through the identification and prediction of determinants of USAT with MHAs. Understanding these factors and their interplay is essential for developers, clinicians, and stakeholders who aim to enhance MHAs’ services and ultimately improve the well-being of users.

Social and non-social cognitive behavioural therapy strategies for depression: findings from the MoodMission smartphone application

ABSTRACT Objective Cognitive behavioural therapy (CBT) is an evidence-based treatment of depression that can include strategies with a social component. Mental health apps (MHapps) are widely used amongst individuals with depression to access CBT strategies. Despite the research on CBT, it is not clear whether there is a difference in the correlation of CBT strategies for depression with a social component or not. Using MoodMission, an empirically validated MHapp that recommends CBT strategies (termed “Missions”), this study investigated whether social or non-social CBT strategies would correlate with participants’ ratings of helpfulness and distress reduction. Method A total of 4,107 participants who completed at least one social or non-social Mission and baseline 9-item Patient Health Questionnaire (PHQ-9) were included. Multilevel modelling with 2-levels was used, with level 1 entered as the fixed effect between Mission type in predicting subjective helpfulness and distress reduction, and level 2 entered as the random effects of participant covariates of age, gender, and PHQ-9 scores. Results Findings indicated that Missions without a social component was a significant positive predictor in distress reduction, but there was no significant difference in predicting subjective helpfulness. Conclusion These findings suggest that individuals with depression using MHapps could benefit from engaging in non-social CBT strategies for the reduction of subjective distress, more so than social CBT strategies. Study limitations included the self-report study design, subjective outcome measures, and a higher representation of female (80.6%) participants. Further research is required to investigate the clinical significance of these findings with a more representative sample.

Implementing a mental health app library in primary care: A feasibility study

Confronted with a wide range of digital health tools (DHT), professionals and patients need guidance to use these tools correctly and optimize health management. In the fall of 2020, a DHT library developed by Quebec-based company TherAppX was implemented in 22 institutions. The library was designed to enable healthcare professionals to use DHT in clinical care. The purpose of the current study was to assess the feasibility of implementing the library, including user experience, changes in DHT recommendation habits, and factors that helped or hindered the implementation process. A multi-methods design focusing on secondary use of quantitative data collected by TherAppX and semi-structured interviews with users was employed. While the quantitative analyses indicated infrequent use of the library, qualitative analyses highlighted several factors that hindered its implementation, including certain library and user characteristics and the unprecedented context of the COVID-19 pandemic. Nevertheless, the quantitative analyses confirmed interest in DHT and their usefulness during follow-ups. The results revealed a marginally significant pre-post changes in the frequency with which DHT were recommended. This study helped identify areas for improvements and indicates that further evaluation is needed. Future implementations would benefit from ensuring optimal conditions for a successful implementation.

Assessing the Influence of Patient Empowerment Gained Through Mental Health Apps on Patient Trust in the Health Care Provider and Patient Compliance With the Recommended Treatment: Cross-sectional Study.

In chronic mental illness, noncompliance with treatment significantly worsens the illness course and outcomes for patients. Considering that nearly 1 billion people worldwide experience mental health issues, including 1 of 5 Canadians in any given year, finding tools to lower noncompliance in these populations is critical for health care systems. A promising avenue is apps that make mental health services more accessible to patients. However, little is known regarding the impact of the empowerment gained from mental health apps on patient compliance with recommended treatment. This study aimed to investigate the impact of patient empowerment gained through mental health apps on patient trust in the health care provider and patient compliance with the recommended treatment. A cross-sectional web-based survey was conducted in Canada. Eligible participants were Canadian adults diagnosed with chronic mental health disorders who were using at least one of the following apps: Dialogue, MindBeacon, Deprexis, Ginger, Talkspace, BetterHelp, MindStrong, Mindshift, Bloom, Headspace, and Calm. A total of 347 valid questionnaires were collected and analyzed using partial least-squares structural equation modeling. Trust in the health care provider and patient compliance were measured with multiple-item scales adapted from existing scales. Patient empowerment was conceived and measured as a higher-order construct encompassing the following 2 dimensions: patient process and patient outcome. All the items contributing to the constructs in the model were measured with 7-point Likert scales. The reliability and validity of the measurement model were assessed, and the path coefficients of the structural model were estimated. The results clearly show that patient empowerment gained through mental health apps positively influenced patient trust in the health care provider (β=.306; P<.001). Patient trust in the health care provider had a positive effect on patient compliance (β=.725; P<.001). The direct relationship between patient empowerment and patient compliance was not significant (β=.061, P=.23). Interestingly, the data highlight that the effect of patient empowerment on patient compliance was fully mediated by trust in the health care provider (β=.222; P<.001). The results show that patient empowerment gained through the mental health app involves 2 dimensions: a process and an outcome. This study shows that for individuals living with mental health disorders, empowerment gained through mental health apps enhances trust in the health care provider. It reveals that patient empowerment impacts patient compliance but only through the full mediating effect of patient trust in the health care provider, indicating that patient trust is a critical variable to enhance patient compliance. Hence, our results confirm that health care systems could encourage the use of mental health apps to favor a climate that facilitates patients' trust in health care provider recommendations, possibly leading to better compliance with the recommended treatment.

Innovative Models for Integrative Prenatal Care

In the rapidly evolving healthcare landscape, integrative care delivery stands at the forefront of pioneering change, particularly in prenatal care. This comprehensive narrative review delves into the development of innovative models for integrative prenatal care, such as telemedicine-integrated home monitoring systems, mental health apps, virtual reality, artificial intelligence-powered predictive analytics and blockchain for secure health data management, proposing a paradigm shift from traditional methodologies to a more holistic, technology-empowered approach. We explore the interplay between cutting-edge technological advancements and interdisciplinary collaboration in crafting a care model that is patient-centric and adaptable to diverse healthcare settings. Moreover, key areas where integration can be significantly enhanced such as telemedicine, patient education, and continuous monitoring were identified, emphasizing the importance of synergy between medical expertise, patient engagement, and technology, aiming to improve outcomes for both mother and child and argue that the future of prenatal care lies in embracing innovation, flexibility, and inclusivity, setting a new standard in healthcare delivery. This work offers practical insights for healthcare professionals and policymakers aspiring to transform prenatal care into a more effective, accessible, and patient-friendly experience.

MENTAL HEALTH AND DIGITAL TECHNOLOGY: A PUBLIC HEALTH REVIEW OF CURRENT TRENDS AND RESPONSES

The intersection of mental health and digital technology has become a critical focus in the realm of public health. This paper provides a concise overview of the current trends and responses within this evolving landscape. The widespread integration of digital technology into daily life has both positive and negative implications for mental health. On one hand, digital platforms offer innovative tools for mental health support, including virtual therapy, mental health apps, and online communities. These resources enhance accessibility and reduce barriers to seeking help. Conversely, concerns have arisen regarding the adverse impact of excessive digital screen time, social media use, and cyberbullying on mental well-being. The paper explores the prevalence of digital mental health interventions, emphasizing the need for evidence-based practices and regulatory frameworks to ensure their efficacy and user safety. Additionally, it addresses the growing recognition of the digital divide and disparities in access to mental health resources, emphasizing the importance of inclusivity in digital mental health initiatives. Responses to these challenges involve collaborative efforts among mental health professionals, technology developers, policymakers, and public health practitioners. The paper highlights the importance of research in understanding the nuanced relationship between digital technology and mental health, informing the development of targeted interventions. Furthermore, it emphasizes the need for comprehensive public health strategies that prioritize digital literacy, mental health education, and the promotion of positive online behaviors. The paper underscores the multifaceted nature of the relationship between mental health and digital technology, calling for a holistic and collaborative approach to address the evolving challenges and opportunities in this dynamic landscape.&#x0D; Keywords: Mental health, Digital technologies, Public health, Trends, Review.

Safeguarding Users of Consumer Mental Health Apps in Research and Product Improvement Studies: an Interview Study

Safeguarding Users of Consumer Mental Health Apps in Research and Product Improvement Studies: an Interview Study

Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study.

Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (β=-.35; t61=-3.05; P=.003), number of activities completed (β=-.12; t61=-2.05; P=.04), days played (β=-.12; t58=-2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (β=-3.05; t45=-2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression.

Exploring Adolescents' Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study.

Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. This study aims to explore adolescents' attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, "What do you think about mental health apps in general?"). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents.

Man up! The mental health‐feminine stereotype and its effect on the adoption of mental health apps

AbstractMental illnesses are among the most frequent health conditions worldwide, affecting both men and women. However, we find that men are more likely than women to avoid adopting mobile apps that are designed to promote users' mental health. Building on previous research that men are often more motivated than women to behave in gender‐congruent ways, we suggest that there exists a mental health‐feminine stereotype that acts as an obstacle to men's adoption of mental health apps. Privacy and self‐help features offered by digital mental health apps are insufficient to overcome the mental health‐stereotype that deter men from pursuing mental health support. Across five studies, we show that consumers feel more feminine when adopting mental health apps, and perceive others who adopt mental health apps to be more feminine than those who do not. We also show that presenting mental health apps in a masculine frame increases the likelihood of men adopting mental health apps, especially those with stronger adherence to traditional masculinity ideology.

A Belgian platform for well-being and mental health apps: Exploring end users’ attitudes, interaction and perceived strengths and limits

A plethora of well-being and mental health apps and websites are available online. However, keeping up with this ever-changing field and assessing the quality of applications proves challenging. The platform onlinehulp-apps.be was created to bundle relevant, screened apps for inhabitants of Flanders (Belgium). In this user study, novice users (i.e., applied psychology bachelor students with little to no prior experience with the platform) were asked to solve hypothetical cases where a professional uses onlinehulp-apps.be to find suitable apps. They then reported on their experience and evaluation of the platform. Their attitudes towards the platform were assessed in a pre-post design to investigate any changes in attitudes before and after using the platform to complete the cases. Results showed an overall positive attitude towards the platform, with minor suggestions primarily relating to adding more themes in which apps are classified.