Use Of Mental Health Apps Research Articles

Bridging the Gap: Use of Mental Health Apps in the Adolescent Population.

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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.

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.

Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review.

The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups. In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature. A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis. A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues. Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted.

Cultural Adaptation of the Actionable Health App Evaluation in Japan: Protocol for a Web-Based Modified Delphi Expert Consensus Study

Background With an increase in both the number of mental health disorders people are experiencing and the difficulty in accessing mental health care, the demand for accessible mental health care services has increased. The use of mobile devices has allowed people to receive care in their daily lives without restrictions on time or location. However, the majority of publicly available mobile health apps are not evidence-based, and the top-rated apps are not always safe or user-friendly and may not offer clinically beneficial results. Objective This study aims to create a cultural adaptation of the American Psychiatric Association’s comprehensive app evaluation framework in Japan using a web-based modified Delphi expert consensus. Methods A web-based modified Delphi study includes developing the Japanese version of the comprehensive app evaluation framework and 3 Delphi rounds. In the first round, our working group sends a questionnaire to the panelists, who then complete it. In the second and third rounds, the working group sends a questionnaire and a summary of the panelists’ answers based on each of the previous rounds. The panelists answer the questionnaires based on this summary. The summarization procedure is automated to help reduce the biases that can be generated when panelists’ answers are summarized and when the panelists receive them. The working group sends only the result of the summarization with the next round’s questionnaire. All interactions between the working group and the panelists will be conducted on Qualtrics (Qualtrics Japan LLC), a questionnaire platform. To culturally validate the comprehensive mental health app evaluation framework, participants from the following three categories will be recruited in Japan: (1) researchers, (2) practitioners, and (3) app developers. Results This study received funding from a crowdfunding campaign in Japan (April 2023). The Delphi study began in January 2023 and will be completed in December 2023. We had already completed the translation of the 105 original app evaluation item questions by December 2022. Conclusions While the need for treatment using mental health apps is increasing, no framework that can be used to develop a centralized database for health apps is available or accessible, and no consensus has been reached among stakeholders in Japan about an appropriate framework. The results of the web-based modified Delphi method presented in this paper may provide direction for the development and use of mental health apps in the future among the relevant stakeholders. Furthermore, this study will enhance recognition of the framework among researchers, clinicians, mental health app developers, and users, in addition to devising new instruments to help users or practitioners efficiently choose the right app for their situations. International Registered Report Identifier (IRRID) PRR1-10.2196/44469

Young adults’ adoption and use of mental health apps: efficient, effective, but no replacement for in-person care

Objective: Millions of people use mobile phone or computer-based applications—apps—to maintain their mental health and connect with treatment providers through text- and video-based chat functions. The present study sought to understand young adults’ motivations for adopting this technology using the unified theory of acceptance and use of technology (UTAUT), how they use mental health apps, and the gratifications they receive from using mental health apps. Participants: One hundred-eighteen mental health app users responded to an online survey. Methods: A survey was conducted with students at a Midwestern university. The survey included questions regarding current mental health services, mental health apps used, UTAUT and gratifications survey items. Results: A regression analysis suggested users’ performance expectancies, effort expectancies, and facilitating conditions predicted the adoption of mental health apps. Young adults most often use mental health apps for stress relief. While they preferred in-person treatment, users described mental health apps as efficient and helpful. Conclusion: Overall, the results reinforce the sense of optimism for the future of mental health apps, suggesting the potential for apps to supplement—but not necessarily replace—in-person care.

Assessment of App Store Description and Privacy Policy to Explore Ethical and Safety Concerns Associated with the Use of Mental Health Apps for Depression.

Mental Health apps (MH apps) could help address the huge unmet mental health care need of developing countries. This study aimed to explore potential ethical, data safety, and privacy issues associated with using MH apps for depression. A cross-sectional assessment of the top 50 MH apps (by Google Play store search result ordering) for depression available in India was conducted in November 2021. Most apps were listed under the category of health and fitness (54%). The median number of total and dangerous permissions requested at the time of download was nine and three, respectively. Privacy policy in English was available for 76%. The average length of the privacy policy was 2171 words, and the mean Flesch-Kincaid reading grade level was 12 (much higher than the recommended cut-off of eight). Important features relevant to safeguarding consumer confidentiality, including names of third parties with which user data could be shared (42%), explicit consent before sharing data with third parties (16%), and assurance regarding the collection of de-identifiable data (11%), were missing from the majority of privacy policies. There is an urgent need to improve the accessibility and usability of privacy policies by app developers, with the active involvement of other stakeholders.

Did Usage of Mental Health Apps Change during COVID-19? A Comparative Study Based on an Objective Recording of Usage Data and Demographics.

This paper aims to objectively compare the use of mental health apps between the pre-COVID-19 and during COVID-19 periods and to study differences amongst the users of these apps based on age and gender. The study utilizes a dataset collected through a smartphone app that objectively records the users’ sessions. The dataset was analyzed to identify users of mental health apps (38 users of mental health apps pre-COVID-19 and 81 users during COVID-19) and to calculate the following usage metrics; the daily average use time, the average session time, the average number of launches, and the number of usage days. The mental health apps were classified into two categories: guidance-based and tracking-based apps. The results include the increased number of users of mental health apps during the COVID-19 period as compared to pre-COVID-19. Adults (aged 24 and above), compared to emerging adults (aged 15–24 years), were found to have a higher usage of overall mental health apps and guidance-based mental health apps. Furthermore, during the COVID-19 pandemic, males were found to be more likely to launch overall mental health apps and guidance-based mental health apps compared to females. The findings from this paper suggest that despite the increased usage of mental health apps amongst males and adults, user engagement with mental health apps remained minimal. This suggests the need for these apps to work towards improved user engagement and retention.

APA App Advisor: Working With Patients to Use Apps

APA App Advisor: Working With Patients to Use Apps

Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study.

BackgroundMental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population.ObjectiveThis study aimed to understand facilitators of and barriers to mental health app use among community college students.MethodsA web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps.ResultsOf the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect.ConclusionsThese findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps.

APA’s App Panel Offers Guidance on Digital Tools

Back to table of contents Previous article Next article ProfessionalFull AccessAPA’s App Panel Offers Guidance on Digital ToolsNathan Tatro, M.A.Nathan TatroSearch for more papers by this author, M.A.Published Online:21 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.37AbstractA new series of articles will provide information from APA experts on the use of apps in psychiatry. Your questions are welcome!“Ask an App Advisor” is a new feature of Psychiatric News in which members of APA’s App Advisor Expert Panel discuss the general use of mental health apps and answer APA members’ questions. This group is composed of APA members and other subject matter experts in mental health from related professions (for example, social work, psychology, nurse practitioners, informaticists) and patients with lived experience. The purpose of this panel is to maintain APA’s App Evaluation Model and to provide resources for professionals and patients to give them tools they can use when deciding what app is appropriate. The articles will also explore clinical, research, and policy interests of the panelists around mHealth (mobile health).This month’s panelist is Julia Tartaglia, M.D. She began working with APA’s panel as its first medical student representative while attending Rutgers Robert Wood Johnson Medical School, where she earned her M.D. with distinction in medical innovation and entrepreneurship. She is now a psychiatry resident at Zucker Hillside Hospital at Northwell Health.Q. Did you use apps in medical school? If so, how were you introduced to them?A. At the time, I wasn’t introduced to them as a part of the curriculum. While my medical school was very forward thinking and introduced a new elective on telemedicine, we did not have any formal or informal exposure to mobile apps for patient care. In clinical practice I did not see any mental health mobile apps being used by physicians or patients. As medical students, there are barriers to introducing new technologies in practice as well. As we are under direct supervision of attendings, I didn’t feel comfortable making recommendations about mobile app usage, especially without any experience or training in doing so, but there is definitely a need for medical school curricula to address the use of apps in clinical care. Personally, I did make use of medical education apps and mobile app tools for medicine, such as flashcard and question bank apps, anatomy apps, medication apps, and calculators.Q. Do you have an interest in a specific type of app?A. In general, I’m very interested in mobile apps that can be used for remote symptom monitoring and for eCBT (digitally based cognitive-behavioral therapy). One of my interests has been burnout and mental illness in the medical community. In medical school, I started working on developing an app for medical students. Burnout and mental illness are occurring at high rates among medical students, with 1 in 3 students meeting the criteria for clinical depression. Yet, medical students are less likely to seek help for emotional and mental health issues than peers in other professions. Further, many schools report that mental health resources are limited and cannot keep up with demand, with students often having to wait a month or more to schedule appointments with school mental health counselors.In response to this, I’m developing a wellness app for medical students that addresses mental health through self-guided eCBT modules and virtual counseling by connecting students to mental health counselors. Our app format will increase access to mental health resources. It will provide a point-of-care solution for students combatting anxiety/depression who may hesitate to seek help via traditional models that schools provide, such as in-person counseling. Further, unlike existing depression/anxiety apps that offer generic advice and solutions, our eCBT modules will be custom designed to address common medical school stressors and cognitive biases, such as imposter syndrome and stress related to board exams and clinical rotations.Check out future issues of Psychiatric News for more conversations with members of APA’s App Advisor Expert Panel. You can also review APA’s sample app evaluations and learn more about our App Evaluation Model. If you have a question for the panel, send an email to [email protected]. ■APA’s App Advisor page can be accessed here.Also, APA has launched a series of webinars during which APA members can ask questions of APA’s App Advisor Panel. Register here.Nathan Tatro, M.A., is deputy director of digital health in APA’s Department of Practice Management and Delivery Systems Policy. ISSUES NewArchived

Leveraging Implementation Science to Understand Factors Influencing Sustained Use of Mental Health Apps: a Narrative Review.

Mental health (MH) smartphone applications (apps), which can aid in self-management of conditions such as depression and anxiety, have demonstrated dramatic growth over the past decade. However, their effectiveness and potential for sustained use remain uncertain. This narrative review leverages implementation science theory to explore factors influencing MH app uptake. The review is guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and discusses the role of the innovation, its recipients, context, and facilitation in influencing successful implementation of MH apps. The review highlights critical literature published between 2015 and 2020 with a focus on depression and anxiety apps. Sources were identified via PubMed, Google Scholar, and Twitter using a range of keywords pertaining to MH apps. Findings suggest that for apps to be successful, they must be advantageous over alternative tools, relatively easy to navigate, and aligned with users’ needs, skills, and resources. Significantly more attention must be paid to the complex contexts in which MH app implementation is occurring in order to refine facilitation strategies. The evidence base is still uncertain regarding the effectiveness and usability of MH apps, and much can be learned from the apps we use daily; namely, simpler is better and plans to integrate full behavioral treatments into smartphone form may be misguided. Non-traditional funding mechanisms that are nimble, responsive, and encouraging of industry partnerships will be necessary to move the course of MH app development in the right direction.

Adherence of the #Here4U App - Military Version to Criteria for the Development of Rigorous Mental Health Apps.

BackgroundOver the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military.ObjectiveThe goal of the #Here4U App – Military Version is to provide evidence-informed mental health support to members of Canada’s military community, leveraging artificial intelligence in the form of IBM Canada’s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate.MethodsAs the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016.ResultsThe #Here4U App – Military Version met the majority of Bakker and colleagues’ criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward.ConclusionsThe #Here4U App – Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery.

Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses.

BackgroundMental health apps have great potential to help people needing support to cope with distress or specific symptoms. In fact, there is an exponential increase in the number of mental health apps available on the internet, with less than 5% being actually studied.ObjectiveThis study aimed to assess the quality of the available evidence regarding the use of mental health apps and to summarize the results obtained so far.MethodsSystematic reviews and meta-analyses were searched, specifically for mobile apps on mental health issues or symptoms, and rated using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsA total of 7 meta-analyses were carefully reviewed and rated. Although some meta-analyses looked at any mental health issue and analyzed the data together, these studies were of poorer quality and did not offer strong empirical support for the apps. Studies focusing specifically on anxiety symptoms or depressive symptoms were of moderate to high quality and generally had small to medium effect sizes. Similarly, the effects of apps on stress and quality of life tended to offer small to medium effects and were of moderate to high quality. Studies looking at stand-alone apps had smaller effect sizes but better empirical quality than studies looking at apps with guidance. The studies that included follow-ups mostly found a sustained impact of the app at an 11-week follow-up.ConclusionsThis meta-review revealed that apps for anxiety and depression hold great promise with clear clinical advantages, either as stand-alone self-management or as adjunctive treatments. More meta-analyses and more quality studies are needed to recommend apps for other mental health issues or for specific populations.

Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study.

BackgroundNearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer.ObjectiveThe aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer.MethodsThis pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute–designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention.ResultsThe minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement.ConclusionsThere is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone–delivered programs with additional phone support can be used to support patients with breast cancer.International Registered Report Identifier (IRRID)RR2-10.2196/11452

Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study.

BackgroundUser engagement is key to the effectiveness of digital mental health interventions. Considerable research has examined the clinical outcomes of overall engagement with mental health apps (eg, frequency and duration of app use). However, few studies have examined how specific app use behaviors can drive change in outcomes. Understanding the clinical outcomes of more nuanced app use could inform the design of mental health apps that are more clinically effective to users.ObjectiveThis study aimed to classify user behaviors in a suite of mental health apps and examine how different types of app use are related to depression and anxiety outcomes. We also compare the clinical outcomes of specific types of app use with those of generic app use (ie, intensity and duration of app use) to understand what aspects of app use may drive symptom improvement.MethodsWe conducted a secondary analysis of system use data from an 8-week randomized trial of a suite of 13 mental health apps. We categorized app use behaviors through a mixed methods analysis combining qualitative content analysis and principal component analysis. Regression analyses were used to assess the association between app use and levels of depression and anxiety at the end of treatment.ResultsA total of 3 distinct clusters of app use behaviors were identified: learning, goal setting, and self-tracking. Each specific behavior had varied effects on outcomes. Participants who engaged in self-tracking experienced reduced depression symptoms, and those who engaged with learning and goal setting at a moderate level (ie, not too much or not too little) also had an improvement in depression. Notably, the combination of these 3 types of behaviors, what we termed “clinically meaningful use,” accounted for roughly the same amount of variance as explained by the overall intensity of app use (ie, total number of app use sessions). This suggests that our categorization of app use behaviors succeeded in capturing app use associated with better outcomes. However, anxiety outcomes were neither associated with specific behaviors nor generic app use.ConclusionsThis study presents the first granular examination of user interactions with mental health apps and their effects on mental health outcomes. It has important implications for the design of mobile health interventions that aim to achieve greater user engagement and improved clinical efficacy.

Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis.

BackgroundUnderstanding patterns of real-world usage of mental health apps is key to maximizing their potential to increase public self-management of care. Although developer-led studies have published results on the use of mental health apps in real-world settings, no study yet has systematically examined usage patterns of a large sample of mental health apps relying on independently collected data.ObjectiveOur aim is to present real-world objective data on user engagement with popular mental health apps.MethodsA systematic engine search was conducted using Google Play to identify Android apps with 10,000 installs or more targeting anxiety, depression, or emotional well-being. Coding of apps included primary incorporated techniques and mental health focus. Behavioral data on real-world usage were obtained from a panel that provides aggregated nonpersonal information on user engagement with mobile apps.ResultsIn total, 93 apps met the inclusion criteria (installs: median 100,000, IQR 90,000). The median percentage of daily active users (open rate) was 4.0% (IQR 4.7%) with a difference between trackers (median 6.3%, IQR 10.2%) and peer-support apps (median 17.0%) versus breathing exercise apps (median 1.6%, IQR 1.6%; all z≥3.42, all P<.001). Among active users, daily minutes of use were significantly higher for mindfulness/meditation (median 21.47, IQR 15.00) and peer support (median 35.08, n=2) apps than for apps incorporating other techniques (tracker, breathing exercise, psychoeducation: medians range 3.53-8.32; all z≥2.11, all P<.05). The medians of app 15-day and 30-day retention rates were 3.9% (IQR 10.3%) and 3.3% (IQR 6.2%), respectively. On day 30, peer support (median 8.9%, n=2), mindfulness/meditation (median 4.7%, IQR 6.2%), and tracker apps (median 6.1%, IQR 20.4%) had significantly higher retention rates than breathing exercise apps (median 0.0%, IQR 0.0%; all z≥2.18, all P≤.04). The pattern of daily use presented a descriptive peak toward the evening for apps incorporating most techniques (tracker, psychoeducation, and peer support) except mindfulness/meditation, which exhibited two peaks (morning and night).ConclusionsAlthough the number of app installs and daily active minutes of use may seem high, only a small portion of users actually used the apps for a long period of time. More studies using different datasets are needed to understand this phenomenon and the ways in which users self-manage their condition in real-world settings.

Using science to sell apps: Evaluation of mental health app store quality claims

Despite the emergence of curated app libraries for mental health apps, personal searches by consumers remain a common method for discovering apps. App store descriptions therefore represent a key channel to inform consumer choice. This study examined the claims invoked through these app store descriptions, the extent to which scientific language is used to support such claims, and the corresponding evidence in the literature. Google Play and iTunes were searched for apps related to depression, self-harm, substance use, anxiety, and schizophrenia. The descriptions of the top-ranking, consumer-focused apps were coded to identify claims of acceptability and effectiveness, and forms of supporting statement. For apps which invoked ostensibly scientific principles, a literature search was conducted to assess their credibility. Seventy-three apps were coded, and the majority (64%) claimed effectiveness at diagnosing a mental health condition, or improving symptoms, mood or self-management. Scientific language was most frequently used to support these effectiveness claims (44%), although this included techniques not validated by literature searches (8/24 = 33%). Two apps described low-quality, primary evidence to support the use of the app. Only one app included a citation to published literature. A minority of apps (14%) described design or development involving lived experience, and none referenced certification or accreditation processes such as app libraries. Scientific language was the most frequently invoked form of support for use of mental health apps; however, high-quality evidence is not commonly described. Improved knowledge translation strategies may improve the adoption of other strategies, such as certification or lived experience co-design.

Use of Mental Health Apps by Breast Cancer Patients and Their Caregivers in the United States: Protocol for a Pilot Pre-Post Study.

BackgroundOver one-third of cancer patients experience clinically significant mental distress, and distress in caregivers can exceed that of the cancer patients for whom they care. There is an urgent need to identify scalable and cost-efficient ways of delivering mental health interventions to cancer patients and their loved ones.ObjectiveThe aim of this study is to describe the protocol to pilot a mobile app–based mental health intervention in breast cancer patients and caregivers.MethodsThe IntelliCare mental health apps are grounded in evidence-based research in psychology. They have not been examined in cancer populations. This pilot study will adopt a within-subject, pre-post study design to inform a potential phase III randomized controlled trial. A target sample of 50 individuals (with roughly equal numbers of patients and caregivers) at least 18 years of age and fluent in English will be recruited at a US National Cancer Institute designated clinical cancer center. Consent will be obtained in writing and a mobile phone will be provided if needed. Self-report surveys assessing mental health outcomes will be administered at a baseline session and after a 7-week intervention. Before using the apps, participants will receive a 30-min coaching call to explain their purpose and function. A 10-min coaching call 3 weeks later will check on user progress and address questions or barriers to use. Self-report and semistructured interviews with participants at the end of the study period will focus on user experience and suggestions for improving the apps and coaching in future studies.ResultsThis study is ongoing, and recruitment will be completed by the end of 2018.ConclusionsResults from this study will inform how scalable mobile phone-delivered programs can be used to support breast cancer patients and their loved ones.Trial RegistrationClinicalTrials.gov NCT03488745; https://clinicaltrials.gov/ct2/show/NCT03488745International Registered Report Identifier (IRRID)DERR1-10.2196/11452

Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study.

BackgroundDespite the popularity of mental health apps, it is unknown if they are actually used by those with mental illness. This study assessed whether differences in clinic setting may influence the use of mental health apps and which factors influence patient perception of apps.ObjectiveThe objective of this study was to gain an understanding of how individuals with mental illness use their mobile phones by exploring their access to mobile phones and their use of mental health apps.MethodsA single time point survey study was conducted over a 2-week period in February 2018 at two nearby outpatient psychiatry clinics: one serving largely mood and anxiety disorder patients with private insurance staffed by both faculty and residents and the other serving largely psychotic disorder patients in a state Department of Mental Health (DMH) setting. A total of 25 patients at the state DMH clinic also consented for a single time point observation of apps currently installed on their personal mobile phone.ResultsA total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10%. Verifying current apps on patients’ mobile phones at the state DMH clinic confirmed that approximately 10% had mental health apps installed. Patients at both clinics were most concerned about privacy of mental health apps, although those at the state DMH clinic viewed cost savings as the greatest benefit while those at the private clinic reported time as the greatest benefit.ConclusionsHigh interest in mental health apps does not automatically translate into high use. Our results of low but similar rates of mental health app use at diverse clinics suggests DMH patients with largely psychotic disorders are as interested and engaged with apps as those in a private insurance clinic treating largely mood and anxiety disorders. Results from our study also highlight the importance of understanding how actual patients are using apps instead of relying on internet-based samples, which often yield higher results due to their likelihood of being selected.