The State of Mental Health Smartphone Apps

Apps currently available offer goal tracking, psychoeducation, and mindfulness but lack state-of-the-art specialized therapies or biofeedback.

Mental health app popularity metrics offer limited help in identifying apps with more privacy. Current app marketplaces offer goal tracking, psychoeducation, and mindfulness but lack state-of-the-art specialized therapies or biofeedback, according to study findings published in the Journal of the American Medical Association Network Open.

Investigators sought to evaluate the current state of mental health apps, examine how or if that landscape has changed, and determine if a correlation exists between app popularity and app privacy scores. These investigators previously examined this data in March 2021. Since then, apps currently available have doubled in quantity, but investigators hypothesize little change in the mental health app landscape and no correlation between app privacy scores and popularity metrics.

They conducted a cross-sectional study evaluating 578 mental health apps using the public-facing M-Health Index and Navigation Database (MIND) in June 2022. Each app was evaluated across 6 categories (app origin and accessibility, privacy and security, clinical foundation, features and engagement, inputs and outputs, and interoperability). Specifically, privacy was ascertained by the existence of a privacy policy, security measures reported, data use and purpose declaration, data deletion availability, and opting out availability.

Apps added since the 2021 evaluation include supporting conditions for substance use (smoking and tobacco) (n=228), sleep (n=106), eating disorders (n=65), headache (n=48), and pain (n=47). All apps were gathered from the Google Play Store and the Apple App Store and entered into MIND by 1 of 10 app raters (college students, medical students, and research assistants who underwent a 4-hour interrater reliability training), then evaluated using MIND to answer 105 objective app questions.

The current app marketplaces primarily offered basic features such as psychoeducation, goal tracking, and mindfulness but fewer innovative features such as biofeedback or specialized therapies.

Investigators noted among the 578 apps (278 in 2021), 27.7% were available only on iOS, 26.6% available only on Android, and 45.7% were available on both. Additionally, 17% were available on the web. Among all apps, 91% were developed by for-profit companies.

There were 88% of the apps that advertised that the app was free to download, but 44% still required in-app purchases and 34% required subscriptions to unlock the entire app functionality. All apps were available in English and 18% were available in Spanish. There were 65% that functioned without an internet connection.

Investigators found the most frequent app features included psychoeducation (41%), goal setting (38%), and mindfulness (38%). The least common app features included biofeedback (1%), acceptance and commitment therapy (2%), and behavioral therapy (2%).

They noted 443 apps (77%) posted a privacy policy and there was no statistically significant correlation between privacy scores and Google Play Store star ratings (r=0.041; P =.48) or Apple App Store star ratings (r=0.058; P =.29). They noted a weak correlation between the number of app downloads on the Google Play Store and privacy scores (χ25 = 22.1; P <.001). The mean reading grade level for the privacy policies requires reading comprehension above grade 12. There were 44% of the apps that shared personal health information with third parties.

Surveys (45%), diary entries (34%), and microphone (21%) were the most common inputs. Notifications (68%), data summary (61%), and references and information (50%) were the most common outputs. Investigators noted 30% of the apps allowed users to export data, but only 2% offered integration with an electronic medical record.

Substance abuse related to smoking or tobacco (33%), stress and anxiety (28%), and nonserious mood disorders (20%) were the most common mental illness applications. The top 7 app features were unchanged from the 2021 analysis ([1] mood tracking, [2] journaling, [3] mindfulness, [4] psychoeducation, [5] deep breathing, [6] symptom tracking, and [7] goal-setting and habits).

Study limitations include the cross-sectional design, data derived from app self-declaration, no evaluation of quality of app features or the underlying science, inclusion of apps that cost $10 or less only, and the fact that content quality was not analyzed.

“The current app marketplaces primarily offered basic features such as psychoeducation, goal tracking, and mindfulness but fewer innovative features such as biofeedback or specialized therapies,” investigators concluded. They wrote “Privacy challenges remained common, and app popularity metrics provided little help in identifying apps with more privacy.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Camacho E, Cohen A, Torous J. Assessment of mental health services available through smartphone apps. JAMA Netw Open. Published online December 28, 2022. doi:10.1001/jamanetworkopen.2022.48784