Mobile-based interventions for common mental disorders in youth: a systematic evaluation of pediatric health apps

Abstract Background The access to empirically-supported treatments for common mental disorders in children and adolescents is often limited. Mental health apps might extend service supplies, as they are deemed to be cost-efficient, scalable and appealing for youth. However, little is known about the quality of available apps. Therefore, we aimed to systematically evaluate current mobile-based interventions for pediatric anxiety, depression and posttraumatic stress disorder (PTSD). Methods Systematic searches were conducted in Google Play Store and Apple App Store to identify relevant apps. To be eligible for inclusion, apps needed to be: (1) designed to target either anxiety, depression or PTSD in youth (0–18 years); (2) developed for children, adolescents or caregivers; (3) provided in English or German; (4) operative after download. The quality of eligible apps was assessed with two standardized rating systems (i.e., Mobile App Rating Scale (MARS) and ENLIGHT) independently by two reviewers. Results Overall, the searches revealed 3806 apps, with 15 mental health apps (0.39%) fulfilling our inclusion criteria. The mean overall scores suggested a moderate app quality (MARS: M = 3.59, SD = 0.50; ENLIGHT: M = 3.22, SD = 0.73). Moreover, only one app was evaluated in an RCT. The correlation of both rating scales was high (r = .936; p < .001), whereas no significant correlations were found between rating scales and user ratings (p > .05). Conclusions Our results point to a rather poor overall app quality, and indicate an absence of scientific-driven development and lack of methodologically sound evaluation of apps. Thus, future high-quality research is required, both in terms of theoretically informed intervention development and assessment of mental health apps in RCTs. Furthermore, institutionalized best-practices that provide central information on different aspects of apps (e.g., effectiveness, safety, and data security) for patients, caregivers, stakeholders and mental health professionals are urgently needed.

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Quality of service and commitment to tobacco dependence treatment for individuals living with mental disorders in France: A pilot study

International Journal of Social Psychiatry ◽

10.1177/00207640211042914 ◽

2021 ◽

pp. 002076402110429

Author(s):

João M Castaldelli-Maia ◽

Priscila D Gonçalves ◽

Danielle R Lima ◽

Helena F Moura ◽

Gisèle Apter

Keyword(s):

Mental Health ◽

Quality Of Service ◽

Pilot Study ◽

Mental Disorders ◽

Mental Health Professionals ◽

Health Professionals ◽

Tobacco Dependence ◽

Treatment Quality ◽

Tobacco Treatment

Background: There are remarkably high smoking rates in patients living with mental disorders (PLWMD), and the absence of a specific treatment policy for smoking cessation for these patients worldwide. The present study aimed to (i) investigate the quality of service and commitment to tobacco dependence treatment, and (ii) produce high-quality French versions of the Index of Tobacco Treatment Quality (ITTQ) and Tobacco Treatment Commitment Scale (TTCS). Methods: ITTQ and TTCS were used to assess French mental health professionals ( n = 80). Both scales were translated from their original language following standard procedures (i.e. forward translation). Descriptive analysis for total score, each factor and item were calculated for the entire sample, followed by subgroup analysis by gender, and role of the practitioner. Results: Nurses presented higher levels of both treatment commitment and treatment quality in their mental health care units, compared to psychiatrists, and residents. Overall, counseling offering was low and there was a perception that it is unfair to take tobacco away from PLWMD. In the other hand, there were high levels of smoking assessment and perceptions that nicotine dependence should be included in drug treatment programs. Conclusions: There is a gap in tobacco treatment implementation for French PLWMD. The present pilot study alerts about the problem, and should stimulate larger studies validating such measures for wide use with French-speaking mental health professionals. French nurses presented higher levels of both treatment commitment and quality, and could be in a leadership position for such implementation. Encouraging the implementation of tobacco counseling within conventional mental health treatment is critical to improve cessation rates among this population. There is a potential for the sustainability of tobacco treatment interventions since the levels of commitment observed here were higher than in previous studies conducted abroad.

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The Arabic Version of the Mobile App Rating Scale: Development and Validation Study (Preprint)

10.2196/preprints.16956 ◽

2019 ◽

Author(s):

Marco Bardus ◽

Nathalie Awada ◽

Lilian A Ghandour ◽

Elie-Jacques Fares ◽

Tarek Gherbal ◽

...

Keyword(s):

Weight Management ◽

Information Quality ◽

Rating Scale ◽

Arab World ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Mobile App ◽

Health Apps ◽

Highly Correlated

BACKGROUND With thousands of health apps in app stores globally, it is crucial to systemically and thoroughly evaluate the quality of these apps due to their potential influence on health decisions and outcomes. The Mobile App Rating Scale (MARS) is the only currently available tool that provides a comprehensive, multidimensional evaluation of app quality, which has been used to compare medical apps from American and European app stores in various areas, available in English, Italian, Spanish, and German. However, this tool is not available in Arabic. OBJECTIVE This study aimed to translate and adapt MARS to Arabic and validate the tool with a sample of health apps aimed at managing or preventing obesity and associated disorders. METHODS We followed a well-established and defined “universalist” process of cross-cultural adaptation using a mixed methods approach. Early translations of the tool, accompanied by confirmation of the contents by two rounds of separate discussions, were included and culminated in a final version, which was then back-translated into English. Two trained researchers piloted the MARS in Arabic (MARS-Ar) with a sample of 10 weight management apps obtained from Google Play and the App Store. Interrater reliability was established using intraclass correlation coefficients (ICCs). After reliability was ascertained, the two researchers independently evaluated a set of additional 56 apps. RESULTS MARS-Ar was highly aligned with the original English version. The ICCs for MARS-Ar (0.836, 95% CI 0.817-0.853) and MARS English (0.838, 95% CI 0.819-0.855) were good. The MARS-Ar subscales were highly correlated with the original counterparts (P<.001). The lowest correlation was observed in the area of usability (r=0.685), followed by aesthetics (r=0.827), information quality (r=0.854), engagement (r=0.894), and total app quality (r=0.897). Subjective quality was also highly correlated (r=0.820). CONCLUSIONS MARS-Ar is a valid instrument to assess app quality among trained Arabic-speaking users of health and fitness apps. Researchers and public health professionals in the Arab world can use the overall MARS score and its subscales to reliably evaluate the quality of weight management apps. Further research is necessary to test the MARS-Ar on apps addressing various health issues, such as attention or anxiety prevention, or sexual and reproductive health.

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The German Version of the Mobile App Rating Scale (MARS-G): Development and Validation Study

JMIR mhealth and uhealth ◽

10.2196/14479 ◽

2020 ◽

Vol 8 (3) ◽

pp. e14479 ◽

Cited By ~ 11

Author(s):

Eva-Maria Messner ◽

Yannik Terhorst ◽

Antonia Barke ◽

Harald Baumeister ◽

Stoyan Stoyanov ◽

...

Keyword(s):

Internal Consistency ◽

Rating Scale ◽

Assessment Tool ◽

Disease Onset ◽

Mobile App ◽

Systematic Evaluation ◽

German Version ◽

Validity And Reliability ◽

Health Apps

Background The number of mobile health apps (MHAs), which are developed to promote healthy behaviors, prevent disease onset, manage and cure diseases, or assist with rehabilitation measures, has exploded. App store star ratings and descriptions usually provide insufficient or even false information about app quality, although they are popular among end users. A rigorous systematic approach to establish and evaluate the quality of MHAs is urgently needed. The Mobile App Rating Scale (MARS) is an assessment tool that facilitates the objective and systematic evaluation of the quality of MHAs. However, a German MARS is currently not available. Objective The aim of this study was to translate and validate a German version of the MARS (MARS-G). Methods The original 19-item MARS was forward and backward translated twice, and the MARS-G was created. App description items were extended, and 104 MHAs were rated twice by eight independent bilingual researchers, using the MARS-G and MARS. The internal consistency, validity, and reliability of both scales were assessed. Mokken scale analysis was used to investigate the scalability of the overall scores. Results The retranslated scale showed excellent alignment with the original MARS. Additionally, the properties of the MARS-G were comparable to those of the original MARS. The internal consistency was good for all subscales (ie, omega ranged from 0.72 to 0.91). The correlation coefficients (r) between the dimensions of the MARS-G and MARS ranged from 0.93 to 0.98. The scalability of the MARS (H=0.50) and MARS-G (H=0.48) were good. Conclusions The MARS-G is a reliable and valid tool for experts and stakeholders to assess the quality of health apps in German-speaking populations. The overall score is a reliable quality indicator. However, further studies are needed to assess the factorial structure of the MARS and MARS-G.

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Living under siege: resilience, hopelessness, and psychological distress among Palestinian students in the Gaza Strip

Global Mental Health ◽

10.1017/gmh.2021.37 ◽

2021 ◽

Vol 8 ◽

Author(s):

Guido Veronese ◽

Alessandro Pepe ◽

Marwan Diab ◽

Yasser Abu Jamey ◽

Ashraf Kagee

Keyword(s):

Mental Health ◽

Human Rights ◽

Psychological Distress ◽

Mental Disorders ◽

Common Mental Disorders ◽

Gaza Strip ◽

Mental Symptoms ◽

The Gaza Strip ◽

Anxiety Depression ◽

The Impact

Abstract Background Moving from an approach oriented to adaptation and functioning, the current paper explored the network of cumulative associations between the effects of the siege and resilience on mental health. Methods We sought to explore the impact of the siege on psychological distress (anxiety, depression, and stress) and the moderating effect of resilience and hopelessness in a sample of 550 Palestinian university students. We hypothesized that the siege effect would impact psychological distress so that the more people were affected by the siege, the more mental symptoms of common mental disorders they would report. We also expected that the siege would negatively impact both resilience and participants' hopelessness. Results Findings showed that higher scores on the scale measuring effect of the siege were associated with hopelessness. Furthermore, living under siege compromised participants’ resilience. The more the siege affected individuals, the lower resilience were protecting participants mental health and the more hopelessness was exposing them to anxiety, stress, and depression. Conclusion Our findings draw attention to how the ongoing violation of human rights influences people's mental health in Gaza. Implications for clinicians and policymakers are discussed.

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Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the "Needle in a Haystack" (Preprint)

10.2196/preprints.17085 ◽

2019 ◽

Author(s):

Florian Dittrich ◽

Sascha Beck ◽

Anna Katharina Harren ◽

Felix Reinecke ◽

Sebastian Serong ◽

...

Keyword(s):

Rating Scale ◽

Mobile App ◽

High Quality ◽

Clinical Routine ◽

Health Apps ◽

App Store ◽

Orthopedic Surgeons ◽

Future Challenges ◽

Mobile Health Apps

BACKGROUND It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. OBJECTIVE This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. METHODS We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis–checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. RESULTS The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. CONCLUSIONS The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice.

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Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation (Preprint)

10.2196/preprints.34054 ◽

2021 ◽

Author(s):

Xiaoqian Wu ◽

Lin Xu ◽

PengFei Li ◽

TingTing Tang ◽

Cheng Huang

Keyword(s):

Mental Health ◽

Rating Scale ◽

Mobile Apps ◽

Scientific Basis ◽

Mobile App ◽

Security Measures ◽

Privacy And Security ◽

Health Apps ◽

Mental Health Awareness ◽

Privacy Measures

BACKGROUND Mental disorders impose varying degrees of burden on patients and their surroundings. However, people are reluctant to take the initiative to seek mental health services because of the uneven distribution of resources and stigmatization. Thus, mobile apps are considered an effective way to eliminate these obstacles and improve mental health awareness. OBJECTIVE This study aimed to evaluate the quality, function, privacy measures, and evidence-based and professional background of multipurpose mental health apps in Chinese commercial app stores. METHODS A systematic search was conducted on iOS and Android platforms in China to identify multipurpose mental health apps. Two independent reviewers evaluated the identified mobile apps using Mobile App Rating Scale (MARS). Each app was downloaded, and the general characteristics, privacy and security measures, development background, and functional characteristics of each app were evaluated. RESULTS A total of 40 apps were analyzed, of which 35 apps (87.5%) were developed by companies and 33 apps (82.5%) provided links to access the privacy policy; 52.5% did not mention the involvement of relevant professionals or the guidance of scientific basis in the app development process. The main built-in functions of these apps include psychological education (38/40, 95%), self-assessment (34/40, 85%), and counseling (33/40, 83%). The overall quality average MARS score of the 40 apps was 3.53 (standard deviation 0.39), and the total score was between 2.96 and 4.30. The total score of MARS was significantly positively correlated with the scores of each subscale (r = 0.62–0.88; P <.001). However, the user score of the app market was not significantly correlated with the total score of MARS (r = 0.23; P =.19). CONCLUSIONS The quality of multipurpose mental health apps in China’s main app market is generally good and provides various functional combinations. However, health professionals are less involved in the development of these apps, and the privacy protection policy of the apps also needs to be described in more detail. This study provides a reference for the development of multipurpose mental health apps.

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Universal mental health screening with a focus on suicidal behaviour using smartphones in a Mexican rural community: protocol for the SMART-SCREEN population-based survey

BMJ Open ◽

10.1136/bmjopen-2019-035041 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035041

Author(s):

Pavel E Arenas-Castañeda ◽

Fuensanta Aroca Bisquert ◽

Ismael Martinez-Nicolas ◽

Luis A Castillo Espíndola ◽

Igor Barahona ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Suicide Risk ◽

Rating Scales ◽

Well Being ◽

Population Based ◽

Mobile App ◽

Health Concern ◽

Suicide Mortality ◽

Computer Assisted

IntroductionMental disorders represent the second cause of years lived with disability worldwide. Suicide mortality has been targeted as a key public health concern by the WHO. Smartphone technology provides a huge potential to develop massive and fast surveys. Given the vast cultural diversity of Mexico and its abrupt orography, smartphone-based resources are invaluable in order to adequately manage resources, services and preventive measures in the population. The objective of this study is to conduct a universal suicide risk screening in a rural area of Mexico, measuring also other mental health outcomes such as depression, anxiety and alcohol and substance use disorders.Methods and analysisA population-based cross-sectional study with a temporary sampling space of 9 months will be performed between September 2019 and June 2020. We expect to recruit a large percentage of the target population (at least 70%) in a short-term survey of Milpa Alta Delegation, which accounts for 137 927 inhabitants in a territorial extension of 288 km2.They will be recruited via an institutional call and a massive public campaign to fill in an online questionnaire through mobile-assisted or computer-assisted web app. This questionnaire will include data on general health, validated questionnaires including Well-being Index 5, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale 2, Alcohol Use Disorders Identification Test, selected questions of the Drug Abuse Screening Test and Columbia-Suicide Severity Rating Scales and Diagnostic and statistical manual of mental disorders (DSM-5) questions about self-harm.We will take into account information regarding time to mobile app response and geo-spatial location, and aggregated data on social, demographical and environmental variables. Traditional regression modelling, multilevel mixed methods and data-driven machine learning approaches will be used to test hypotheses regarding suicide risk factors at the individual and the population level.Ethics and disseminationEthical approval (002/2019) was granted by the Ethics Review Board of the Hospital Psiquiátrico Yucatán, Yucatán (Mexico). This protocol has been registered in ClinicalTrials.gov. The starting date of the study is 3 September 2019. Results will serve for the planning and healthcare of groups with greater mental health needs and will be disseminated via publications in peer-reviewed journal and presented at relevant mental health conferences.Trial registration numberNCT04067063.

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Quality evaluation of smartphone applications for laboratory medicine

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-0710 ◽

2018 ◽

Vol 57 (3) ◽

pp. 388-397 ◽

Cited By ~ 1

Author(s):

Snežana Jovičić ◽

Joanna Siodmiak ◽

Ian D. Watson

Keyword(s):

Quality Evaluation ◽

Rating Scale ◽

Laboratory Medicine ◽

Mobile App ◽

Subjective Quality ◽

Total Quality ◽

Technical Aspects ◽

Health Apps ◽

Significant Difference

Abstract Background Many of the mobile applications (apps) used for delivering health interventions involve laboratory medicine data. This survey was conducted to search the online market for health apps that manage laboratory medicine data. The aim was to review them and perform a quality evaluation. Methods Apps search criteria were “Lab results blood work”, “Lab results”, and “Health apps”. After the stepwise exclusion process, 52 selected apps were downloaded and analyzed. For review and content analysis of the apps, a multidimensional tool for classifying and rating the quality of mobile health apps – Mobile App Rating Scale (MARS), was used. Results Selected apps were classified into five categories according to their intended use by patients or physicians, and the type of data engaged. Spearman’s correlation analysis found significant correlations between MARS individual scoring items, as with the subjective quality and number of technical aspects. Kruskal-Wallis analysis showed a significant difference in the number of technical aspects employed, MARS engagement and informational quality score items, total score, and subjective quality. The lowest values for all of these items were in the category of apps designed for patients, and the post hoc test showed that the difference was statistically significant between this and the values in all other categories. Conclusions Apps designed for patients, are of the poorest quality, considering the total quality of the content and information they provide, estimated using the MARS tool. This estimation needs to be validated for laboratory medicine apps, and eventually modified after consideration of specific quality benchmarks.

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Common Mental Disorders

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i3.6308 ◽

2012 ◽

Vol 9 (3) ◽

pp. 213-217

Author(s):

A Risal

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Mental Health Professionals ◽

Common Mental Disorders ◽

Economic Status ◽

Pathways To Care ◽

Middle Income

Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms typically encountered in community and primary care settings. Risk factors for these disorders are mainly lower socio-economic status, psychological illnesses, poor reproductive health, gender disadvantage and physical ill-health. WHO has recommended that treatment of all these disorders should be based in primary care to be more effective and accessible to all the community people. The structure of mental health care in primary care is generally understood in terms of the “pathways to care” model and it plays a major role in countries like ours where community-based mental health services do not exist. Both the psychological and pharmacological therapies are found to be equally effective for treating these disorders. Integration of mental health into primary care can be considered as the stepping stone in the way forward to tackle the barriers and problems in effective management of common mental disorders in the community. The acute shortage of mental health professionals and the relatively low levels of awareness about mental disorders make it mandatory that primary health care should remain the single largest sector for mental health care in low and middle income countries like ours.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6308 Kathmandu Univ Med J 2011;9(3):213-7

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The Arabic Version of the Mobile App Rating Scale: Development and Validation Study

JMIR mhealth and uhealth ◽

10.2196/16956 ◽

2020 ◽

Vol 8 (3) ◽

pp. e16956

Author(s):

Marco Bardus ◽

Nathalie Awada ◽

Lilian A Ghandour ◽

Elie-Jacques Fares ◽

Tarek Gherbal ◽

...

Keyword(s):

Weight Management ◽

Information Quality ◽

Rating Scale ◽

Arab World ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Mobile App ◽

Health Apps ◽

Highly Correlated

Background With thousands of health apps in app stores globally, it is crucial to systemically and thoroughly evaluate the quality of these apps due to their potential influence on health decisions and outcomes. The Mobile App Rating Scale (MARS) is the only currently available tool that provides a comprehensive, multidimensional evaluation of app quality, which has been used to compare medical apps from American and European app stores in various areas, available in English, Italian, Spanish, and German. However, this tool is not available in Arabic. Objective This study aimed to translate and adapt MARS to Arabic and validate the tool with a sample of health apps aimed at managing or preventing obesity and associated disorders. Methods We followed a well-established and defined “universalist” process of cross-cultural adaptation using a mixed methods approach. Early translations of the tool, accompanied by confirmation of the contents by two rounds of separate discussions, were included and culminated in a final version, which was then back-translated into English. Two trained researchers piloted the MARS in Arabic (MARS-Ar) with a sample of 10 weight management apps obtained from Google Play and the App Store. Interrater reliability was established using intraclass correlation coefficients (ICCs). After reliability was ascertained, the two researchers independently evaluated a set of additional 56 apps. Results MARS-Ar was highly aligned with the original English version. The ICCs for MARS-Ar (0.836, 95% CI 0.817-0.853) and MARS English (0.838, 95% CI 0.819-0.855) were good. The MARS-Ar subscales were highly correlated with the original counterparts (P<.001). The lowest correlation was observed in the area of usability (r=0.685), followed by aesthetics (r=0.827), information quality (r=0.854), engagement (r=0.894), and total app quality (r=0.897). Subjective quality was also highly correlated (r=0.820). Conclusions MARS-Ar is a valid instrument to assess app quality among trained Arabic-speaking users of health and fitness apps. Researchers and public health professionals in the Arab world can use the overall MARS score and its subscales to reliably evaluate the quality of weight management apps. Further research is necessary to test the MARS-Ar on apps addressing various health issues, such as attention or anxiety prevention, or sexual and reproductive health.

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