Education on depression in mental health apps: Systematic assessment of characteristics and adherence with evidence-based guidelines (Preprint)

BACKGROUND Mental health disorders affect one in ten people globally, of which around 300 million are affected by depression. At least half of affected people remain untreated. Cognitive behavioral therapy (CBT) is an effective treatment but access to specialized providers, habitually challenging, has worsened with COVID-19. Internet-based CBT (iCBT) is effective and a feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression but accessing the right app might be cumbersome given the large number and wide variety of apps offered by public app marketplaces. OBJECTIVE To systematically assess features, functionality, data security and congruence with evidence of self-guided CBT-based apps available in major app stores, suitable for users suffering from depression. METHODS A systematic assessment of self-guided CBT-based apps available in Google Play and Apple’s App Store was conducted. Apps launched or updated since August 2018 were identified through a systematic search in 42matters using CBT-related terms. Apps meeting inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, comprising apps’ general characteristics, CBT-related features, including six evidence-based CBT techniques as informed by a CBT manual, CBT competences framework and a literature review of iCBT clinical trial protocols (psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety), and technical aspects and quality assurance. Results were reported as a narrative review, using descriptive statistics. RESULTS The initial search yielded 3006 apps, of which 98 apps met inclusion criteria and were systematically assessed. There were 20 wellbeing apps, 65 mental health apps and 13 depression apps. Twenty-eight apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 77/98 apps. Only a third of apps offered suicide- risk management resources while less than 20% of apps offered COVID-19-related information. Most apps included a privacy policy, but only a third of apps presented it before account creation. Eighty percent of privacy policies stated sharing data with third party service providers. Half of app development teams included academic institutions or healthcare providers. CONCLUSIONS Only few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in the health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient-centered and enhance users’ data security. CLINICALTRIAL NA

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Mental health apps education on depression: Systematic assessment (Preprint)

10.2196/preprints.28942 ◽

2021 ◽

Author(s):

Laura Martinengo ◽

Anne-Claire Stona ◽

Lorainne Tudor Car ◽

Jimmy Lee ◽

Konstadina Griva ◽

...

Keyword(s):

Mental Health ◽

Clinical Guidelines ◽

Help Seeking ◽

Support Network ◽

Evidence Based ◽

Educational Content ◽

Systematic Assessment ◽

Android Apps ◽

Symptoms Of Depression ◽

Health Apps

BACKGROUND Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of included information is unclear OBJECTIVE To systematically evaluate adherence to depression clinical guidelines of the information offered by mental health apps available in major commercial app stores. METHODS A systematic assessment of the educational content about depression in apps available in Google Play and Apple’s App Store was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting inclusion criteria were downloaded and assessed using an iPhone 7 (iOS 14.0.1) and a Sony XPERIA XZs (Android 8.0.0) smartphones. The 156 questions assessment checklist comprised general characteristics of apps, appraisal of educational content and its adherence to evidence-based clinical guidelines, and technical aspects and quality assurance. Results were tabulated and reported as a narrative review, using descriptive statistics. RESULTS The app search retrieved 2,218 apps of which 58 were included in the analysis (29 Android apps and 29 iOS apps). Thirty-seven apps (64%) offered educational content within a more comprehensive depression or mental health management app. Twelve apps (21%) provided non-evidence-based information. Most apps (51/58, 88%) included up to 20/38 educational topics assessed. Common educational topics were listing symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% of apps, while suicide risk was mentioned by 71% of apps, generally as one item in a list of symptoms. Forty-four (76%) apps highlighted the importance of help-seeking, and 50% of apps emphasized the importance of involving the user’s support network. Thirty apps (52%) referenced their content and ten apps (17%) included advertisements. CONCLUSIONS Information in mental health and depression apps is often brief and incomplete. One in five apps provided non-evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education and/or point the users to relevant resources. A multi-stakeholder consensus on a more stringent development and publication process for mental health apps is imperative.

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Mobile Mental Health Apps in China: Systematic App Store Search (Preprint)

10.2196/preprints.14915 ◽

2019 ◽

Author(s):

Huifang Yin ◽

Klaas J Wardenaar ◽

Yuhao Wang ◽

Nan Wang ◽

Wenjin Chen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Problems ◽

Mobile Apps ◽

Psychiatric Patients ◽

Evidence Based ◽

Health Apps ◽

Main Technique ◽

Stress Relieving ◽

Mobile Mental Health

BACKGROUND Smartphones have become ubiquitous in China, offering a promising way to deliver mental health interventions; however, little is known about the current use and characteristics of smartphone apps for mental health. OBJECTIVE The purpose of this study was to gain insight into mobile mental health apps available in China as of December 2018. METHODS A systematic search was conducted to identify and evaluate the most downloaded apps from iOS and Android platforms. Apps were categorized according to their main purpose and downloaded to evaluate their content. Each app’s affiliation, cost, target users, information security, and evidence-based nature were evaluated. RESULTS Of the 172 unique apps that were identified, there were 37 apps (21.5%) for psychological counseling, 50 apps (29.1%) for assessment, 12 apps (7.0%) to relieve stress, 24 apps (14.0%) for psychoeducation, and 49 (28.4%) multipurpose apps (ie, a combination of counseling and assessment). Most apps were developed for adults in the general population (166/172, 96.5%), rather than for psychiatric patients. App-based counseling was mostly provided by psychologists, and of the assessed apps, only 40% (70/172) used evidence-based scales to assess mental health problems such as anxiety or depressed mood. Guided meditation was used as the main technique in stress-relieving apps. CONCLUSIONS Many apps contained useful and evidence-based elements, such as good quality information, validated measurements, and useful meditation methods; however, for mobile apps to contribute significantly to mental health care in China, considerable challenges remain, including the need for more patient-focused apps that can actually take on the role of a health care provider. In addition, efficacy studies are needed.

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Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

Psychiatric Bulletin ◽

10.1017/s0955603600002567 ◽

2003 ◽

Vol 27 (07) ◽

pp. 266-270 ◽

Cited By ~ 8

Author(s):

David Meagher ◽

Maria Moran

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Quality Score ◽

Evidence Based ◽

Community Mental Health Service ◽

Prescribing Practice ◽

Quality Of Prescribing ◽

Evidence Based Guidelines

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

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Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

Psychiatric Bulletin ◽

10.1192/pb.27.7.266 ◽

2003 ◽

Vol 27 (7) ◽

pp. 266-270 ◽

Cited By ~ 13

Author(s):

David Meagher ◽

Maria Moran

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Quality Score ◽

Evidence Based ◽

Community Mental Health Service ◽

Prescribing Practice ◽

Quality Of Prescribing ◽

Evidence Based Guidelines

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

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Mobile Mental Health Apps in China: Systematic App Store Search

Journal of Medical Internet Research ◽

10.2196/14915 ◽

2020 ◽

Vol 22 (7) ◽

pp. e14915

Author(s):

Huifang Yin ◽

Klaas J Wardenaar ◽

Yuhao Wang ◽

Nan Wang ◽

Wenjin Chen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Problems ◽

Mobile Apps ◽

Psychiatric Patients ◽

Evidence Based ◽

Health Apps ◽

Main Technique ◽

Stress Relieving ◽

Mobile Mental Health

Background Smartphones have become ubiquitous in China, offering a promising way to deliver mental health interventions; however, little is known about the current use and characteristics of smartphone apps for mental health. Objective The purpose of this study was to gain insight into mobile mental health apps available in China as of December 2018. Methods A systematic search was conducted to identify and evaluate the most downloaded apps from iOS and Android platforms. Apps were categorized according to their main purpose and downloaded to evaluate their content. Each app’s affiliation, cost, target users, information security, and evidence-based nature were evaluated. Results Of the 172 unique apps that were identified, there were 37 apps (21.5%) for psychological counseling, 50 apps (29.1%) for assessment, 12 apps (7.0%) to relieve stress, 24 apps (14.0%) for psychoeducation, and 49 (28.4%) multipurpose apps (ie, a combination of counseling and assessment). Most apps were developed for adults in the general population (166/172, 96.5%), rather than for psychiatric patients. App-based counseling was mostly provided by psychologists, and of the assessed apps, only 40% (70/172) used evidence-based scales to assess mental health problems such as anxiety or depressed mood. Guided meditation was used as the main technique in stress-relieving apps. Conclusions Many apps contained useful and evidence-based elements, such as good quality information, validated measurements, and useful meditation methods; however, for mobile apps to contribute significantly to mental health care in China, considerable challenges remain, including the need for more patient-focused apps that can actually take on the role of a health care provider. In addition, efficacy studies are needed.

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Mapping actions to improve access to medicines for mental disorders in low and middle income countries

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796016001165 ◽

2017 ◽

Vol 26 (5) ◽

pp. 481-490 ◽

Cited By ~ 3

Author(s):

C. Barbui ◽

T. Dua ◽

K. Kolappa ◽

B. Saraceno ◽

S. Saxena

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Essential Medicines ◽

World Health ◽

Evidence Based ◽

Appropriate Use ◽

Psychotropic Medicines ◽

Access To Essential Medicines ◽

Evidence Based Guidelines ◽

Improve Access

Aims.In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013–2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.Methods.Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.Results.A 4 × 4 framework mapping actions as a function of the four components of access – selection, availability, affordability and appropriate use – and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.Conclusions.Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.

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Pathophysiology of Tinnitus and Evidence-Based Options for Tinnitus Management

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig2.157 ◽

2017 ◽

Vol 2 (2) ◽

pp. 157-168

Author(s):

James A. Henry

Keyword(s):

Mental Health ◽

Cognitive Behavioral Therapy ◽

Hearing Aids ◽

Behavioral Therapy ◽

Evidence Based ◽

Sound Therapy ◽

Starting Point ◽

Evidence Based Guidelines ◽

To Receive ◽

Audiologic Evaluation

Tinnitus is the perception of sound that has no source outside of the head – it is a “phantom” sound. A great many people experience chronic tinnitus, which can be problematic to different degrees. To date, no cure for tinnitus has been discovered in spite of worldwide efforts from researchers studying the pathophysiological mechanisms of tinnitus. Until a cure is discovered, individuals whose tinnitus is bothersome have evidence-based options available. Tinnitus management is provided mainly by audiologists, otolaryngologists, and mental health (MH) providers. The starting point for most patients is to receive an audiologic evaluation. Audiologists can provide tinnitus counseling and fit hearing aids, both of which can be beneficial for tinnitus management. Patients with symptoms of secondary tinnitus (somatosounds) should be referred to an otolaryngologist for a medical examination. If further tinnitus-specific services are needed for primary (idiopathic) tinnitus, then MH providers can offer cognitive-behavioral therapy and audiologists can facilitate different approaches to sound therapy. It is essential for all providers to follow evidence-based guidelines when offering tinnitus management services.

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Digital health developments and drawbacks: a review and analysis of top-returned apps for bipolar disorder

International Journal of Bipolar Disorders ◽

10.1186/s40345-020-00202-4 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Sarah Lagan ◽

Abinaya Ramakrishnan ◽

Evan Lamont ◽

Aparna Ramakrishnan ◽

Mark Frye ◽

...

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Evaluation System ◽

Comprehensive Evaluation ◽

Mobile Apps ◽

Digital Health ◽

Unmet Need ◽

Evidence Based ◽

Mood Management ◽

Health Apps

Abstract Background Although a growing body of literature highlights the potential benefit of smartphone-based mobile apps to aid in self-management and treatment of bipolar disorder, it is unclear whether such evidence-based apps are readily available and accessible to a user of the app store. Results Using our systematic framework for the evaluation of mental health apps, we analyzed the accessibility, privacy, clinical foundation, features, and interoperability of the top-returned 100 apps for bipolar disorder. Only 56% of the apps mentioned bipolar disorder specifically in their title, description, or content. Only one app’s efficacy was supported in a peer-reviewed study, and 32 apps lacked privacy policies. The most common features provided were mood tracking, journaling, and psychoeducation. Conclusions Our analysis reveals substantial limitations in the current digital environment for individuals seeking an evidence-based, clinically usable app for bipolar disorder. Although there have been academic advances in development of digital interventions for bipolar disorder, this work has yet to be translated to the publicly available app marketplace. This unmet need of digital mood management underscores the need for a comprehensive evaluation system of mental health apps, which we have endeavored to provide through our framework and accompanying database (apps.digitalpsych.org).

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An Assessment Framework for e-Mental Health Apps in Canada: Results of a Modified Delphi Process (Preprint)

10.2196/preprints.10016 ◽

2018 ◽

Author(s):

Jennifer Zelmer ◽

Krystle van Hoof ◽

MaryAnn Notarianni ◽

Trevor van Mierlo ◽

Megan Schellenberg ◽

...

Keyword(s):

Mental Health ◽

Delphi Process ◽

Security And Privacy ◽

Rapid Review ◽

Evidence Based ◽

Assessment Framework ◽

Health Apps ◽

Modified Delphi ◽

Mapping Process ◽

Guiding Principles

BACKGROUND The number of e-mental health apps is increasing rapidly. Studies have shown that the use of some apps is beneficial, whereas others are ineffective or do not meet users’ privacy expectations. Individuals and organizations that curate, recommend, host, use, or pay for apps have an interest in categorizing apps according to the consensus criteria of usability and effectiveness. Others have previously published recommendations for assessing health-related apps; however, the extent to which these recommendations can be generalized across different population groups (eg, culture, gender, and language) remains unclear. This study describes an attempt by Canadian stakeholders to develop an e-mental health assessment framework that responds to the unique needs of people living in Canada in an evidence-based manner. OBJECTIVE The objective of our study was to achieve consensus from a broad group of Canadian stakeholders on guiding principles and criteria for a framework to assess e-mental health apps in Canada. METHODS We developed an initial set of guiding principles and criteria from a rapid review and environmental scan of pre-existing app assessment frameworks. The initial list was refined through a two-round modified Delphi process. Participants (N=25) included app developers and users, health care providers, mental health advocates, people with lived experience of a mental health problem or mental illness, policy makers, and researchers. Consensus on each guideline or criterion was defined a priori as at least 70% agreement. The first round of voting was conducted electronically. Prior to Round 2 voting, in-person presentations from experts and a persona empathy mapping process were used to explore the perspectives of diverse stakeholders. RESULTS Of all respondents, 68% (17/25) in Round 1 and 100% (13/13) in Round 2 agreed that a framework for evaluating health apps is needed to help Canadian consumers identify high-quality apps. Consensus was reached on 9 guiding principles: evidence based, gender responsive, culturally appropriate, user centered, risk based, internationally aligned, enabling innovation, transparent and fair, and based on ethical norms. In addition, 15 informative and evaluative criteria were defined to assess the effectiveness, functionality, clinical applicability, interoperability, usability, transparency regarding security and privacy, security or privacy standards, supported platforms, targeted users, developers’ transparency, funding transparency, price, user desirability, user inclusion, and meaningful inclusion of a diverse range of communities. CONCLUSIONS Canadian mental health stakeholders reached the consensus on a framework of 9 guiding principles and 15 criteria important in assessing e-mental health apps. What differentiates the Canadian framework from other scales is explicit attention to user inclusion at all stages of the development, gender responsiveness, and cultural appropriateness. Furthermore, an empathy mapping process markedly influenced the development of the framework. This framework may be used to inform future mental health policies and programs.

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