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

Tania Lecomte, Stéphane Potvin, Marc Corbière, Stéphane Guay, Crystal Samson, Briana Cloutier, Audrey Francoeur, Antoine Pennou, Yasser Khazaal, Tania Lecomte, Stéphane Potvin, Marc Corbière, Stéphane Guay, Crystal Samson, Briana Cloutier, Audrey Francoeur, Antoine Pennou, Yasser Khazaal

Abstract

Background: Mental 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.

Objective: This 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.

Methods: Systematic 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.

Results: A 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.

Conclusions: This 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.

Keywords: anxiety; apps; depression; mental health; meta; review.

Conflict of interest statement

Conflicts of Interest: None declared.

©Tania Lecomte, Stéphane Potvin, Marc Corbière, Stéphane Guay, Crystal Samson, Briana Cloutier, Audrey Francoeur, Antoine Pennou, Yasser Khazaal. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 29.05.2020.

Figures

Figure 1
Figure 1
Flow diagram.

References

    1. Becker S, Miron-Shatz T, Schumacher N, Krocza J, Diamantidis C, Albrecht U. mHealth 2.0: experiences, possibilities, and perspectives. JMIR Mhealth Uhealth. 2014 May 16;2(2):e24. doi: 10.2196/mhealth.3328.
    1. Bradway M, Carrion C, Vallespin B, Saadatfard O, Puigdomènech E, Espallargues M, Kotzeva A. mHealth assessment: conceptualization of a global framework. JMIR Mhealth Uhealth. 2017 May 2;5(5):e60. doi: 10.2196/mhealth.7291.
    1. Martínez-Pérez B, de la Torre-Díez I, López-Coronado M. Mobile health applications for the most prevalent conditions by the World Health Organization: review and analysis. J Med Internet Res. 2013 Jun 14;15(6):e120. doi: 10.2196/jmir.2600.
    1. van Singer M, Chatton A, Khazaal Y. Quality of smartphone apps related to panic disorder. Front Psychiatry. 2015;6:96. doi: 10.3389/fpsyt.2015.00096. doi: 10.3389/fpsyt.2015.00096.
    1. Penzenstadler L, Chatton A, van Singer M, Khazaal Y. Quality of smartphone apps related to alcohol use disorder. Eur Addict Res. 2016;22(6):329–38. doi: 10.1159/000449097.
    1. Nicholas J, Larsen ME, Proudfoot J, Christensen H. Mobile apps for bipolar disorder: a systematic review of features and content quality. J Med Internet Res. 2015 Aug 17;17(8):e198. doi: 10.2196/jmir.4581.
    1. Choi J, Noh G, Park D. Smoking cessation apps for smartphones: content analysis with the self-determination theory. J Med Internet Res. 2014 Feb 12;16(2):e44. doi: 10.2196/jmir.3061.
    1. Azar KM, Lesser LI, Laing BY, Stephens J, Aurora MS, Burke LE, Palaniappan LP. Mobile applications for weight management: theory-based content analysis. Am J Prev Med. 2013 Nov;45(5):583–9. doi: 10.1016/j.amepre.2013.07.005.
    1. Bell IH, Lim MH, Rossell SL, Thomas N. Ecological momentary assessment and intervention in the treatment of psychotic disorders: a systematic review. Psychiatr Serv. 2017 Nov 1;68(11):1172–81. doi: 10.1176/appi.ps.201600523.
    1. World Health Organization. 2017. [2020-03-22]. Frequently Asked Questions on Global Task Force on Digital Health for TB and Its Work
    1. Rahmani AM, Gia TN, Negash B, Anzanpour A, Azimi I, Jiang M, Liljeberg P. Exploiting smart e-Health gateways at the edge of healthcare Internet-of-Things: A fog computing approach. Future Gener Comput Syst. 2018 Jan;78:641–58. doi: 10.1016/j.future.2017.02.014.
    1. International Telecommunications Union. 2016. ICT Facts and Figures - 2016 .
    1. Owen JE, Jaworski BK, Kuhn E, Makin-Byrd KN, Ramsey KM, Hoffman JE. mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR Ment Health. 2015;2(1):e7. doi: 10.2196/mental.3935.
    1. Monney G, Penzenstadler L, Dupraz O, Etter J, Khazaal Y. mHealth app for cannabis users: satisfaction and perceived usefulness. Front Psychiatry. 2015;6:120. doi: 10.3389/fpsyt.2015.00120. doi: 10.3389/fpsyt.2015.00120.
    1. Kiluk BD, Carroll KM. New developments in behavioral treatments for substance use disorders. Curr Psychiatry Rep. 2013 Dec;15(12):420. doi: 10.1007/s11920-013-0420-1.
    1. Sort A, Khazaal Y. Six tips on how to bring epic wins to health care. Front Psychiatry. 2017;8:264. doi: 10.3389/fpsyt.2017.00264. doi: 10.3389/fpsyt.2017.00264.
    1. Torous J, Hsin H. Empowering the digital therapeutic relationship: virtual clinics for digital health interventions. NPJ Digit Med. 2018;1:16. doi: 10.1038/s41746-018-0028-2.
    1. Fatseas M, Serre F, Swendsen J, Auriacombe M. Effects of anxiety and mood disorders on craving and substance use among patients with substance use disorder: an ecological momentary assessment study. Drug Alcohol Depend. 2018 Jun 1;187:242–8. doi: 10.1016/j.drugalcdep.2018.03.008.
    1. Jones A, Tiplady B, Houben K, Nederkoorn C, Field M. Do daily fluctuations in inhibitory control predict alcohol consumption? An ecological momentary assessment study. Psychopharmacology (Berl) 2018 May;235(5):1487–96. doi: 10.1007/s00213-018-4860-5.
    1. Merikangas KR, Swendsen J, Hickie IB, Cui L, Shou H, Merikangas AK, Zhang J, Lamers F, Crainiceanu C, Volkow ND, Zipunnikov V. Real-time mobile monitoring of the dynamic associations among motor activity, energy, mood, and sleep in adults with bipolar disorder. JAMA Psychiatry. 2019 Feb 1;76(2):190–8. doi: 10.1001/jamapsychiatry.2018.3546.
    1. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1–32. doi: 10.1146/annurev.clinpsy.3.022806.091415.
    1. Moore RC, Depp CA, Wetherell JL, Lenze EJ. Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults. J Psychiatr Res. 2016 Apr;75:116–23. doi: 10.1016/j.jpsychires.2016.01.011.
    1. Torous J, Wisniewski H, Bird B, Carpenter E, David G, Elejalde E, Fulford D, Guimond S, Hays R, Henson P, Hoffman L, Lim C, Menon M, Noel V, Pearson J, Peterson R, Susheela A, Troy H, Vaidyam A, Weizenbaum E, Naslund JA, Keshavan M. Creating a digital health smartphone app and digital phenotyping platform for mental health and diverse healthcare needs: an interdisciplinary and collaborative approach. J Technol Behav Sci. 2019 Apr 27;4(2):73–85. doi: 10.1007/s41347-019-00095-w. doi: 10.1007/s41347-019-00095-w.
    1. Neary M, Schueller SM. State of the field of mental health apps. Cogn Behav Pract. 2018 Nov;25(4):531–7. doi: 10.1016/j.cbpra.2018.01.002. doi: 10.1016/j.cbpra.2018.01.002.
    1. Mantani A, Kato T, Furukawa TA, Horikoshi M, Imai H, Hiroe T, Chino B, Funayama T, Yonemoto N, Zhou Q, Kawanishi N. Smartphone cognitive behavioral therapy as an adjunct to pharmacotherapy for refractory depression: randomized controlled trial. J Med Internet Res. 2017 Nov 3;19(11):e373. doi: 10.2196/jmir.8602.
    1. Berry N, Lobban F, Emsley R, Bucci S. Acceptability of interventions delivered online and through mobile phones for people who experience severe mental health problems: a systematic review. J Med Internet Res. 2016 May 31;18(5):e121. doi: 10.2196/jmir.5250.
    1. Firth J, Cotter J, Torous J, Bucci S, Firth JA, Yung AR. Mobile phone ownership and endorsement of 'mHealth' among people with psychosis: a meta-analysis of cross-sectional studies. Schizophr Bull. 2016 Mar;42(2):448–55. doi: 10.1093/schbul/sbv132.
    1. Naslund JA, Marsch LA, McHugo GJ, Bartels SJ. Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature. J Ment Health. 2015;24(5):321–32. doi: 10.3109/09638237.2015.1019054.
    1. Kuhn E, Kanuri N, Hoffman JE, Garvert DW, Ruzek JI, Taylor CB. A randomized controlled trial of a smartphone app for posttraumatic stress disorder symptoms. J Consult Clin Psychol. 2017 Mar;85(3):267–73. doi: 10.1037/ccp0000163.
    1. Batra S, Baker RA, Wang T, Forma F, DiBiasi F, Peters-Strickland T. Digital health technology for use in patients with serious mental illness: a systematic review of the literature. Med Devices (Auckl) 2017;10:237–51. doi: 10.2147/MDER.S144158. doi: 10.2147/MDER.S144158.
    1. Velligan D, Mintz J, Maples N, Xueying L, Gajewski S, Carr H, Sierra C. A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia. Schizophr Bull. 2013 Sep;39(5):999–1007. doi: 10.1093/schbul/sbs116.
    1. Ben-Zeev D, Kaiser SM, Brenner CJ, Begale M, Duffecy J, Mohr DC. Development and usability testing of FOCUS: a smartphone system for self-management of schizophrenia. Psychiatr Rehabil J. 2013 Dec;36(4):289–96. doi: 10.1037/prj0000019.
    1. Khazaal Y, Monney G, Richter F, Achab S. Game-control, rational of an application to support the limits of games. Article in French. Jeu-contrôle, rationnel d’une application de soutien aux limites de jeux. J Ther Comport Cogn. 2017 Sep;27(3):129–37. doi: 10.1016/j.jtcc.2017.05.003.
    1. Bertholet N, Godinho A, Cunningham JA. Smartphone application for unhealthy alcohol use: pilot randomized controlled trial in the general population. Drug Alcohol Depend. 2019 Feb 1;195:101–5. doi: 10.1016/j.drugalcdep.2018.12.002.
    1. Tait RJ, Kirkman JJ, Schaub MP. A participatory health promotion mobile app addressing alcohol use problems (the Daybreak Program): protocol for a randomized controlled trial. JMIR Res Protoc. 2018 May 31;7(5):e148. doi: 10.2196/resprot.9982.
    1. Gustafson DH, McTavish FM, Chih M, Atwood AK, Johnson RA, Boyle MG, Levy MS, Driscoll H, Chisholm SM, Dillenburg L, Isham A, Shah D. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014 May;71(5):566–72. doi: 10.1001/jamapsychiatry.2013.4642.
    1. Wright CJ, Dietze PM, Agius PA, Kuntsche E, Livingston M, Black OC, Room R, Hellard M, Lim MS. Mobile phone-based ecological momentary intervention to reduce young adults' alcohol use in the event: a three-armed randomized controlled trial. JMIR Mhealth Uhealth. 2018 Jul 20;6(7):e149. doi: 10.2196/mhealth.9324.
    1. Crane D, Garnett C, Michie S, West R, Brown J. A smartphone app to reduce excessive alcohol consumption: identifying the effectiveness of intervention components in a factorial randomised control trial. Sci Rep. 2018 Mar 12;8(1):4384. doi: 10.1038/s41598-018-22420-8. doi: 10.1038/s41598-018-22420-8.
    1. Firth J, Torous J, Nicholas J, Carney R, Rosenbaum S, Sarris J. Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. J Affect Disord. 2017 Aug 15;218:15–22. doi: 10.1016/j.jad.2017.04.046.
    1. Firth J, Torous J, Nicholas J, Carney R, Pratap A, Rosenbaum S, Sarris J. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017 Oct;16(3):287–98. doi: 10.1002/wps.20472. doi: 10.1002/wps.20472.
    1. Weisel KK, Fuhrmann LM, Berking M, Baumeister H, Cuijpers P, Ebert DD. Standalone smartphone apps for mental health-a systematic review and meta-analysis. NPJ Digit Med. 2019;2:118. doi: 10.1038/s41746-019-0188-8.
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW, Zaza S, GRADE Working Group Grading quality of evidence and strength of recommendations. Br Med J. 2004 Jun 19;328(7454):1490. doi: 10.1136/bmj.328.7454.1490.
    1. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011 Apr;64(4):401–6. doi: 10.1016/j.jclinepi.2010.07.015.
    1. Lindhiem O, Bennett CB, Rosen D, Silk J. Mobile technology boosts the effectiveness of psychotherapy and behavioral interventions: a meta-analysis. Behav Modif. 2015 Nov;39(6):785–804. doi: 10.1177/0145445515595198.
    1. Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF. Changing mental health and positive psychological well-being using ecological momentary interventions: a systematic review and meta-analysis. J Med Internet Res. 2016 Jun 27;18(6):e152. doi: 10.2196/jmir.5642.
    1. Stratton E, Lampit A, Choi I, Calvo RA, Harvey SB, Glozier N. Effectiveness of eHealth interventions for reducing mental health conditions in employees: a systematic review and meta-analysis. PLoS One. 2017;12(12):e0189904. doi: 10.1371/journal.pone.0189904.
    1. Linardon J, Cuijpers P, Carlbring P, Messer M, Fuller-Tyszkiewicz M. The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials. World Psychiatry. 2019 Oct;18(3):325–36. doi: 10.1002/wps.20673. doi: 10.1002/wps.20673.
    1. Witt K, Spittal MJ, Carter G, Pirkis J, Hetrick S, Currier D, Robinson J, Milner A. Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC Psychiatry. 2017 Aug 15;17(1):297. doi: 10.1186/s12888-017-1458-0.
    1. Opriş D, Pintea S, García-Palacios A, Botella C, Szamosközi S, David D. Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depress Anxiety. 2012 Feb;29(2):85–93. doi: 10.1002/da.20910.
    1. Pinquart M, Duberstein PR, Lyness JM. Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis. Aging Ment Health. 2007 Nov;11(6):645–57. doi: 10.1080/13607860701529635.
    1. Gruszka P, Burger C, Jensen MP. Optimizing expectations via mobile apps: a new approach for examining and enhancing placebo effects. Front Psychiatry. 2019;10:365. doi: 10.3389/fpsyt.2019.00365. doi: 10.3389/fpsyt.2019.00365.
    1. Torous J, Firth J. The digital placebo effect: mobile mental health meets clinical psychiatry. Lancet Psychiatry. 2016 Feb;3(2):100–2. doi: 10.1016/S2215-0366(15)00565-9.
    1. Giosan C, Cobeanu O, Mogoaşe C, Szentagotai A, Mureşan V, Boian R. Reducing depressive symptomatology with a smartphone app: study protocol for a randomized, placebo-controlled trial. Trials. 2017 May 12;18(1):215. doi: 10.1186/s13063-017-1960-1.
    1. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010 Oct 13;5(10):e13196. doi: 10.1371/journal.pone.0013196.
    1. Marzano L, Bardill A, Fields B, Herd K, Veale D, Grey N, Moran P. The application of mHealth to mental health: opportunities and challenges. Lancet Psychiatry. 2015 Oct;2(10):942–8. doi: 10.1016/S2215-0366(15)00268-0.
    1. Linardon J, Fuller-Tyszkiewicz M. Attrition and adherence in smartphone-delivered interventions for mental health problems: a systematic and meta-analytic review. J Consult Clin Psychol. 2020 Jan;88(1):1–13. doi: 10.1037/ccp0000459.
    1. Fleming TM, de Beurs D, Khazaal Y, Gaggioli A, Riva G, Botella C, Baños RM, Aschieri F, Bavin LM, Kleiboer A, Merry S, Lau HM, Riper H. Maximizing the impact of e-therapy and serious gaming: time for a paradigm shift. Front Psychiatry. 2016;7:65. doi: 10.3389/fpsyt.2016.00065. doi: 10.3389/fpsyt.2016.00065.
    1. Edwards EA, Lumsden J, Rivas C, Steed L, Edwards LA, Thiyagarajan A, Sohanpal R, Caton H, Griffiths CJ, Munafò MR, Taylor S, Walton RT. Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps. BMJ Open. 2016 Oct 4;6(10):e012447. doi: 10.1136/bmjopen-2016-012447.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa