Android and iPhone Mobile Apps for Psychosocial Wellness and Stress Management: Systematic Search in App Stores and Literature Review

Nancy Lau, Alison O'Daffer, Susannah Colt, Joyce P Yi-Frazier, Tonya M Palermo, Elizabeth McCauley, Abby R Rosenberg, Nancy Lau, Alison O'Daffer, Susannah Colt, Joyce P Yi-Frazier, Tonya M Palermo, Elizabeth McCauley, Abby R Rosenberg

Abstract

Background: In an oversaturated market of publicly available mobile apps for psychosocial self-care and stress management, health care providers, patients, and consumers interested in mental health-related apps may wonder which, if any, are efficacious. Readily available metrics for consumers include user popularity and media buzz rather than scientific evidence.

Objective: This systematic review aimed to (1) examine the breadth of therapeutic contents and features of psychosocial wellness and stress management apps available to self-help seekers for public download and (2) determine which of these apps have original research support.

Methods: First, we conducted a systematic review of publicly available apps on the iPhone App Store (Apple Inc) and Android Google Play (Google LLC) platforms using conventional self-help-seeking search terms related to wellness and stress. The results were limited to English-language apps available for free download. In total, 2 reviewers independently evaluated all apps and discussed the findings to reach 100% consensus regarding inclusion. Second, a literature review was conducted on the included apps to identify supporting studies with original data collection.

Results: We screened 3287 apps and found 1009 psychosocial wellness and stress management apps. Content varied widely. The most common evidence-based strategy was mindfulness-meditation, followed by positive psychology and goal setting. Most apps were intended to be used as self-help interventions, with only 1.09% (11/1009) involving an electronic therapist and 1.88% (19/1009) designed as a supplement to in-person psychotherapy. Only 4.66% (47/1009) of apps targeted individuals with psychological disorders, and less than 1% of apps (6/1009, 0.59%) targeted individuals with other chronic illnesses. Approximately 2% (21/1009, 2.08%) were supported by original research publications, with a total of 25 efficacy studies and 10 feasibility studies. The Headspace mindfulness app had the most evidence, including 8 efficacy studies. Most other scientifically backed apps were supported by a single feasibility or efficacy study.

Conclusions: Only 2.08% (21/1009) of publicly available psychosocial wellness and stress management mobile apps discoverable to self-help seekers have published, peer-reviewed evidence of feasibility and/or efficacy. Clinicians and investigators may use these findings to help patients and families navigate the volume of emerging digital health interventions for stress management and wellness.

Keywords: mHealth; mental health; mobile health.

Conflict of interest statement

Conflicts of Interest: None declared.

©Nancy Lau, Alison O'Daffer, Susannah Colt, Joyce P Yi-Frazier, Tonya M Palermo, Elizabeth McCauley, Abby R Rosenberg. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 22.05.2020.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses diagram.
Figure 2
Figure 2
Intervention and didactic content for all stress management apps (N=1009). Content categories were assigned based on descriptions by the app developer. Categories were not mutually exclusive, and a single app could be represented across one or more. E-therapist: electronic therapist.
Figure 3
Figure 3
Intervention and didactic content for research-supported apps (n=21) vs all stress management apps (N=1009). Content categories were assigned based on descriptions by the app developer. Categories were not mutually exclusive, and a single app could be represented across one or more.
Figure 4
Figure 4
Summary of risk of bias.

References

    1. Bakker D, Kazantzis N, Rickwood D, Rickard N. Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR Ment Health. 2016 Mar 1;3(1):e7. doi: 10.2196/mental.4984.
    1. Anderson M, Jiang J. Pew Research Center. 2018. [2020-04-02]. Teens, Social Media & Technology
    1. Pew Research Center. 2019. [2019-04-04]. Mobile Fact Sheet
    1. Meeker M, Wu L. RMS Media: The Media Specialists. 2013. [2020-04-14]. Internet Trends: D11 Conference .
    1. Mohr DC, Burns MN, Schueller SM, Clarke G, Klinkman M. Behavioral intervention technologies: evidence review and recommendations for future research in mental health. Gen Hosp Psychiatry. 2013;35(4):332–8. doi: 10.1016/j.genhosppsych.2013.03.008.
    1. Pohl M. Research2Guidance. 2017. [2019-10-01]. 325,000 Mobile Health Apps Available in 2017-Android Now the Leading Mhealth Platform
    1. Chib A, Lin SH. Theoretical advancements in mhealth: a systematic review of mobile apps. J Health Commun. 2018;23(10-11):909–55. doi: 10.1080/10810730.2018.1544676.
    1. Krebs P, Duncan DT. Health app use among us mobile phone owners: a national survey. JMIR Mhealth Uhealth. 2015 Nov 4;3(4):e101. doi: 10.2196/mhealth.4924.
    1. Bose J, Hedden S, Lipari R, Park-Lee E. SAMHSA: Substance Abuse and Mental Health Services. 2017. [2019-08-01]. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health .
    1. Anderson NB, Johnson SB, Belar C, Breckler S, Norda KC, Ballard D, Bufka LF, Bossolo L, Bethune S, Brownawell A, Kelley K. American Psychological Association. 2012. [2019-10-01]. Stress in America: Our Health at Risk .
    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. European Agency for Safety and Health at Work. 2014. [2019-07-01]. Calculating the Cost of Work-related Stress And Psychosocial Risks .
    1. Anderson M. Pew Research Center. 2019. [2019-06-19]. Mobile Technology and Home Broadband
    1. Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC. Barriers to mental health treatment: results from the national comorbidity survey replication. Psychol Med. 2011 Aug;41(8):1751–61. doi: 10.1017/S0033291710002291.
    1. Proudfoot J, Parker G, Hadzi Pavlovic D, Manicavasagar V, Adler E, Whitton A. Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress. J Med Internet Res. 2010 Dec 19;12(5):e64. doi: 10.2196/jmir.1475.
    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. Weekly T, Walker N, Beck J, Akers S, Weaver M. A review of apps for calming, relaxation, and mindfulness interventions for pediatric palliative care patients. Children (Basel) 2018 Jan 26;5(2):16. doi: 10.3390/children5020016.
    1. Greenle MM, Morgan B, Sayani S, Meghani SH. Identifying mobile apps targeting palliative care patients and family members. J Palliat Med. 2018 Oct;21(10):1380–5. doi: 10.1089/jpm.2018.0157.
    1. Coulon SM, Monroe CM, West DS. A systematic, multi-domain review of mobile smartphone apps for evidence-based stress management. Am J Prev Med. 2016 Jul;51(1):95–105. doi: 10.1016/j.amepre.2016.01.026.
    1. Livingston NA, Shingleton R, Heilman ME, Brief D. Self-help smartphone applications for alcohol use, PTSD, anxiety, and depression: addressing the new research-practice gap. J Technol Behav Sci. 2019 May 9;4(2):139–51. doi: 10.1007/s41347-019-00099-6.
    1. Statista. 2020. [2019-07-01]. Subscriber Share Held by Smartphone Operating Systems in the United States From 2012 to 2019
    1. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015 Jan 1;4:1. doi: 10.1186/2046-4053-4-1.
    1. van Daele T, Hermans D, van Audenhove C, van den Bergh O. Stress reduction through psychoeducation: a meta- analytic review. Health Educ Behav. 2012 Aug;39(4):474–85. doi: 10.1177/1090198111419202.
    1. Yates TM, Masten AS. Fostering the future: resilience theory and the practice of positive psychology. In: Linley PA, Joseph S, editors. Positive Psychology in Practice. New York City, USA: John Wiley & Sons; 2004. pp. 521–39.
    1. Farquharson L, MacLeod AK. A brief goal-setting and planning intervention to improve well-being for people with psychiatric disorders. Psychother Psychosom. 2014;83(2):122–4. doi: 10.1159/000356332.
    1. Gu J, Strauss C, Bond R, Cavanagh K. Corrigendum to 'how do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies' [clinical psychology review 37 (2015) 1-12] Clin Psychol Rev. 2016 Nov;49:119. doi: 10.1016/j.cpr.2016.09.011.
    1. Compas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, Williams E, Thigpen JC. Coping, emotion regulation, and psychopathology in childhood and adolescence: a meta-analysis and narrative review. Psychol Bull. 2017 Sep;143(9):939–91. doi: 10.1037/bul0000110.
    1. Davis DE, Choe E, Meyers J, Wade N, Varjas K, Gifford A, Quinn A, Hook JN, van Tongeren DR, Griffin BJ, Worthington EL. Thankful for the little things: a meta-analysis of gratitude interventions. J Couns Psychol. 2016 Jan;63(1):20–31. doi: 10.1037/cou0000107.
    1. Alarcon GM, Bowling NA, Khazon S. Great expectations: a meta-analytic examination of optimism and hope. Pers Individ Differ. 2013 May;54(7):821–7. doi: 10.1016/j.paid.2012.12.004.
    1. Layous K, Lyubomirsky S. The how, why, what, when, and who of happiness: mechanisms underlying the success of positive activity interventions. Positive Emot. 2014:473–95. doi: 10.1093/acprof:oso/9780199926725.003.0025.
    1. Anderson K, Burford O, Emmerton L. Mobile health apps to facilitate self-care: a qualitative study of user experiences. PLoS One. 2016;11(5):e0156164. doi: 10.1371/journal.pone.0156164.
    1. Lieberman M. HubSpot Blog. 2014. [2019-11-01]. 10 Stats About Inbound Marketing That Will Make Your Jaw Drop .
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group. Cochrane Statistical Methods Group The cochrane collaboration's tool for assessing risk of bias in randomised trials. Br Med J. 2011 Oct 18;343:d5928. doi: 10.1136/bmj.d5928.
    1. Fitzpatrick KK, Darcy A, Vierhile M. Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Ment Health. 2017 Jun 6;4(2):e19. doi: 10.2196/mental.7785.
    1. Walsh KM, Saab BJ, Farb NA. Effects of a mindfulness meditation app on subjective well-being: active randomized controlled trial and experience sampling study. JMIR Ment Health. 2019 Jan 8;6(1):e10844. doi: 10.2196/10844.
    1. Bush NE, Smolenski DJ, Denneson LM, Williams HB, Thomas EK, Dobscha SK. A virtual hope box: randomized controlled trial of a smartphone app for emotional regulation and coping with distress. Psychiatr Serv. 2017 Apr 1;68(4):330–6. doi: 10.1176/appi.ps.201600283.
    1. Roepke AM, Jaffee SR, Riffle OM, McGonigal J, Broome R, Maxwell B. Randomized controlled trial of SuperBetter, a smartphone-based/internet-based self-help tool to reduce depressive symptoms. Games Health J. 2015 Jun;4(3):235–46. doi: 10.1089/g4h.2014.0046.
    1. Athanas AJ, McCorrison JM, Smalley S, Price J, Grady J, Campistron J, Schork NJ. Association between improvement in baseline mood and long-term use of a mindfulness and meditation app: observational study. JMIR Ment Health. 2019 May 8;6(5):e12617. doi: 10.2196/12617.
    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. Possemato K, Kuhn E, Johnson E, Hoffman JE, Owen JE, Kanuri N, de Stefano L, Brooks E. Using PTSD coach in primary care with and without clinician support: a pilot randomized controlled trial. Gen Hosp Psychiatry. 2016;38:94–8. doi: 10.1016/j.genhosppsych.2015.09.005.
    1. Miner A, Kuhn E, Hoffman JE, Owen JE, Ruzek JI, Taylor CB. Feasibility, acceptability, and potential efficacy of the PTSD Coach app: a pilot randomized controlled trial with community trauma survivors. Psychol Trauma. 2016 May;8(3):384–92. doi: 10.1037/tra0000092.
    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. Wood AE, Prins A, Bush NE, Hsia JF, Bourn LE, Earley MD, Walser RD, Ruzek J. Reduction of burnout in mental health care providers using the provider resilience mobile application. Community Ment Health J. 2017 May;53(4):452–9. doi: 10.1007/s10597-016-0076-5.
    1. Moberg C, Niles A, Beermann D. Guided self-help works: randomized waitlist controlled trial of Pacifica, a mobile app integrating cognitive behavioral therapy and mindfulness for stress, anxiety, and depression. J Med Internet Res. 2019 Jun 8;21(6):e12556. doi: 10.2196/12556.
    1. Bakker D, Kazantzis N, Rickwood D, Rickard N. A randomized controlled trial of three smartphone apps for enhancing public mental health. Behav Res Ther. 2018 Oct;109:75–83. doi: 10.1016/j.brat.2018.08.003.
    1. Flett JA, Hayne H, Riordan BC, Thompson LM, Conner TS. Mobile mindfulness meditation: a randomised controlled trial of the effect of two popular apps on mental health. Mindfulness. 2018 Oct 31;10(5):863–76. doi: 10.1007/s12671-018-1050-9.
    1. Haug NA. PsyberGuide. 2016. [2019-07-01]. Headspace: An Expert Review
    1. Kubo A, Altschuler A, Kurtovich E, Hendlish S, Laurent CA, Kolevska T, Li Y, Avins A. A pilot mobile-based mindfulness intervention for cancer patients and their informal caregivers. Mindfulness (N Y) 2018 Dec;9(6):1885–94. doi: 10.1007/s12671-018-0931-2.
    1. Wylde CM, Mahrer NE, Meyer RM, Gold JI. Mindfulness for novice pediatric nurses: smartphone application versus traditional intervention. J Pediatr Nurs. 2017;36:205–12. doi: 10.1016/j.pedn.2017.06.008.
    1. Wen L, Sweeney TE, Welton L, Trockel M, Katznelson L. Encouraging mindfulness in medical house staff via smartphone app: a pilot study. Acad Psychiatry. 2017 Oct;41(5):646–50. doi: 10.1007/s40596-017-0768-3.
    1. Noone C, Hogan MJ. A randomised active-controlled trial to examine the effects of an online mindfulness intervention on executive control, critical thinking and key thinking dispositions in a university student sample. BMC Psychol. 2018 Apr 5;6(1):13. doi: 10.1186/s40359-018-0226-3.
    1. Howells A, Ivtzan I, Eiroa-Orosa FJ. Putting the ‘app’ in happiness: a randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing. J Happiness Stud. 2014 Oct 29;17(1):163–85. doi: 10.1007/s10902-014-9589-1.
    1. Economides M, Martman J, Bell MJ, Sanderson B. Improvements in stress, affect, and irritability following brief use of a mindfulness-based smartphone app: a randomized controlled trial. Mindfulness (N Y) 2018;9(5):1584–93. doi: 10.1007/s12671-018-0905-4.
    1. Champion L, Economides M, Chandler C. The efficacy of a brief app-based mindfulness intervention on psychosocial outcomes in healthy adults: a pilot randomised controlled trial. PLoS One. 2018;13(12):e0209482. doi: 10.1371/journal.pone.0209482.
    1. Parks AC, Williams AL, Tugade MM, Hokes KE, Honomichl RD, Zilca RD. Testing a scalable web and smartphone based intervention to improve depression, anxiety, and resilience: a randomized controlled trial. Int J Wellbeing. 2018 Dec 8;8(2):22–67. doi: 10.5502/ijw.v8i2.745.
    1. Chittaro L, Vianello A. Evaluation of a mobile mindfulness app distributed through on-line stores: a 4-week study. Int J Hum-Comput St. 2016 Feb;86:63–80. doi: 10.1016/j.ijhcs.2015.09.004.
    1. Huberty J, Green J, Glissmann C, Larkey L, Puzia M, Lee C. Efficacy of the mindfulness meditation mobile app 'calm' to reduce stress among college students: randomized controlled trial. JMIR Mhealth Uhealth. 2019 Jun 25;7(6):e14273. doi: 10.2196/14273.
    1. Lee RA, Jung ME. Evaluation of an mhealth app (DeStressify) on university students' mental health: pilot trial. JMIR Ment Health. 2018 Jan 23;5(1):e2. doi: 10.2196/mental.8324.
    1. Huberty J, Eckert R, Larkey L, Kurka J, de Jesús SA, Yoo W, Mesa R. Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials. JMIR Form Res. 2019 Apr 29;3(2):e12662. doi: 10.2196/12662.
    1. Diefenbach S, Müssig A. Counterproductive effects of gamification: an analysis on the example of the gamified task manager Habitica. Int J Hum Comput St. 2019 Jul;127:190–210. doi: 10.1016/j.ijhcs.2018.09.004.
    1. Linette D, Bryant J. Managing Stress in Health Care With Meditation: Got a Minute? Am Nurse Today. 2017;12(10):-.
    1. Bush NE, Ouellette G, Kinn J. Utility of the T2 mood tracker mobile application among army warrior transition unit service members. Mil Med. 2014 Dec;179(12):1453–7. doi: 10.7205/MILMED-D-14-00271.
    1. Carey TA, Haviland J, Tai SJ, Vanags T, Mansell W. MindSurf: a pilot study to assess the usability and acceptability of a smartphone app designed to promote contentment, wellbeing, and goal achievement. BMC Psychiatry. 2016 Dec 12;16(1):442. doi: 10.1186/s12888-016-1168-z.
    1. Griauzde D, Kullgren JT, Liestenfeltz B, Ansari T, Johnson EH, Fedewa A, Saslow LR, Richardson C, Heisler M. A mobile phone-based program to promote healthy behaviors among adults with prediabetes who declined participation in free diabetes prevention programs: mixed-methods pilot randomized controlled trial. JMIR Mhealth Uhealth. 2019 Jan 9;7(1):e11267. doi: 10.2196/11267.
    1. Bakker D, Kazantzis N, Rickwood D, Rickard N. Development and pilot evaluation of smartphone-delivered cognitive behavior therapy strategies for mood- and anxiety-related problems: MoodMission. Cogn Behav Prac. 2018 Nov;25(4):496–514. doi: 10.1016/j.cbpra.2018.07.002.
    1. Kuhn E, Greene C, Hoffman J, Nguyen T, Wald L, Schmidt J, Ramsey KM, Ruzek J. Preliminary evaluation of PTSD coach, a smartphone app for post-traumatic stress symptoms. Mil Med. 2014 Jan;179(1):12–8. doi: 10.7205/MILMED-D-13-00271.
    1. Bush NE, Dobscha SK, Crumpton R, Denneson LM, Hoffman JE, Crain A, Cromer R, Kinn JT. A Virtual Hope Box smartphone app as an accessory to therapy: proof-of-concept in a clinical sample of veterans. Suicide Life Threat Behav. 2015 Feb;45(1):1–9. doi: 10.1111/sltb.12103.
    1. Rosenthal R. The file drawer problem and tolerance for null results. Psychol Bull. 1979;86(3):638–41. doi: 10.1037/0033-2909.86.3.638.
    1. World Health Organization . WHO Guideline Recommendations On Digital Interventions For Health System Strengthening. Geneva, Switzerland: World Health Organization; 2019.
    1. European Commission. 2017. [2020-03-09]. Report of the Working Group on mHealth Assessment Guidelines .
    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.
    1. Hingle M, Patrick H, Sacher PM, Sweet CC. The intersection of behavioral science and digital health: the case for academic-industry partnerships. Health Educ Behav. 2019 Feb;46(1):5–9. doi: 10.1177/1090198118788600.
    1. Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health (mhealth) applications (apps) J Biomed Inform. 2016 Apr;60:243–51. doi: 10.1016/j.jbi.2016.02.002.
    1. Wasil AR, Venturo-Conerly KE, Shingleton RM, Weisz JR. A review of popular smartphone apps for depression and anxiety: assessing the inclusion of evidence-based content. Behav Res Ther. 2019 Dec;123:103498. doi: 10.1016/j.brat.2019.103498.
    1. PsyberGuide. [2019-03-09].
    1. Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000 Jun;68(3):438–50. doi: 10.1037/0022-006x.68.3.438.
    1. Williams A, Parks A, Cormier G, Stafford J, Whillans A. Improving resilience among employees high in depression, anxiety, and workplace distress. Int J Manag Res. 2018 Dec;9(1-2):4–22.
    1. Carpenter Jordan, Crutchley Patrick, Zilca Ran D, Schwartz H Andrew, Smith Laura K, Cobb Angela M, Parks Acacia C. Correction: Seeing the "Big" Picture: Big Data Methods for Exploring Relationships Between Usage, Language, and Outcome in Internet Intervention Data. J Med Internet Res. 2017 Dec 19;19(12):e347. doi: 10.2196/jmir.8099.
    1. Kuo BC. Culture’s consequences on coping. J Cross Cul Psychol. 2010 Sep 9;42(6):1084–100. doi: 10.1177/0022022110381126.
    1. Chun C, Moos R, Cronkite R. Handbook of Multicultural Perspectives on Stress and Coping. Boston, MA: Springer; 2006. Culture: a fundamental context for the stress and coping paradigm; pp. 29–53.
    1. O'Connor DB, Shimizu M. Sense of personal control, stress and coping style: a cross-cultural study. Stress Health. 2002 Oct;18(4):173–83. doi: 10.1002/smi.939.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다