The Monetization Strategies of Apps for Anxiety Management: an International Comparison
Many mobile applications (apps) are available for anxiety management, but little is known about how their monetization strategies influence their success. This study evaluates how monetization strategies differ between anxiety apps intended for the United States (US) and People’s Republic of China markets, and which monetization strategies are most associated with commercial success. During July 2018, the US and China versions of the iOS App Store were queried for apps mentioning anxiety. Apps were then reviewed to determine whether they cost money to download, offered in-app purchases, or had a subscription fee. The number of reviews and average ratings apps received were recorded as measures of commercial success. The relationships between nation, monetization strategy, and commercial success were assessed using both chi-square tests and multivariate regressions. Selection criteria were met by 382 apps. Most (346) of the apps were from the US store. Apps were significantly (P < 0.05) more likely to be completely free in the China store (41.7%) than in the US store (25.4%). Apps from the US store were significantly more likely to have a download fee (P < 0.01) and to have a subscription model (P < 0.001). Subscription models were significantly (P < 0.01) associated with more ratings and with apps being more likely to be rated 4+ on a 5-point scale (P < 0.01). Anxiety apps in the US and China used different monetization strategies. Subscription models were associated with commercial success.
KeywordsMental disorders Anxiety Stress Technology Mobile phones
ordinary least squares regression
Compliance with Ethical Standards
Conflict of Interest
None of the authors have conflicts of interest related to this study. Dr. Powell reports employment by Payer+Provider Syndicate and stock ownership of Community Health Systems, CVS Health Corp, HCA Healthcare, Payer+Provider Syndicate, Quorum Health Corp, and Tenet Health Corp. Dr. Powell is a paid member of the Scientific Advisory Board of PsyberGuide and of the Expert’s Council of the Mary Christie Foundation. Dr. Torous is supported by a grant from the NIMH: 1K23MH116130-01.
- Alonso, J., Liu, Z., Evans-Lacko, S., Sadikova, E., Sampson, N., Chatterji, S., Abdulmalik, J., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., & Bruffaerts, R. (2018). Treatment gap for anxiety disorders is global: results of the World Mental Health Surveys in 21 countries. Depression and Anxiety., 35(3), 195–208.CrossRefGoogle Scholar
- An, S., & Lee, H. (2017). Adoption of mobile apps for mental health: socio-psychological and technological factors. In International Conference on Wireless Mobile Communication and Healthcare (pp. 29–37). Cham: Springer.Google Scholar
- AppInChina. (2019). How can you monetize your app in China? Retrieved from http://www.appinchina.co/blog/monetize-your-app-in-china/. Accessed 23 Feb 2019.
- Apple. (2019). Ratings, reviews, and respo nses. Retrieved from http://developer.apple.com/app-store/ratings-and-reviews/. Accessed 24 Feb 2019.
- Deloitte. (2018). The app economy in the United States. Retrieved from http://www.ftc.gov/system/files/documents/public_comments/2018/08/ftc-2018-0048-d-0121-155299.pdf. Accessed 17 Jan 2019.
- Federal Trade Commission. (2016). Lumosity to pay $2 million to settle FTC deceptive advertising charges for its “brain training” program. Retrieved from http://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges. Accessed 23 Feb 2019.
- Health management and policy alert. (2013). Patient apps for improved healthcare: from novelty to mainstream. Retrieved from http://kingsfund.blogs.com/health_management/2013/11/patient-apps-for-improved-healthcare-from-novelty-to-mainstream.html. Accessed 11 Nov 2018.
- McNiel, D. E., & Binder, R. (2018). Current regulation of mobile mental health applications. The Journal of the American Academy of Psychiatry and the Law, 46, 204–211.Google Scholar
- Mohammadi, R., Ayatolahi, M. T., Hoveidamanesh, S., Ghanavati, R., & Pournik, O. (2018). Reflection on mobile applications for blood pressure management: a systematic review on potential effects and initiatives. Studies in Health Technology and Informatics., 247, 306–310.Google Scholar
- Mohr, D. C., Tomasino, K. N., Lattie, E. G., Palac, H. L., Kwasny, M. J., Weingardt, K., Karr, C. J., Kaiser, S. M., Rossom, R. C., Bardsley, L. R., & Caccamo, L. (2017). IntelliCare: an eclectic, skills-based app suite for the treatment of depression and anxiety. Journal of medical Internet research., 19(1), e10.CrossRefGoogle Scholar
- National Institute of Mental Health. (2018). Any anxiety disorder. Retrieved from http://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml. Accessed 11 Dec 2018.
- The Verge. (2018). Apple and WeChat resolve disagreement over App Store cut on tips. Retrieved from http://www.theverge.com/2018/1/16/16896008/apple-wechat-tips-agreement. Accessed 24 Feb 2019.
- Torous, J., Firth, J., Huckvale, K., Larsen, M. E., Cosco, T. D., Carney, R., Chan, S., Pratap, A., Yellowlees, P., Wykes, T., & Keshavan, M. (2018). The emerging imperative for a consensus approach toward the rating and clinical recommendation of mental health apps. The Journal of Nervous and Mental Disease., 206(8), 662–666.Google Scholar
- Van Singer, M., Chatton, A., & Khazaal, Y. (2015). Quality of smartphone apps related to panic disorder. Frontiers in Psychiatry, 6, 96.Google Scholar