Review of Use and Integration of Mobile Apps Into Psychiatric Treatments
Purpose of Review
Mental health practitioners should understand the features of current, publicly available apps; the features of novel, research apps; and issues behind the integration of mobile apps and digital health services into clinical workflows.
The review is based on a research literature and the authors’ clinical and healthcare administration experiences. Articles searched—on telepsychiatry, telemental health, mobile mental health, informatics, cellular phone, ambulatory monitoring, telemetry, and algorithms—were restricted to 2016 and 2017. Technologies are used in a variety of clinical settings, including patients with varying mental illness severity, social supports, and technological literacy. Good practices for evaluating apps, understanding user needs, and training and educating users can increase success rates. Ethics and risk management should be considered.
Mobile apps are versatile. Integrating apps into psychiatric treatment requires addressing both patient and clinical workflows, design and usability principles, accessibility, social concerns, and digital health literacy.
KeywordsMental health apps Smartphone apps Psychiatric services Telepsychiatry Clinical informatics Ambulatory monitoring
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Chan S, Torous J, Hinton L, Yellowlees P. Psychiatric apps: patient self-assessment, communication, and potential treatment interventions. In: Mucic D, Hilty D, editors. E-mental health. Basel: Karger Medical and Scientific Publishers; 2015.Google Scholar
- 3.Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Pew Research Center. 2016. http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-continues-to-climb-in-emerging-economies/. Accessed 15 Sept 2017.
- 4.Wu Q, Sum K, Nathan-Roberts D, editors. How fitness trackers facilitate health behavior change. Proceedings of the Human Factors and Ergonomics Society Annual Meeting; 2016: SAGE Publications Sage CA: Los Angeles, CA.Google Scholar
- 5.• Bennion M, Hardy G, Moore R, Millings A. E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services. BMJ Open. 2017;7(1):e014844. The authors tabulate a very comprehensive list of depression, CBT, and other mental health apps and programs used in UK’s health system. Their efforts underscore why app reporting is necessary, as UK’s health system components and trusts were not consistently collecting usage statistics. CrossRefPubMedPubMedCentralGoogle Scholar
- 9.• Gregory JM, Sukhera J, Taylor-Gates M. Integrating smartphone technology at the time of discharge from a child and adolescent inpatient psychiatry unit. J Can Acad Child Adolesc Psychiatry. 2017;26(1):45–50. This paper is interesting and unique because it implements app recommendations and downloading in an inpatient child psychiatric hospital in Canada. Authors note that there’s no other research on smartphones in inpatient units. PubMedPubMedCentralGoogle Scholar
- 15.Barrigón ML, Berrouiguet S, Carballo JJ, Bonal-Giménez C, Fernández-Navarro P, Pfang B, et al. User profiles of an electronic mental health tool for ecological momentary assessment: MEmind. Int J Methods Psychiatr Res. 2017;26(1) https://doi.org/10.1002/mpr.1554.
- 16.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;4(2):e19. https://doi.org/10.2196/mental.7785.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.•• Miner AS, Milstein A, Schueller S, Hegde R, Mangurian C, Linos E. Smartphone-based conversational agents and responses to questions about mental health, interpersonal violence, and physical health. JAMA Intern Med. 2016;176(5):619–25. https://doi.org/10.1001/jamainternmed.2016.0400. This widely publicized paper shows how operating system features—conversational agents like Apple Siri and Google Now (now Google Assistant)—can be used as mental health interventions. The paper stimulated discussion in popular press for the role of conversational agents in recognizing suicide and domestic violence. CrossRefPubMedPubMedCentralGoogle Scholar
- 18.•• Maples-Keller JL, Bunnell BE, Kim SJ, Rothbaum BO. The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harv Rev Psychiatry. 2017;25(3):103–13. https://doi.org/10.1097/HRP.0000000000000138. This is a comprehensive overview of the current state of virtual reality in psychiatric treatment. CrossRefPubMedGoogle Scholar
- 19.Kirchner TR, Shiffman S. Spatio-temporal determinants of mental health and well-being: advances in geographically-explicit ecological momentary assessment (GEMA). Soc Psychiatry Psychiatr Epidemiol. 2016;51(9):1211–23. https://doi.org/10.1007/s00127-016-1277-5.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Chow PI, Fua K, Huang Y, Bonelli W, Xiong H, Barnes LE, et al. Using mobile sensing to test clinical models of depression, social anxiety, state affect, and social isolation among college students. J Med Internet Res. 2017;19(3):e62. https://doi.org/10.2196/jmir.6820.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Braun S, Annovazzi C, Botella C, Bridler R, Camussi E, Delfino JP, et al. Assessing chronic stress, coping skills, and mood disorders through speech analysis: a self-assessment ‘Voice App’ for laptops, tablets, and smartphones. Psychopathology. 2016;49(6):406–19. https://doi.org/10.1159/000450959.CrossRefPubMedGoogle Scholar
- 22.Schriewer K, Bulaj G. Music streaming services as adjunct therapies for depression, anxiety, and bipolar symptoms: convergence of digital technologies, mobile apps, emotions, and global mental health. Front Public Health. 2016;4:217. https://doi.org/10.3389/fpubh.2016.00217.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Place S, Blanch-Hartigan D, Rubin C, Gorrostieta C, Mead C, Kane J, et al. Behavioral indicators on a mobile sensing platform predict clinically validated psychiatric symptoms of mood and anxiety disorders. J Med Internet Res. 2017;19(3):e75. https://doi.org/10.2196/jmir.6678.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Suhara Y, Xu Y, Pentland AS, editors. DeepMood: forecasting depressed mood based on self-reported histories via recurrent neural networks. Proceedings of the 26th International Conference on World Wide Web; 2017: International World Wide Web Conferences Steering Committee.Google Scholar
- 27.•• American Psychiatric Association. Mental Health Apps. American Psychiatric Association. 2017. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps. Accessed 4 July2017. The webpage provides a comprehensive overview of evaluating apps, and why this is important.
- 31.• Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth Uhealth. 2015;3(3):e82. https://doi.org/10.2196/mhealth.4328. This applies the MARS criteria to evaluating mobile apps, specifically in mindfulness interventions, and breaks out the elements of mindfulness that should be present in apps. CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Maheu MM, Nicolucci V, Pulier ML, Wall KM, Frye TJ, Hudlicka E. The interactive mobile app review toolkit (IMART): a clinical practice-oriented system. Journal of Technology in Behavioral Science. 2017:1–13.Google Scholar
- 34.Kaipainen K, Valkkynen P, Kilkku N. Applicability of acceptance and commitment therapy-based mobile app in depression nursing. Transl Behav Med. 2016; https://doi.org/10.1007/s13142-016-0451-3.
- 35.Mares ML, Gustafson DH, Glass JE, Quanbeck A, McDowell H, McTavish F, et al. Implementing an mHealth system for substance use disorders in primary care: a mixed methods study of clinicians’ initial expectations and first year experiences. BMC Med Inform Decis Mak. 2016;16(1):126. https://doi.org/10.1186/s12911-016-0365-5.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Robotham D, Satkunanathan S, Doughty L, Wykes T. Do we still have a digital divide in mental health? A five-year survey follow-up. J Med Internet Res 2016;18(11):e309. https://doi.org/10.2196/jmir.6511.
- 37.Glass JE, McKay JR, Gustafson DH, Kornfield R, Rathouz PJ, McTavish FM, et al. Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders. J Subst Abus Treat. 2017;77:57–66. https://doi.org/10.1016/j.jsat.2017.03.011.Google Scholar
- 38.Perski O, Blandford A, Ubhi HK, West R, Michie S. Smokers’ and drinkers’ choice of smartphone applications and expectations of engagement: a think aloud and interview study. BMC medical informatics and decision making. 2017;17(1):25. https://doi.org/10.1186/s12911-017-0422-8.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Rotondi AJ, Spring MR, Hanusa BH, Eack SM, Haas GL. Designing eHealth applications to reduce cognitive effort for persons with severe mental illness: page complexity, navigation simplicity, and comprehensibility. JMIR human factors. 2017;4(1):e1. https://doi.org/10.2196/humanfactors.6221.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Westergaard RP, Genz A, Panico K, Surkan PJ, Keruly J, Hutton HE, et al. Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders. Addiction Science & Clinical Practice. 2017;12(1):11. https://doi.org/10.1186/s13722-017-0076-y.CrossRefGoogle Scholar
- 42.• Jennings L, Lee N, Shore D, Strohminger N, Allison B, Conserve DF, et al. U.S. minority homeless youth’s access to and use of mobile phones: implications for mHealth intervention design. J Health Commun. 2016;21(7):725–33. https://doi.org/10.1080/10810730.2015.1103331. This qualitative research is an excellent example of countering the stereotypes that youth desire mobile phones and share their lives openly. It finds that youth may find phones as a source of harassment, financial burden, and privacy concern! CrossRefPubMedGoogle Scholar
- 44.Sood M, Chadda RK, Singh P. Mobile health (mHealth) in mental health: scope and applications in low-resource settings. The National medical journal of India. 2016;29(6):341–3.Google Scholar
- 45.•• Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unutzer J, Patel V, et al. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. The lancet Psychiatry. 2017; https://doi.org/10.1016/s2215-0366(17)30096-2. This review has numerous tables of online and e-health programs for mental health encompassing adherence, recovery supports, and self-help, along with mental health worker screening and education.
- 47.Musyimi CW, Mutiso VN, Haji ZR, Nandoya ES, Ndetei DM. Mobile based mhGAP-IG depression screening in Kenya. Community Ment Health J. 2016; https://doi.org/10.1007/s10597-016-0072-9.
- 50.• Torous J, Roberts LW. The ethical use of mobile health technology in clinical psychiatry. J Nerv Ment Dis. 2017;205(1):4–8. https://doi.org/10.1097/nmd.0000000000000596. This discusses ethical issues clinicians should consider before recommending technologies, learning about how data is sold, about how governments and commercial entities are monitoring users, and includes a table of “automated emotion recognition” technologies. CrossRefPubMedGoogle Scholar
- 51.Hilty DM, Crawford A, Teshima J, Chan S, Sunderji N, Yellowlees PM, et al: A framework for telepsychiatric training and e-health: competency-based education, evaluation and implications. Int Rev Psychiatry 2015;27(6):569–92.Google Scholar
- 52.Hilty DM, Chan S, Torous J, Mahautmr J, Mucic DM: New frontiers in healthcare and technology: Internet- and web-based mental options emerge to complement in-person and telepsychiatric care options. J Health Med Informatics 2015;6(4):1–14.Google Scholar