Apps for Depression: Are They Ready to Work?

Abstract

Purpose of Review

To summarize the latest evidence about mobile phone applications for the management of depression.

Recent Findings

Depression apps are very heterogeneous, given the absence of standards for their development, description, and evaluation. Randomized clinical trials show the effectiveness of some of these applications in reducing depressive symptoms. Attrition is an important issue whose evaluation is limited by the frequent use of incentives in the studies.

Summary

The number of mobile applications for depression far exceeds the number of studies evaluating their efficacy and feasibility. Despite the limitations of the digital market, there are a small number of apps that have demonstrated sufficient effectiveness and tolerability to think of short-term clinical use. However, there are still barriers at different levels that may delay the implementation of these interventions in daily clinical practice.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Murray C, Lopez A. Measuring the global burden of disease. N Engl J Med. 2013;369(5):448–57. https://doi.org/10.1056/nejmra1201534.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Lawrence D, Hancock K, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population-based registers. BMJ. 2013;346(may21 1):f2539. https://doi.org/10.1136/bmj.f2539.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Rivera M, Porras-Segovia A, Rovira P, Molina E, Gutiérrez B, Cervilla J. Associations of major depressive disorder with chronic physical conditions, obesity and medication use: results from the PISMA-ep study.

  4. 4.

    Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(02):119–24. https://doi.org/10.1192/bjp.bp.116.188078.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Peng W, Kanthawala S, Yuan S, Hussain SA. A qualitative study of user perceptions of mobile health apps. BMC Public Health. 2016;16(1):1158.

    Article  Google Scholar 

  6. 6.

    O’Dea B, Calear A, Perry Y. Is e-health the answer to gaps in adolescent mental health service provision? Curr Opin Psychiatry. 2015;28(4):336–42. https://doi.org/10.1097/yco.0000000000000170.

    Article  PubMed  Google Scholar 

  7. 7.

    Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Pew Res Cent. 2016;22.

  8. 8.

    Berrouiguet S, Perez-Rodriguez M, Larsen M, Baca-García E, Courtet P, Oquendo M. From eHealth to iHealth: transition to participatory and personalized medicine in mental health. J Med Internet Res. 2018;20(1):e2. https://doi.org/10.2196/jmir.7412.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    • Proudfoot J, Clarke J, Birch M, et al. Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial. BMC Psychiatry. 2013;13(1). https://doi.org/10.1186/1471-244x-13-312. An RCT evaluating the app myCompass. There was a significant decrease in depressive symptoms. Most used features were short motivational messages and symptom tracking.

  10. 10.

    Torous J, Chan SR, Yee-Marie TS, Behrens J, Mathew I, Conrad EJ, et al. Patient smartphone ownership and interest in mobile apps to monitor symptoms of mental health conditions: a survey in four geographically distinct psychiatric clinics. JMIR Ment Health. 2014;1(1):e5. https://doi.org/10.2196/mental.4004.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    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;15(6):e120.

    Article  Google Scholar 

  12. 12.

    Tal A, Torous J. The digital mental health revolution: opportunities and risks. Psychiatr Rehab J. 2017;40(3):263–5. https://doi.org/10.1037/prj0000285.

    Article  Google Scholar 

  13. 13.

    •• Firth J, Torous J, Nicholas J, et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017;16(3):287–98. https://doi.org/10.1002/wps.20472. The first meta-analysis of RCTs evaluating apps for depression. Pooled results from 3414 participants showed a significant decrease in depressive symptoms.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Shen N, Levitan M-J, Johnson A, et al. Finding a depression app: a review and content analysis of the depression app marketplace. JMIR MHealth UHealth. 2015;3:e16.

    Article  Google Scholar 

  15. 15.

    Huguet A, Rao S, McGrath P, Wozney L, Wheaton M, Conrod J, et al. A systematic review of cognitive behavioral therapy and behavioral activation apps for depression. PLoS One. 2016;11(5):e0154248. https://doi.org/10.1371/journal.pone.0154248.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Kumar S, Nilsen W, Abernethy A, Atienza A, Patrick K, Pavel M. Mobile health technology evaluation. Am J Prev Med. 2013;45(2):228–36. https://doi.org/10.1016/j.amepre.2013.03.017.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Wisniewski H, Liu G, Henson P, Vaidyam A, Hajratalli NK, Onnela JP, et al. Understanding the quality, effectiveness and attributes of top-rated smartphone health apps. Evid Based Ment Health. 2019;22(1):4–9. https://doi.org/10.1136/ebmental-2018-300069.

    Article  PubMed  Google Scholar 

  18. 18.

    Mathiasen K, Andersen TE, Riper H, Kleiboer AA, Roessler KK. Blended CBT versus face-to-face CBT: a randomised non-inferiority trial. BMC Psychiatry. 2016;16(1):432.

    Article  Google Scholar 

  19. 19.

    Rathbone AL, Clarry L, Prescott J. Assessing the efficacy of mobile health apps using the basic principles of cognitive behavioral therapy: systematic review. J Med Internet Res. 2017;19(11):e399. https://doi.org/10.2196/jmir.8598 Review.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Birney A, Gunn R, Russell J, Ary D. MoodHacker Mobile Web app with email for adults to self-manage mild-to-moderate depression: randomized controlled trial. JMIR Mhealth Uhealth. 2016;4(1):e8. https://doi.org/10.2196/mhealth.4231.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Emslie G, Kennard B, Mayes T, Nakonezny PA, Zhu L, Tao R, et al. Insomnia moderates outcome of serotonin-selective reuptake inhibitor treatment in depressed youth. J Child Adolesc Psychopharmacol. 2012;22(1):21–8. https://doi.org/10.1089/cap.2011.0096.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Horsch CH, Lancee J, Griffioen-Both F, Spruit S, Fitrianie S, Neerincx MA, et al. Mobile phone-delivered cognitive behavioral therapy for insomnia: a randomized waitlist controlled trial. J Med Internet Res. 2017;19(4):e70. https://doi.org/10.2196/jmir.6524.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Berrouiguet S, Baca-García E, Brandt S, Walter M, Courtet P. Fundamentals for future mobile-health (mHealth): a systematic review of mobile phone and Web-based text messaging in mental health. J Med Internet Res. 2016;18(6):e135. https://doi.org/10.2196/jmir.5066.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Nuij C, van Ballegooijen W, Ruwaard J, de Beurs D, Mokkenstorm J, van Duijn E, et al. Smartphone-based safety planning and self-monitoring for suicidal patients: rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study. Internet Interv. 2018;13:16–23. https://doi.org/10.1016/j.invent.2018.04.005 eCollection 2018 Sep.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Santo K, Richtering SS, Chalmers J, Thiagalingam A, Chow CK, Redfern J. Mobile phone apps to improve medication adherence: a systematic stepwise process to identify high-quality apps. JMIR Mhealth Uhealth. 2016;4(4):e132.

    Article  Google Scholar 

  26. 26.

    Bennabi D, Aouizerate B, El-Hage W, Doumy O, Moliere F, Courtet P, et al. Risk factors for treatment resistance in unipolar depression: a systematic review. J Affect Disord. 2015;171:137–41. https://doi.org/10.1016/j.jad.2014.09.020.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    • Mo Y, Gong W, Wang J, Sheng X, Xu D. The association between the use of antenatal care smartphone apps in pregnant women and antenatal depression: cross-sectional study. JMIR Mhealth Uhealth. 2018;6(11):e11508. https://doi.org/10.2196/11508. A cross-sectional study performed in 1304 pregnant women. The explored antenatal care apps had a significant protective effect on antenatal depression.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Fleming J, Hill Y, Burns M. Usability of a culturally informed mHealth intervention for symptoms of anxiety and depression: feedback from young sexual minority men. JMIR Hum Factors. 2017;4(3):e22. https://doi.org/10.2196/humanfactors.7392.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Hetrick SE, Robinson J, Burge E, Blandon R, Mobilio B, Rice SM, et al. Youth codesign of a mobile phone app to facilitate self-monitoring and management of mood symptoms in young people with major depression, suicidal ideation, and self-harm. JMIR Ment Health. 2018;5(1):e9. https://doi.org/10.2196/mental.9041.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Grist R, Porter J, Stallard P. Mental health mobile apps for preadolescents and adolescents: a systematic review. J Med Internet Res. 2017;19(5):e176. https://doi.org/10.2196/jmir.7332.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    • Hur J, Kim B, Park D, Choi S. A scenario-based cognitive behavioral therapy mobile app to reduce dysfunctional beliefs in individuals with depression: a randomized controlled trial. Telemed e-Health. 2018;24(9):710–6. https://doi.org/10.1089/tmj.2017.0214. One of the most recent RCT on apps for depression; it evaluated the app Todac-Todac, showing a significant decrease in depressive symptoms and negative beliefs.

    Article  Google Scholar 

  32. 32.

    • Pratap A, Renn B, Volponi J, et al. Using mobile apps to assess and treat depression in Hispanic and Latino populations: fully remote randomized clinical trial. J Med Internet Res. 2018;20(8):e10130. https://doi.org/10.2196/10130. An RCT that tested the mobile applications iPST, Project EVO, and Health Tips. There was a significant decrease in depressive symptoms.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Arean P, Hallgren K, Jordan J, Gazzaley A, Atkins DC, Heagerty PJ, et al. The use and effectiveness of mobile apps for depression: results from a fully remote clinical trial. J Med Internet Res. 2016;18(12):e330. https://doi.org/10.2196/jmir.6482.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Baumel A, Tinkelman A, Mathur N, Kane J. Digital peer-support platform (7Cups) as an adjunct treatment for women with postpartum depression: feasibility, acceptability, and preliminary efficacy study. JMIR Mhealth Uhealth. 2018;6(2):e38. https://doi.org/10.2196/mhealth.9482.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Corden M, Koucky E, Brenner C, et al. MedLink: a mobile intervention to improve medication adherence and processes of care for treatment of depression in general medicine. Digit Health. 2016;2:205520761666306. https://doi.org/10.1177/2055207616663069.

    Article  Google Scholar 

  36. 36.

    Fogarty AS, Proudfoot J, Whittle EL, Clarke J, Player MJ, Christensen H, et al. Preliminary evaluation of a brief Web and mobile phone intervention for men with depression: men’s positive coping strategies and associated depression, resilience, and work and social functioning. JMIR Ment Health. 2017;4(3):e33. https://doi.org/10.2196/mental.7769.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Furukawa T, Horikoshi M, Fujita H, Tsujino N, Jinnin R, Kako Y, et al. Cognitive and behavioral skills exercises completed by patients with major depression during smartphone cognitive behavioral therapy: secondary analysis of a randomized controlled trial. JMIR Ment Health. 2018;5(1):e4. https://doi.org/10.2196/mental.9092.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Goldin P, Lindholm R, Ranta K, Hilgert O, Helteenvuori T, Raevuori A. Feasibility of a therapist-supported, mobile phone–delivered online intervention for depression: longitudinal observational study. JMIR Form Res. 2019;3(1):e11509. https://doi.org/10.2196/11509.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Mantani A, Kato T, Furukawa T, Horikoshi M, Imai H, Hiroe T, et al. Smartphone cognitive behavioral therapy as an adjunct to pharmacotherapy for refractory depression: randomized controlled trial. J Med Internet Res. 2017;19(11):e373. https://doi.org/10.2196/jmir.8602.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Mohr D, Montague E, Stiles-Shields C, et al. MedLink: a mobile intervention to address failure points in the treatment of depression in general medicine, Proceedings of the 9th International Conference on Pervasive Computing Technologies for Healthcare. 2015. https://doi.org/10.4108/icst.pervasivehealth.2015.259042.

  41. 41.

    Mohr D, Tomasino K, Lattie E, Palac HL, Kwasny MJ, Weingardt K, et al. IntelliCare: an eclectic, skills-based app suite for the treatment of depression and anxiety. J Med Internet Res. 2017;19(1):e10. https://doi.org/10.2196/jmir.6645.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    O'Toole M, Arendt M, Pedersen C. Testing an app-assisted treatment for suicide prevention in a randomized controlled trial: effects on suicide risk and depression. Behav Ther. 2019;50(2):421–9. https://doi.org/10.1016/j.beth.2018.07.007.

    Article  PubMed  Google Scholar 

  43. 43.

    Schlosser D, Campellone T, Truong B, et al. Efficacy of PRIME, a mobile app intervention designed to improve motivation in young people with schizophrenia. Schizophr Bull. 2018;44(5):1010–20. https://doi.org/10.1093/schbul/sby078.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Silva-Almodovar A, Surve S, Axon D, Cooper D, Nahata M. Self-directed engagement with a mobile app (Sinasprite) and its effects on confidence in coping skills, depression, and anxiety: retrospective longitudinal study. JMIR Mhealth Uhealth. 2018;6(3):e64. https://doi.org/10.2196/mhealth.9612.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Whitton A, Proudfoot J, Clarke J, Birch MR, Parker G, Manicavasagar V, et al. Breaking open the black box: isolating the most potent features of a Web and mobile phone-based intervention for depression, anxiety, and stress. JMIR Ment Health. 2015;2(1):e3. https://doi.org/10.2196/mental.3573.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1):e11. https://doi.org/10.2196/jmir.7.1.e11.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Fuller-Tyszkiewicz M, Richardson B, Klein B, Skouteris H, Christensen H, Austin D, et al. A mobile app–based intervention for depression: end-user and expert usability testing study. JMIR Ment Health. 2018;5(3):e54. https://doi.org/10.2196/mental.9445.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Lipschitz J, Miller CJ, Hogan TP, Burdick KE, Lippin-Foster R, Simon SR, et al. Adoption of mobile apps for depression and anxiety: cross-sectional survey study on patient interest and barriers to engagement. JMIR Ment Health. 2019;6(1):e11334. https://doi.org/10.2196/11334.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    BinDhim N, Shaman A, Trevena L, Basyouni M, Pont L, Alhawassi T. Depression screening via a smartphone app: cross-country user characteristics and feasibility. J Am Med Inform Assoc. 2014. https://doi.org/10.1136/amiajnl-2014-002840.

  50. 50.

    Stiles-Shields C, Montague E, Lattie E, Kwasny M, Mohr D. What might get in the way: barriers to the use of apps for depression. Digit Health. 2017;3:205520761771382. https://doi.org/10.1177/2055207617713827.

    Article  Google Scholar 

  51. 51.

    Erbes CR, Stinson R, Kuhn E, Polusny M, Urban J, Hoffman J, et al. Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD. Mil Med. 2014;179(11):1218–22. https://doi.org/10.7205/MILMED-D-14-00014.

    Article  PubMed  Google Scholar 

  52. 52.

    Bower DJ, Barry N, Reid M, Norrie J. Designing and implementing e-health applications in the UK’s National Health Service. J Health Commun. 2005;10(8):733–50.

    Article  Google Scholar 

  53. 53.

    Schueller SM, Neary M, O'Loughlin K, Adkins EC. Discovery of and interest in health apps among those with mental health needs: survey and focus group study. J Med Internet Res. 2018;20(6):e10141. https://doi.org/10.2196/10141.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Miller CJ, McInnes DK, Stolzmann K, Bauer MS. Interest in use of technology for healthcare among veterans receiving treatment for mental health. Telemed J E Health. 2016;22(10):847–54.

    Article  Google Scholar 

  55. 55.

    Kaipainen K, Välkkynen P, Kilkku N. Applicability of acceptance and commitment therapy-based mobile app in depression nursing. Transl Behav Med. 2017;7(2):242–53. https://doi.org/10.1007/s13142-016-0451-3.

    Article  PubMed  Google Scholar 

  56. 56.

    Griebel L, Enwald H, Gilstad H, Pohl AL, Moreland J, Sedlmayr M. eHealth literacy research-quo vadis? Inform Health Soc Care. 2018;43(4):427–42. https://doi.org/10.1080/17538157.2017.1364247.

    Article  PubMed  Google Scholar 

  57. 57.

    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. https://doi.org/10.1371/journal.pone.0156164 eCollection 2016.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Yasini M, Beranger J, Desmarais P, Perez L, Marchand G. mHealth quality: a process to seal the qualified mobile health apps. Stud Health Technol Inform. 2016;228:205–9.

    PubMed  Google Scholar 

  59. 59.

    Lee TT, Kesselheim AS. U.S. Food and Drug Administration precertification pilot program for digital health software: weighing the benefits and risks. Ann Intern Med. 2018;168(10):730–2. https://doi.org/10.7326/M17-2715.

    Article  PubMed  Google Scholar 

  60. 60.

    Chan S, Torous J, Hinton L, Yellowlees P. Towards a framework for evaluating mobile mental health apps. Telemed J E Health. 2015;21(12):1038–41. https://doi.org/10.1089/tmj.2015.0002.

    Article  PubMed  Google Scholar 

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Acknowledgments

The editors would like to thank Dr. Pilar A. Sáiz for taking the time to review this manuscript.

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Correspondence to Alejandro Porras-Segovia.

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Alejandro Porras-Segovia, Isaac Díaz-Oliván, Luis Gutiérrez-Rojas, Henry Dunne, Manon Moreno, and Enrique Baca-García each declare no potential conflicts of interest.

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Porras-Segovia, A., Díaz-Oliván, I., Gutiérrez-Rojas, L. et al. Apps for Depression: Are They Ready to Work?. Curr Psychiatry Rep 22, 11 (2020). https://doi.org/10.1007/s11920-020-1134-9

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Keywords

  • Depression
  • m-health
  • e-health