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Bang M, Jang CW, Kim HS, Park JH, Cho HE. Mobile applications for cognitive training: Content analysis and quality review. Internet Interv 2023; 33:100632. [PMID: 37312799 PMCID: PMC10258500 DOI: 10.1016/j.invent.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 03/31/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background As the number of individuals suffering from cognitive diseases continues to rise, dealing with the diminished cognitive function that comes with age has become a serious public health concern. While the use of mobile applications (apps) as digital treatments for cognitive training shows promise, the analysis of their content and quality remains unclear. Objective The aim of this study was to systematically search and assess cognitive training apps using the multidimensional mobile app rating scale (MARS) to rate objective quality and identify critical points. Methods A search was conducted on the Google Play Store and Apple App Store in February 2022 using the terms "cognitive training" and "cognitive rehabilitation." The cognitive domains provided by each app were analyzed, and the frequency and percentage according to the apps were obtained. The MARS, a mHealth app quality rating tool including multidimensional measures, was used to analyze the quality of the apps. The relationship between the MARS score, the number of reviews, and 5-star ratings were examined. Results Of the 53 apps, 52 (98 %) included memory function, 48 (91 %) included attention function, 24 (45 %) included executive function, and 19 (36 %) included visuospatial function. The mean (SD) scores of MARS, 5-star ratings, and reviews of 53 apps were 3.09 (0.61), 4.33 (0.30), and 62,415.43 (121,578.77). From the between-section comparison, engagement (mean 2.97, SD 0.68) obtained lower scores than functionality (mean 3.18, SD 0.62), aesthetics (mean 3.13, SD 0.72), and information (mean 3.11, SD 0.54). The mean quality score and reviews showed a statistically significant association (r = 0.447 and P = .001*). As the number of domains increased, the mean quality score showed a statistically significant increasing trend (P = .002*). Conclusions Most apps provided training for the memory and attention domains, but few apps included executive function or visuospatial domains. The quality of the apps improved significantly when more domains were provided, and was positively associated with the number of reviews received. These results could be useful for the future development of mobile apps for cognitive training.
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Affiliation(s)
- Myeonghwan Bang
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Integrative Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Chan Woong Jang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jung Hyun Park
- Department of Integrative Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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Vera Cruz G, Aboujaoude E, Khan R, Rochat L, Ben Brahim F, Courtois R, Khazaal Y. Smartphone apps for mental health and wellbeing: A usage survey and machine learning analysis of psychological and behavioral predictors. Digit Health 2023; 9:20552076231152164. [PMID: 36714544 PMCID: PMC9880571 DOI: 10.1177/20552076231152164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Objective Despite the availability of thousands of mental health applications, the extent to which they are used and the factors associated with their use remain largely unknown. The present study aims to (a) assess in a representative US-based population sample the use of smartphone apps for mental health and wellbeing (SAMHW), (b) determine the variables predicting the use of SAMHW, and (c) explore how a set of variables related to mental health, smartphone use, and smartphone "addiction" may be associated with the use of SAMHW. Methods Data was collected via online questionnaire from 1989 adults. The data gathered included information on smartphone use behavior, mental health, and the use of SAMHW. Latent class analysis was used to categorize participants. Machine learning and logistic regression analyses were used to determine the most important predictors of SAMHW use and associations between predictors and outcome variables. Results While two-thirds of participants had a statistically high probability for using SAMHW, nearly twice more had high probability for using them to improve wellbeing compared to using them to address mental health problems (43% vs. 18%). In both groups, these participants were more likely to be female and in the younger adult age bracket than male and in the adult or older adult age bracket. According to the machine learning model, the most important predictors for using the relevant smartphone apps were variables associated with smartphone problematic use, COVID-19 impact, and mental health problems. Conclusion Findings from the present study confirm that the use of SAMHW is growing, particularly among younger adult and female individuals who are negatively impacted by problematic smartphone use, COVID-19, and mental health problems. These individuals tend to bypass traditional care via psychotherapy or psychopharmacology, relying instead on smartphones to address mental health conditions or improve wellbeing. Advising users of these apps to also seek professional help and promoting efforts to prove the efficacy and safety of SAMHW would seem necessary.
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Affiliation(s)
- Germano Vera Cruz
- Department of Psychology, University of Picardie Jules Verne,
Amiens, France,Yasser Khazaal, CHUV, Département de
Psychiatrie, Service de médecine des addictions, Rue du Bugnon 23, 1011
Lausanne, Switzerland.
| | - Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
| | - Riaz Khan
- Addiction Psychiatry, Foederatio Medicorum Helveticorum, Geneva,
Switzerland
| | - Lucien Rochat
- Addiction Division, Department of Psychiatry, University Hospitals
of Geneva, Geneva, Switzerland
| | | | - Robert Courtois
- Department of Psychology, University of Tours, Tours, France
| | - Yasser Khazaal
- Addiction Medicine, Lausanne University
Hospital, Lausanne, Switzerland,Department of Psychiatry, Lausanne University, Lausanne,
Switzerland,Department of Psychiatry and Addictology, Montreal University,
Montreal, QC, Canada
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3
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Evans K, Donelan J, Rennick-Egglestone S, Cox S, Kuipers Y. Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals' Guide to Locating and Assessing Anxiety Apps. J Med Internet Res 2022; 24:e31831. [PMID: 35319482 PMCID: PMC8987965 DOI: 10.2196/31831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
Background Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women’s experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps. Objective This review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women. Methods A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps. Results Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers’ scores and app user rating scores, with higher user rating scores associated with lower reviewer scores. Conclusions App developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria.
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Affiliation(s)
- Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jasper Donelan
- Digital Research, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Serena Cox
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Yvonne Kuipers
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, United Kingdom
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Biswas M, Tania MH, Kaiser MS, Kabir R, Mahmud M, Kemal AA. ACCU3RATE: A mobile health application rating scale based on user reviews. PLoS One 2021; 16:e0258050. [PMID: 34914718 PMCID: PMC8675707 DOI: 10.1371/journal.pone.0258050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Over the last decade, mobile health applications (mHealth App) have evolved exponentially to assess and support our health and well-being. Objective This paper presents an Artificial Intelligence (AI)-enabled mHealth app rating tool, called ACCU3RATE, which takes multidimensional measures such as user star rating, user review and features declared by the developer to generate the rating of an app. However, currently, there is very little conceptual understanding on how user reviews affect app rating from a multi-dimensional perspective. This study applies AI-based text mining technique to develop more comprehensive understanding of user feedback based on several important factors, determining the mHealth app ratings. Method Based on the literature, six variables were identified that influence the mHealth app rating scale. These factors are user star rating, user text review, user interface (UI) design, functionality, security and privacy, and clinical approval. Natural Language Toolkit package is used for interpreting text and to identify the App users’ sentiment. Additional considerations were accessibility, protection and privacy, UI design for people living with physical disability. Moreover, the details of clinical approval, if exists, were taken from the developer’s statement. Finally, we fused all the inputs using fuzzy logic to calculate the new app rating score. Results and conclusions ACCU3RATE concentrates on heart related Apps found in the play store and App gallery. The findings indicate the efficacy of the proposed method as opposed to the current device scale. This study has implications for both App developers and consumers who are using mHealth Apps to monitor and track their health. The performance evaluation shows that the proposed mHealth scale has shown excellent reliability as well as internal consistency of the scale, and high inter-rater reliability index. It has also been noticed that the fuzzy based rating scale, as in ACCU3RATE, matches more closely to the rating performed by experts.
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Affiliation(s)
- Milon Biswas
- Computer Science and Engineering, Bangladesh University of Business and Technology, Mirpur, Dhaka, Bangladesh
| | - Marzia Hoque Tania
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - M. Shamim Kaiser
- Institute of Information Technology, Jahangirnagar University, Savar, Dhaka, Bangladesh
- * E-mail:
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Chelmsford, United Kingdom
| | - Mufti Mahmud
- Department of Computer Science, Nottingham TrentUniversity, Nottingham, United Kingdom
| | - Atika Ahmad Kemal
- Management and Marketing at Essex Business School (EBS), University of Essex, Colchester, United Kingdom
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5
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Gadde NS, Yap KYL. Mobile Health Apps That Act as Surgical Preparatory Guides: App Store Search and Quality Evaluation. JMIR Perioper Med 2021; 4:e27037. [PMID: 34851296 PMCID: PMC8672284 DOI: 10.2196/27037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/30/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) apps are becoming increasingly common in surgical practices for training, education, and communication. Factors leading to increased delays, morbidity, and mortality in surgery include inadequate preoperative patient preparation due to a failure to identify patients and procedure details, and missing instruments and equipment required for the procedure. Many apps are available for supporting preoperative, intraoperative, and postoperative care. However, there is a lack of studies that assess the quality of apps that act as surgical preparatory guides. OBJECTIVE The aim of this study is to evaluate the quality of apps that act as surgical preparatory guides for operating room personnel through an in-house quality assessment tool. METHODS The quality assessment tool comprises 35 questions categorized into 5 sections: (1) engagement (customization, interactivity, target audience; 19 points), (2) functionality (performance, ease of use, navigation; 12 points), (3) aesthetics (layout, visual appeal; 6 points), (4) information (quality and quantity of information, visual information, credibility; 29 points), and (5) privacy and security (4 points). An app search was conducted in the Australian Apple and Google Play stores using the following keywords: "surgical apps", "surgical preferences", "surgeon preferences", "operating room", and "perioperative procedures". The overall total scores and scores for each section were reported as medians and IQRs, expressed as raw scores and percentages. RESULTS A total of 5 unique apps were evaluated on both iOS and Android platforms. The median overall score across all apps was 35/70 (50%; IQR 38.6%-64.3%). ScrubUp (48/70, 69%) and MySurgeon (42/70, 60%) had the highest overall scores, followed by PrefCard (35/70, 50%) and Scrubnote (28/70, 40%). The lowest scoring app was BrainPadd (26/70, 37%). The sections with the highest median scores, in decreasing order, were privacy and security (4/4, 100%; IQR 75%-100%), aesthetics (5/6, 83%; IQR 75%-91.7%), engagement (15/19, 79%; IQR 57.9%-86.8%), functionality (7/12, 58%; IQR 29.2%-75%), and information (5/29, 17%; IQR 15.5%-34.5%). Most apps scored well (4/4, 100%) on privacy and security, except for Scrubnote (2/4, 50%). ScrubUp received a perfect score for aesthetics (6/6, 100%). MySurgeon (17/19, 90%) had the highest engagement score, while ScrubUp and MySurgeon had the highest functionality scores (9/12, 75% each). All apps scored below 50% for the information section, with ScrubUp having the highest score of 13/29 (45%). CONCLUSIONS ScrubUp and MySurgeon had the highest quality scores and can be used as adjuncts to hospital protocols by operating room personnel for their surgical preparation. Developers are encouraged to develop appropriate apps for surgical preparation based on relevant guidelines and standards, as well as the quality evaluation criteria in our tool. Operating room personnel can also use this tool as a guide to select and assess their preferred apps in their practices.
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Affiliation(s)
- Naga Sindhura Gadde
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kevin Yi-Lwern Yap
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
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6
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Ramos G, Ponting C, Labao JP, Sobowale K. Considerations of diversity, equity, and inclusion in mental health apps: A scoping review of evaluation frameworks. Behav Res Ther 2021; 147:103990. [PMID: 34715396 DOI: 10.1016/j.brat.2021.103990] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/26/2021] [Accepted: 10/12/2021] [Indexed: 01/02/2023]
Abstract
Mental health applications or apps are a promising approach to reduce the pervasive unmet mental health need observed among marginalized groups. However, these groups face unique challenges to engage in and benefit from these interventions, and apps that consider issues of diversity, equity, and inclusion (DEI) may be better positioned to reach them. App evaluation frameworks emerge as crucial tools for researchers, clinicians, and users to select evidence-based apps. Nevertheless, it is unclear the extent to which existing assessment tools capture DEI factors. The present scoping review identified 68 studies that employed one or more assessment tools to evaluate a mental health app, leading to 44 unique app evaluation frameworks. Results showed that most frameworks were developed after 2015, and only 58% of them considered at least one DEI criterion. Frameworks that performed exceptionally well were those that combined multiple standardized and validated measures. This lack of consideration for DEI variables may limit the ability of app-based interventions to serve marginalized communities, or even worse, create new disparities. Therefore, we provide recommendations to improve current app evaluation frameworks' cultural robustness and clinical utility, maximizing their effectiveness when working with individuals from marginalized communities.
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carolyn Ponting
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jerome P Labao
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Kunmi Sobowale
- University of California, Los Angeles-Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
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7
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Khazaal Y, Potvin S, Pennou A, Djomo W, Borgeat F, Lecomte T. Des repères pour la conception des apps ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081512ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectif Proposer quelques repères pour faciliter le processus de création d’applications pour téléphones intelligents (apps) en santé mentale.
Méthode Présentation brève de l’intérêt potentiel des apps et proposition argumentée d’étapes clés pour la création des apps. L’article se base sur une revue narrative, un retour d’expérience et des discussions de groupes d’experts.
Résultats Les apps ont des caractéristiques ubiquitaires particulièrement intéressantes pour le domaine de la santé mentale. Potentiellement connectées à de multiples technologies, mobiles et disponibles en tout temps, elles permettent une grande flexibilité de conception. Afin d’augmenter les chances d’efficacité et de bonne dissémination d’une app donnée, certains principes pourraient guider de manière utile le travail de conception des apps : 9 repères sont proposés, en particulier une bonne intégration des utilisateurs finaux autour d’objectifs cibles bien définis durant tout le processus de création de tels outils.
Conclusion Les repères proposés pourraient faciliter le processus de création d’apps pour la santé mentale.
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Affiliation(s)
- Yasser Khazaal
- Service de médecine des addictions, Département de Psychiatrie CHUV et Université de Lausanne
- Département de psychiatrie et d’addictologie, Université de Montréal
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Stéphane Potvin
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal
- Département de psychologie, Université de Montréal
| | - Antoine Pennou
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal
- Département de psychologie, Université de Montréal
| | - William Djomo
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - François Borgeat
- Département de psychiatrie et d’addictologie, Université de Montréal
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Tania Lecomte
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal
- Département de psychologie, Université de Montréal
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Hensher M, Cooper P, Dona SWA, Angeles MR, Nguyen D, Heynsbergh N, Chatterton ML, Peeters A. Scoping review: Development and assessment of evaluation frameworks of mobile health apps for recommendations to consumers. J Am Med Inform Assoc 2021; 28:1318-1329. [PMID: 33787894 PMCID: PMC8263081 DOI: 10.1093/jamia/ocab041] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/12/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Objective The study sought to review the different assessment items that have been used within existing health app evaluation frameworks aimed at individual, clinician, or organizational users, and to analyze the scoring and evaluation methods used in these frameworks. Materials and Methods We searched multiple bibliographic databases and conducted backward searches of reference lists, using search terms that were synonyms of “health apps,” “evaluation,” and “frameworks.” The review covered publications from 2011 to April 2020. Studies on health app evaluation frameworks and studies that elaborated on the scaling and scoring mechanisms applied in such frameworks were included. Results Ten common domains were identified across general health app evaluation frameworks. A list of 430 assessment criteria was compiled across 97 identified studies. The most frequently used scaling mechanism was a 5-point Likert scale. Most studies have adopted summary statistics to generate the total scoring of each app, and the most popular approach taken was the calculation of mean or average scores. Other frameworks did not use any scaling or scoring mechanism and adopted criteria-based, pictorial, or descriptive approaches, or “threshold” filter. Discussion There is wide variance in the approaches to evaluating health apps within published frameworks, and this variance leads to ongoing uncertainty in how to evaluate health apps. Conclusions A new evaluation framework is needed that can integrate the full range of evaluative criteria within one structure, and provide summative guidance on health app rating, to support individual app users, clinicians, and health organizations in choosing or recommending the best health app.
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Affiliation(s)
- Martin Hensher
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Paul Cooper
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Sithara Wanni Arachchige Dona
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mary Rose Angeles
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Dieu Nguyen
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Natalie Heynsbergh
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mary Lou Chatterton
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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9
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Akbar S, Coiera E, Magrabi F. Safety concerns with consumer-facing mobile health applications and their consequences: a scoping review. J Am Med Inform Assoc 2021; 27:330-340. [PMID: 31599936 PMCID: PMC7025360 DOI: 10.1093/jamia/ocz175] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To summarize the research literature about safety concerns with consumer-facing health apps and their consequences. Materials and Methods We searched bibliographic databases including PubMed, Web of Science, Scopus, and Cochrane libraries from January 2013 to May 2019 for articles about health apps. Descriptive information about safety concerns and consequences were extracted and classified into natural categories. The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) statement. Results Of the 74 studies identified, the majority were reviews of a single or a group of similar apps (n = 66, 89%), nearly half related to disease management (n = 34, 46%). A total of 80 safety concerns were identified, 67 related to the quality of information presented including incorrect or incomplete information, variation in content, and incorrect or inappropriate response to consumer needs. The remaining 13 related to app functionality including gaps in features, lack of validation for user input, delayed processing, failure to respond to health dangers, and faulty alarms. Of the 52 reports of actual or potential consequences, 5 had potential for patient harm. We also identified 66 reports about gaps in app development, including the lack of expert involvement, poor evidence base, and poor validation. Conclusions Safety of apps is an emerging public health issue. The available evidence shows that apps pose clinical risks to consumers. Involvement of consumers, regulators, and healthcare professionals in development and testing can improve quality. Additionally, mandatory reporting of safety concerns is needed to improve outcomes.
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Affiliation(s)
- Saba Akbar
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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10
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Ebenfeld L, Lehr D, Ebert DD, Kleine Stegemann S, Riper H, Funk B, Berking M. Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial. J Med Internet Res 2021; 23:e20829. [PMID: 33661121 PMCID: PMC7974752 DOI: 10.2196/20829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/06/2020] [Accepted: 01/17/2021] [Indexed: 01/30/2023] Open
Abstract
Background Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions. Objective This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder. Methods Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale. Results Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95% CI 0.38-1.24). Conclusions Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder. Trial Registration German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran International Registered Report Identifier (IRRID) RR2-10.1186/1745-6215-15-427
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Affiliation(s)
| | - Dirk Lehr
- Leuphana University, Lüneburg, Germany
| | - David Daniel Ebert
- Leuphana University, Lüneburg, Germany.,Technical University of Munich, Munich, Germany
| | | | - Heleen Riper
- GGZ ingeest Amsterdam, Amsterdam, Netherlands.,Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Matthias Berking
- Friedrich-Alexander-University Nuremberg-Erlangen, Nuremberg-Erlangen, Germany
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Maatoug R, Peiffer-Smadja N, Delval G, Brochu T, Pitrat B, Millet B. Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study. JMIR Form Res 2021; 5:e14179. [PMID: 33625367 PMCID: PMC7946583 DOI: 10.2196/14179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective The main objective of this study was twofold: (1) to assess patients’ compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients’ data into a user-friendly format. Results Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations.
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Affiliation(s)
- Redwan Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Nathan Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution, UMR 1137, University Paris Diderot, Paris, France
| | - Guillaume Delval
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Térence Brochu
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Benjamin Pitrat
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Bruno Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
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Lecomte T, Potvin S, Corbière M, Guay S, Samson C, Cloutier B, Francoeur A, Pennou A, Khazaal Y. Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses. JMIR Mhealth Uhealth 2020; 8:e17458. [PMID: 32348289 PMCID: PMC7293054 DOI: 10.2196/17458] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022] Open
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.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Centre de recherche, l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de recherche, l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry, University of Montreal, Montreal, QC, Canada
| | - Marc Corbière
- Centre de recherche, l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Education, Career Counselling, University du Quebec a Montreal, Montreal, QC, Canada
| | - Stéphane Guay
- Centre de recherche, l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Criminology, University of Montreal, Montreal, QC, Canada
| | - Crystal Samson
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Briana Cloutier
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Audrey Francoeur
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Antoine Pennou
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Yasser Khazaal
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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13
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Azad-Khaneghah P, Neubauer N, Miguel Cruz A, Liu L. Mobile health app usability and quality rating scales: a systematic review. Disabil Rehabil Assist Technol 2020; 16:712-721. [PMID: 31910687 DOI: 10.1080/17483107.2019.1701103] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the rating scales used to evaluate usability and quality of mobile health applications, and to compare their purpose, content, and intended target users (i.e., patients, caregivers, or researchers). MATERIAL AND METHODS We conducted a systematic review of the literature in accordance with the PRISMA statement on Medline, CINAHL, PsycINFO, IEEE Explore databases, as well as a review of the grey literature to identify rating scales used to evaluate usability and quality of mobile health applications (m-health apps), between January 1, 2000 and July 31, 2018. Two researchers screened the titles and abstracts of articles that met inclusion criteria, and retrieved usability and quality rating scales from the articles. RESULTS We identified 24 usability scales and 25 quality rating scales in 87 peer-reviewed articles. We identified only one quality rating scale designed for non-expert users (i.e., patients or caregivers). None of the studies used a theoretical framework for app evaluation to support the scales. The validity of existing quality rating scales is yet to be investigated. CONCLUSION Existing usability and quality rating scales are targeted at professionals, not end users who are patients or caregivers. Rating scales that are usable by all end-users would make mobile health apps accessible and meaningful to consumers.Implications for rehabilitationThe number of mobile health applications on app stores that can be used for rehabilitation is increasing.Most healthcare providers lack the training to identify m-health apps with high quality to be used in rehabilitation.This study has reviewed the current rating scales that can help clinicians and care providers rate the quality of m-health apps and identify the ones that are most appropriate for their practice.
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Affiliation(s)
| | - Noelannah Neubauer
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Antonio Miguel Cruz
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lili Liu
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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14
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Apolinário-Hagen J, Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:291-329. [DOI: 10.1007/978-981-32-9705-0_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Alhuwail D, Albaj R, Ahmad F, Aldakheel K. The state of mental digi-therapeutics: A systematic assessment of depression and anxiety apps available for Arabic speakers. Int J Med Inform 2019; 135:104056. [PMID: 31918341 DOI: 10.1016/j.ijmedinf.2019.104056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 11/10/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mental disorders are a major public health problem leading to premature mortality, homelessness, addiction problems, poor physical health, and suicide. The prevalence of mental disorders in Arab countries, is high. The proliferation and ubiquity of smartphones and their apps in the Arab world may be the long-awaited for digital therapeutic for mental health disorders. However, the evidence about the availability and characteristics of mental health apps available to Arabic speakers remains poor. OBJECTIVE To conduct a systematic assessment of the features of depression and anxiety mobile apps available for Arabic speakers. METHODS A critical review of all the currently available depression and anxiety apps, available free of charge to Arabic speakers. The apps are evaluated using the Mobile App Rating Scale (MARS). Further, a categorization of apps' main functions, inspired by the mhGAP guidelines, is developed to classify the apps based on their main functions. RESULTS A total of 23 apps are identified with far more apps available on the Google Play Store (n = 21) versus only two apps on the iOS App Store. The majority of the apps (n = 16) provide general information about either anxiety, depression, or both. Six apps are of spiritual nature mainly referring to the Islamic faith and the Holy Quran, with one app referring to the Christian faith. Another five apps provide advice on alternative treatments, mainly concerning herbal medicine recipes. Only two apps provided utilities for users, specifically about medication reminders. CONCLUSIONS Mental health digi-threaputics have huge potentials to transform mental health care delivery. However, more empirical studies are needed to assure their quality and efficacy. The results of this study clearly highlight the current gaps to address the needs of Arabic speakers; only 23 apps were identified in this study, mostly with low app quality scores. There is a need to involve expert healthcare professionals in the development of mental health apps and for healthcare providers to empower patients through discussing apps that are useful and discern them from those that can potentially cause harm.
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Affiliation(s)
- Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait; Health Informatics Unit, Dasman Diabetes Institute, Kuwait.
| | - Rama Albaj
- Information Science Department, Kuwait University, Kuwait
| | - Fatma Ahmad
- Information Science Department, Kuwait University, Kuwait
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16
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Nouri R, R Niakan Kalhori S, Ghazisaeedi M, Marchand G, Yasini M. Criteria for assessing the quality of mHealth apps: a systematic review. J Am Med Inform Assoc 2019; 25:1089-1098. [PMID: 29788283 DOI: 10.1093/jamia/ocy050] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/17/2018] [Indexed: 12/16/2022] Open
Abstract
Objective Review the existing studies including an assessment tool/method to assess the quality of mHealth apps; extract their criteria; and provide a classification of the collected criteria. Methods In accordance with the PRISMA statement, a literature search was conducted in MEDLINE, EMBase, ISI and Scopus for English language citations published from January 1, 2008 to December 22, 2016 for studies including tools or methods for quality assessment of mHealth apps. Two researchers screened the titles and abstracts of all retrieved citations against the inclusion and exclusion criteria. The full text of relevant papers was then individually examined by the same researchers. A senior researcher resolved eventual disagreements and confirmed the relevance of all included papers. The authors, date of publication, subject fields of target mHealth apps, development method, and assessment criteria were extracted from each paper. The extracted assessment criteria were then reviewed, compared, and classified by an expert panel of two medical informatics specialists and two health information management specialists. Results Twenty-three papers were included in the review. Thirty-eight main classes of assessment criteria were identified. These were reorganized by expert panel into 7 main classes (Design, Information/Content, Usability, Functionality, Ethical Issues, Security and Privacy, and User-perceived value) with 37 sub-classes of criteria. Conclusions There is a wide heterogeneity in assessment criteria for mHealth apps. It is necessary to define the exact meanings and degree of distinctness of each criterion. This will help to improve the existing tools and may lead to achieve a better comprehensive mHealth app assessment tool.
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Affiliation(s)
- Rasool Nouri
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mobin Yasini
- Research and Development Department, DMD Santé, Paris, France
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17
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Ebenfeld L, Kleine Stegemann S, Lehr D, Ebert DD, Funk B, Riper H, Berking M. A mobile application for panic disorder and agoraphobia: Insights from a multi-methods feasibility study. Internet Interv 2019; 19:100296. [PMID: 31890640 PMCID: PMC6926267 DOI: 10.1016/j.invent.2019.100296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Panic disorder with and without agoraphobia (PD) is a common psychological disorder. Internet-based interventions have the potential to offer highly scalable low-threshold evidence-based care to people suffering from PD. GET.ON Panic is a newly developed internet-based intervention addressing symptoms of PD. In order to transfer the training into the daily life of the individuals, we integrated mobile components in the training and created a so-called hybrid online training. The development and beta-testing of such a training requires a novel interdisciplinary approach between IT specialists and psychologists. From this point of view, we would like to share our experiences in this exploratory paper. METHODS This initial feasibility study (N = 10) offers, on the one hand, a brief overview of the interdisciplinary development phase of the mobile application and on the other hand, provides first insights into the usage, usability and acceptance of this mobile application using qualitative interview data as well quantitative measures of 8 completing participants. For these reasons, we used a pre-posttest design without a control group. Furthermore, we present initial clinical outcomes of the intervention on e.g. panic symptom severity, depressive symptoms as well additional anxiety measures. Finally, we end with implications for further research in the relatively new field of mobile mental health. RESULTS Overall, usability, user satisfaction, motivational value and technology acceptance of the app were perceived as high. The usage of app components was diverse: The use of interoceptive exposure exercises and daily summaries on anxiety and mood was highest while using in-vivo exposure exercises and monitoring panic symptoms was perceived as difficult. Furthermore, participants showed after the training less clinical symptoms as at baseline-assessment. DISCUSSION The current feasibility study contributes to an in-depth understanding of the potential of mobile technology in e-mental health. Overall, the GET.ON Panic app appears to be an acceptable and motivational part of a CBT-based hybrid online training for PD that has the potential to promote training success. After some suggested adjustments have been made, the efficacy should be investigated in a randomized controlled trial.
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Affiliation(s)
- Lara Ebenfeld
- Leuphana University, Lueneburg, Germany,Corresponding author.
| | | | - Dirk Lehr
- Leuphana University, Lueneburg, Germany
| | - David Daniel Ebert
- Leuphana University, Lueneburg, Germany,Friedrich-Alexander-University Nuremberg-Erlangen, Germany,Free University of Amsterdam and the Amsterdam Public Health Research Institute, the Netherlands
| | | | - Heleen Riper
- Free University of Amsterdam Medical Center, the Netherlands,GGZ ingest Amsterdam, the Netherlands,Free University of Amsterdam and the Amsterdam Public Health Research Institute, the Netherlands
| | - Matthias Berking
- Leuphana University, Lueneburg, Germany,Friedrich-Alexander-University Nuremberg-Erlangen, Germany
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18
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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; 18:325-336. [PMID: 31496095 PMCID: PMC6732686 DOI: 10.1002/wps.20673] [Citation(s) in RCA: 319] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although impressive progress has been made toward developing empirically-supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app-supported smartphone interventions are touted as a possible solution, access to up-to-date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta-analysis of 66 randomized controlled trials of app-supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=-0.05, n=3), post-traumatic stress symptoms (g=0.18, n=4), and negative affect (g=-0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
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Affiliation(s)
- Jake Linardon
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Per Carlbring
- Department of PsychologyStockholm UniversityStockholmSweden
| | - Mariel Messer
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Matthew Fuller‐Tyszkiewicz
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,Center for Social and Early Emotional DevelopmentDeakin UniversityBurwoodVictoriaAustralia
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Wright JH, Mishkind M, Eells TD, Chan SR. Computer-Assisted Cognitive-Behavior Therapy and Mobile Apps for Depression and Anxiety. Curr Psychiatry Rep 2019; 21:62. [PMID: 31250242 DOI: 10.1007/s11920-019-1031-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW We reviewed research on computer-assisted cognitive-behavior therapy (CCBT) and mobile applications with the goals of assessing the effectiveness of these newer methods of delivering or augmenting treatment and making recommendations on the clinical use of computer tools in psychotherapy of depression and anxiety. RECENT FINDINGS Research on CCBT has found solid evidence for efficacy when the use of a therapeutic computer program is supported by a clinician or other helping professionals. Lower levels of efficacy or ineffectiveness typically have been found when computer programs are used as stand-alone treatments. A large number of mobile apps have been created that claim to be useful for depression and/or anxiety. However, considerable caution is warranted in evaluating mobile apps and recommending them to patients. Research on mobile apps is still in an early stage of development. A number of well-established CCBT programs have been studied in multiple randomized, controlled trials and have been found to be effective. Such programs appear to have adequate quality, security, and efficacy to be used in clinical practice. Mobile apps offer easy portability and immediate access to coping strategies and may be useful for augmenting treatment. But clinicians need to select apps with integrity and reliable content for clinical use.
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Affiliation(s)
| | - Matthew Mishkind
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tracy D Eells
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Steven R Chan
- Palo Alto VA Health, Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California, Davis, Davis, CA, USA
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20
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Varfi N, Rothen S, Jasiowka K, Lepers T, Bianchi-Demicheli F, Khazaal Y. Sexual Desire, Mood, Attachment Style, Impulsivity, and Self-Esteem as Predictive Factors for Addictive Cybersex. JMIR Ment Health 2019; 6:e9978. [PMID: 30664470 PMCID: PMC6360388 DOI: 10.2196/mental.9978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 11/01/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND An increasing number of studies are concerned with various aspects of cybersex addiction, the difficulty some persons have in limiting cybersex use despite a negative impact on everyday life. OBJECTIVE The aim of this study was to assess potential links between the outcome variable cybersex addiction, assessed with the Compulsive Internet Use Scale (CIUS) adapted for cybersex use, and several psychological and psychopathological factors, including sexual desire, mood, attachment style, impulsivity, and self-esteem, by taking into account the age, sex, and sexual orientation of cybersex users. METHODS A Web-based survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: CIUS adapted for cybersex use, Sexual Desire Inventory, and Short Depression-Happiness Scale. Moreover, attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Impulsivity was measured by using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale. Global self-esteem was assessed with the 1-item Self-Esteem Scale. RESULTS A sample of 145 subjects completed the study. Addictive cybersex use was associated with higher levels of sexual desire, depressive mood, avoidant attachment style, and male gender but not with impulsivity. CONCLUSIONS Addictive cybersex use is a function of sexual desire, depressive mood, and avoidant attachment.
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Apolinário-Hagen J. Internet-Delivered Psychological Treatment Options for Panic Disorder: A Review on Their Efficacy and Acceptability. Psychiatry Investig 2019; 16:37-49. [PMID: 30122031 PMCID: PMC6354039 DOI: 10.30773/pi.2018.06.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Internet-delivered psychological treatments have been suggested as a chance to expand the access to professional help. However, little is known about the usefulness of different support formats and approaches of digital treatments for panic disorder among clinicians. OBJECTIVE This narrative review aimed to explore the recent evidence base on the efficacy and acceptability of different internet-delivered treatments for adults with panic disorder. METHODS A systematic search in electronic databases (Pubmed/Medline, PSYNDEX) and a hand search were performed to identify articles on randomized controlled trials published within the past five years (2012/12/10-2017/12/12) in English peer-reviewed journals. RESULTS Eight studies (1,013 participants) involving 10 interventions met the inclusion criteria. Nine interventions were primarly based on Cognitive Behavioral Therapy principles. Most interventions were effective, when compared to a control condition (6 of 8 comparisons). Minimal guidance was associated with improved outcomes in one study and adherence in two studies (3 comparisons). Furthermore, no differences were found based on treatment approach (2 comparisons). Regarding acceptability, the attrition rates were moderate to high, ranging from 9.8% to 42.1% of randomized participants. Adherence rates also varied largely (7.8-75%), whereas participant satisfaction of program completers was assessed overall high (5 studies). CONCLUSION Diverse effective internet-delivered treatments are available for the self-management of panic symptoms. Especially selfguided and transdiagnostic Cognitive Behavioral Therapy approaches appear being efficient options for the dissemination in routine care. However, due to the limited evidence base, further efforts are required to improve the actual uptake of internet-delivered treatments and identify moderators of outcomes.
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Magee JC, Adut S, Brazill K, Warnick S. Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2018; 5:345-362. [PMID: 30397577 PMCID: PMC6214367 DOI: 10.1007/s40501-018-0154-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care. RECENT FINDINGS Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice. SUMMARY Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.
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Affiliation(s)
- Joshua C Magee
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Sarah Adut
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Kevin Brazill
- University of Illinois College of Medicine at Urbana-Champaign/Carle Physician Group, Department of Family Medicine and Department of Psychiatry, 611 West Park St., Urbana, IL 61801
| | - Stephen Warnick
- University of Michigan Medical School, Department of Family Medicine and Department of Psychiatry, 1150 W. Medical Center Dr., M7300 Med Sci I, SPC 5625, Ann Arbor, MI 48109-5625
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Tozzi F, Nicolaidou I, Galani A, Antoniades A. eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review. JMIR Pediatr Parent 2018; 1:e5. [PMID: 31518330 PMCID: PMC6716078 DOI: 10.2196/pediatrics.7248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as cognitive behavioral therapy, in the treatment of psychological disorders in adults, such as depression, anxiety, obsessive-compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone, self-help) and computer-assisted (in combination with face-to-face therapy, or therapist guided) programs for youth. OBJECTIVE Our objective was to summarize and critically review the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim was to improve the understanding of what would be critical for future development of effective technology-based interventions. METHODS We conducted an exploratory review of the literature through searches in 3 scientific electronic databases (PsycINFO, ScienceDirect, and PubMed). We used keywords in various combinations: child or children, adolescent, preschool children, anxiety, intervention or treatment or program, smartphone applications or apps, online or Web-based tool, computer-based tool, internet-based tool, serious games, cognitive behavioral therapy or CBT, biofeedback, and mindfulness. For inclusion, articles had to (1) employ a technological therapeutic tool with or without the guidance of a therapist; (2) be specific for treatment or prevention of anxiety disorders in children or adolescents; (3) be published between 2000 and 2018; and (4) be published in English and in scientific peer-reviewed journals. RESULTS We identified and examined 197 articles deemed to be relevant. Of these, we excluded 164 because they did not satisfy 1 or more of the requirements. The final review comprised 19 programs. Published studies demonstrated promising results in reducing anxiety, especially relative to the application of cognitive behavioral therapy with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional interventions. Other approaches have been applied to technology-based interventions with inconclusive results. Most programs were developed to be used concurrently with traditional treatments and lacked long-term evaluation. Very little has been done in terms of prevention interventions. CONCLUSIONS Future development of eHealth programs for anxiety management in children will have to address several unmet needs and overcome key challenges. Although developmental stages may limit the applicability to preschool children, prevention should start in early ages. Self-help formats and personalization are highly relevant for large-scale dissemination. Automated data collection should be built in for program evaluation and effectiveness assessment. And finally, a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.
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Affiliation(s)
| | - Iolie Nicolaidou
- Department of Communication and Internet Studies, Cyprus University of Technology, Limassol, Cyprus
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Sort A, Khazaal Y. Six Tips on How to Bring Epic Wins to Health Care. Front Psychiatry 2017; 8:264. [PMID: 29249994 PMCID: PMC5714863 DOI: 10.3389/fpsyt.2017.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 11/15/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Sort
- University of Barcelona, Barcelona, Spain.,PlayBenefit, Barcelona, Spain
| | - Yasser Khazaal
- Research Centre of the Montreal University Institute of Mental Health, Montreal, QC, Canada.,University of Geneva, Geneva, Switzerland.,Geneva University Hospitals, Geneva, Switzerland
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Xiao Q, Lu S, Wang Y, Sun L, Wu Y. Current Status of Cardiovascular Disease-Related Smartphone Apps Downloadable in China. Telemed J E Health 2016; 23:219-225. [PMID: 27356156 DOI: 10.1089/tmj.2016.0083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smartphone apps present a great opportunity for the management of cardiovascular disease (CVD) as the adoption of apps becomes increasingly popular in China. Yet, little is known about the status of CVD-related Smartphone apps in the country. The aim of this study was to examine the current status of CVD-related smartphone apps available for download in China. MATERIALS AND METHODS Using CVD-related keywords written either in Chinese or English, the top 6 most popular smartphone app online stores in China were searched in September 2015. The information accountability of the selected apps was assessed with the Silberg scale. The key topic areas identified from the European Guidelines on cardiovascular disease prevention served to determine information coverage of the top 5 downloaded apps. RESULTS The average Silberg score of 151 apps was 2.87 (out of 9) with most apps not revealing authors' qualifications and information references. There was also a lack of sponsorship disclosure and information update. Moreover, none of the top 5 downloaded apps covered all key areas of CVD management as recommended by the European Guidelines on cardiovascular disease prevention. There was little evidence of health professionals' involvement in the formation of the CVD-related apps. CONCLUSION This study identified areas for improvement concerning information accountability and the scope of coverage of CVD-related apps downloadable in China. The findings may guide the future advancement of CVD-related apps and benefit CVD management in China.
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Affiliation(s)
- Qian Xiao
- 1 School of Nursing, Capital Medical University , Beijing, China
| | - Sai Lu
- 2 College of Health and Biomedicine, Victoria University , Melbourne, Australia
| | - Yanling Wang
- 1 School of Nursing, Capital Medical University , Beijing, China
| | - Liu Sun
- 1 School of Nursing, Capital Medical University , Beijing, China
| | - Ying Wu
- 1 School of Nursing, Capital Medical University , Beijing, China
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Penzenstadler L, Chatton A, Van Singer M, Khazaal Y. Quality of Smartphone Apps Related to Alcohol Use Disorder. Eur Addict Res 2016; 22:329-338. [PMID: 27598779 DOI: 10.1159/000449097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 08/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Apps for smartphones are opening an important range of opportunities for improving the care of people with alcohol use disorders (AUDs). AIMS This study aimed to evaluate the quality of English language apps for AUDs and to compare paid and free apps. The keywords 'alcohol', 'alcohol addiction', 'alcohol help' and 'stop drinking' were entered into the iTunes Store search engine. Apps were evaluated using a standardized assessment designed to rate the quality of apps in terms of accountability, interactivity, self-help score and evidence-based content. The Brief DISCERN score and the criteria of the 'Health on the Net' label were also used as content quality indicators. RESULTS AND CONCLUSIONS Of the 137 unique apps identified, 52 met the inclusion criteria. Overall, the content quality and self-help scores of these AUD apps were poor. The main quality indicators were not linked to payment status. Multiple linear regressions showed that the Brief DISCERN score significantly predicted content quality. Poor content quality and self-help scores of AUD smartphone apps underline the gap between their potential promises and the overall quality of available products in stores. The quality indicators used in the present study may be used for further app developments.
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Affiliation(s)
- Louise Penzenstadler
- Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Monney G, Penzenstadler L, Dupraz O, Etter JF, Khazaal Y. mHealth App for Cannabis Users: Satisfaction and Perceived Usefulness. Front Psychiatry 2015; 6:120. [PMID: 26379561 PMCID: PMC4550753 DOI: 10.3389/fpsyt.2015.00120] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/11/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the characteristics of cannabis users and their levels of satisfaction with Stop-cannabis, an app intended for cannabis users who want to stop or reduce their cannabis use or prevent relapse. METHODS A cross-sectional online survey was administered to users of Stop-cannabis, a French-language app for iOS and Android devices. All app users were invited to participate in the survey via a message sent to the app. RESULTS For hundred and eighty-two users answered the survey. The app was used daily by 348 of the participants (around 70%). More than 80% of participants (397) considered the app to have helped them "a little" or "a lot" to stop or reduce cannabis consumption. Most of the users' suggestions were related to the number or the quality of the messages sent by, or displayed in, the app. CONCLUSION This pilot study supports the feasibility of such an app and its perceived usefulness. A self-selection bias, however, limits the conclusions of the study. The efficacy of the app should be evaluated in a randomized controlled trial.
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Affiliation(s)
- Grégoire Monney
- Department of Mental Health and Psychiatry, Geneva University Hospitals , Geneva , Switzerland ; Faculty of Medicine, Institute of Global Health, University of Geneva , Geneva , Switzerland
| | - Louise Penzenstadler
- Department of Mental Health and Psychiatry, Geneva University Hospitals , Geneva , Switzerland
| | - Olivia Dupraz
- Faculty of Medicine, Institute of Global Health, University of Geneva , Geneva , Switzerland
| | - Jean-François Etter
- Faculty of Medicine, Institute of Global Health, University of Geneva , Geneva , Switzerland ; Department of Psychiatry, University of Geneva , Geneva , Switzerland
| | - Yasser Khazaal
- Department of Mental Health and Psychiatry, Geneva University Hospitals , Geneva , Switzerland ; Department of Psychiatry, University of Geneva , Geneva , Switzerland
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Kobak KA, Mundt JC, Kennard B. Integrating technology into cognitive behavior therapy for adolescent depression: a pilot study. Ann Gen Psychiatry 2015; 14:37. [PMID: 26535048 PMCID: PMC4630889 DOI: 10.1186/s12991-015-0077-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/20/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rapid advances in information technology and telecommunications have resulted in a dramatic increase in the use of mobile devices and the internet to enhance and facilitate access to treatment. Cognitive behavior therapy (CBT) is an empirically based treatment that is well suited for enhancement by new technologies, particularly with youth. To facilitate the dissemination of this evidence-based treatment, we developed a technology-enhanced CBT intervention for the treatment of adolescent depression consisting of (1) online therapist training (2) in-session use of tablets for teaching clients CBT concepts and skills, and (3) text messaging for between session homework reminders and self-monitoring. METHODS Eighteen licensed clinicians (social workers n = 7, psychologists n = 9) were randomized to have their patients receive either the intervention (CBT) or treatment as usual (TAU). Each clinician treated four adolescents for 12 weeks. Clinicians in the CBT arm completed an online tutorial on CBT treatment of adolescent depression, then received an iPad with access to patient education materials for teaching CBT concepts to patients during sessions. Individualized text messages were integrated into treatment for homework reminders, support, and outcomes measurement. Outcome measures included a 49-item multiple choice test for tutorial effectiveness; the system usability scale (SUS) for user satisfaction; quick inventory of depressive symptomatology-adolescent version (QIDS-A-Pat); and clinician and patient ratings on the therapeutic alliance scale for adolescents (TASA). RESULTS A significant increase in knowledge of CBT concepts was found after completing the tutorial, t(8) = 7.02, p < 0.001. Clinician and patient ratings of user satisfaction were high for both the iPad teaching tools, and the text messaging. Ninety-five percent of teens said reviewing their text messages with their therapist was helpful, and all said they would use text messaging in treatment again. Ratings of the therapeutic alliance were higher in the CBT arm t(131) = 4.03, p = 0.001. A significant reduction in depression was found in both groups [t(34) = 8.453, p < 0.001 and t(29) = 6.67, p < 0.001 for CBT and TAU, respectively). Clinical ratings of improvement were greater on all outcome measures for the CBT arm; however, none reached statistical significance. Effect sizes (Cohen's d) ranged from small (QIDS-A) to large (TASA). CONCLUSIONS Results support the feasibility of this technology-enhanced CBT intervention as a means of improving CBT treatment of adolescent depression and may help address the critical shortage of therapists trained on empirically based treatments.
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Affiliation(s)
- Kenneth A Kobak
- Center for Telepsychology, 22 North Harwood, Madison, WI 53717 USA
| | - James C Mundt
- Center for Telepsychology, 22 North Harwood, Madison, WI 53717 USA
| | - Betsy Kennard
- UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390 USA
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