Smartphone apps: can they improve our mental health?

When it comes to mental health, smartphones usually get a bad rap – studies have linked their overuse to loneliness, depression and sleep deprivation.

But there’s also a growing wellbeing movement built around our phones. A search for ‘mental health’ on the App Store or Google Play throws up hundreds of apps geared towards every aspect of our mental health.

There are apps that assess and diagnose our state of mind; apps that allow us to track our feelings and thoughts; apps that provide coping tools such as meditation and cognitive behavioural therapy; and even therapy chatbots.

According to an NHS Digital survey from 2014, around one in six of us experiences depression or an anxiety disorder in any given week. With mental health services increasingly stretched, can these apps provide support to people who are unable to – or don’t want to – access conventional therapies?

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“Every country in the world has limited access to mental health care, and these apps have the potential to deliver evidence-based treatment to the right people at the right time,” says Dr John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and leader of the American Psychiatric Association’s work group on the evaluation of smartphone apps.

However, Torous emphasises the word ‘potential’. There is currently little evidence that these apps can be an effective replacement for standard therapies.

In a paper published in December 2019 in the journal npj Digital Medicine, psychologists in Germany and the Netherlands carried out a meta-analysis of 19 studies that looked at the effectiveness of various mental health apps. The researchers concluded that “using smartphone apps as standalone psychological interventions cannot be recommended based on the current level of evidence”.

Feeling ’appy?

Torous says that mental health apps are most useful when they’re combined with conventional therapy and professional guidance.

In another meta-analysis published in September 2019, researchers in Australia, Sweden and the Netherlands found that the effectiveness of smartphone apps in treating depression doubled when guidance was provided by therapists or research staff. “The apps are best used to augment, extend and expand care, not to replace it,” says Torous.

However, Torous doesn’t believe we should stop downloading mental health apps altogether. They can be helpful on an individual basis, he says, provided we choose them wisely and use them mindfully. They can be a first step towards getting help, for instance, or a useful stopgap for those waiting for treatment.

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So how to choose a mental health app? In some cases, apps can offer incorrect advice, potentially putting people at risk. And they often make claims that simply don’t stand up to scrutiny.

Last year, for example, Torous and colleagues at the University of New South Wales in Australia analysed app store descriptions of 73 high-ranking mental health apps for Android or iOS. Only one app directly referenced a scientific study to back up its claims.

App advice

Torous has three main pieces of advice. “Look for apps that have been updated within the last 180 days,” he says. “If an app hasn’t been updated, it might be because the developers aren’t keeping up to date with medical information. Also, look for apps from developers that you’ve heard of and trust.”

Check whether the app has a privacy policy. “If it doesn’t, that’s a red flag,” he says. “The app may be free, but are you paying for it with your personal health information? You’re sharing sensitive information with these apps, so you need to understand what’s happening to your data and what you’re agreeing to. It’s all about trust – these apps have to show us why we should be open to sharing our intimate details with them.”

A good place to start for health apps, says Torous, is the NHS Apps Library. The apps featured here have all been approved following assessment for a number of different factors, including effectiveness, security, and technical stability. At the time of writing, there are 20 apps in the library geared towards mental health.

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Once you’ve downloaded an app, Torous advises telling a family member or friend. “Mental health apps have a higher chance of being helpful if you can stick with them,” he says. “And one of the best ways of sticking with them is to let someone know, so that they can check in with you and keep you accountable. Don’t go it alone.”

Ultimately, it’s still early days for these apps. The field of psychiatry has been developing for centuries; many of the apps designed to help our mental health have appeared in the last five years or so.

But Torous is confident that the apps will improve. “The evidence may not be there yet,” he says, “but the potential of these apps to increase access to care and offer [therapeutic] tools in the palms of our hands is so powerful that it’s going to keep driving innovation. There’s nothing else that can reach that many people.”

Digital psychiatry: What's in store...

A smartphone app being developed by psychiatrist Dr John Torous and colleagues at Beth Israel Deaconess Medical Center offers a glimpse into the future of digital psychiatry.

The mindLAMP app uses a variety of methods to monitor a user’s mental health. Surveys allow the user to report their symptoms; brain games test the user’s cognitive abilities, such as memory and attention; and a tagging feature allows the user to record who they are with, and where.

The app can link in with Google Fit and Apple HealthKit, collecting data such as step count and heart rate, and it also provides mindfulness games to help users manage and reduce their symptoms.

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In a study published last September, participants with psychosisused the app for three months. By analysing the data, Torous and colleagues could pick out some useful correlations. For example, one participant’s survey scores for depression, anxiety and psychosis began to decrease when she kept to her medication schedule. Another participant’s depression, anxiety and psychosis scores were found to reduce when she had a better night’s sleep.

“Our initial findings provide evidence that use of a smartphone application to monitor symptoms and behaviours produces an individual pattern for each person, indicating that this is a feasible means of monitoring and detecting patient status,” write the researchers, adding that this could help to provide personalised treatment plans.

The variation in individual experiences meant that it wasn’t possible to pick out broader correlations between lifestyle and mental health, but more studies with the app (which has been made open-source so that other institutions can use it) could change that.

The app is currently only available to those who are taking part in a study, but the researchers plan to make the app freely available once the initial studies are complete.