Functionality of Top-Rated Mobile Apps for Depression: Systematic Search and Evaluation

Abstract

Background In the last decade, there has been a proliferation of mobile apps claiming to support the needs of people living with depression. However, it is unclear what functionality is actually provided by apps for depression, or for whom they are intended. Objective This paper aimed to explore the key features of top-rated apps for depression, including descriptive characteristics, functionality, and ethical concerns, to better inform the design of apps for depression. Methods We reviewed top-rated iPhone OS (iOS) and Android mobile apps for depression retrieved from app marketplaces in spring 2019. We applied a systematic analysis to review the selected apps, for which data were gathered from the 2 marketplaces and through direct use of the apps. We report an in-depth analysis of app functionality, namely, screening, tracking, and provision of interventions. Of the initially identified 482 apps, 29 apps met the criteria for inclusion in this review. Apps were included if they remained accessible at the moment of evaluation, were offered in mental health–relevant categories, received a review score greater than 4.0 out of 5.0 by more than 100 reviewers, and had depression as a primary target. Results The analysis revealed that a majority of apps specify the evidence base for their intervention (18/29, 62%), whereas a smaller proportion describes receiving clinical input into their design (12/29, 41%). All the selected apps are rated as suitable for children and adolescents on the marketplace, but 83% (24/29) do not provide a privacy policy consistent with their rating. The findings also show that most apps provide multiple functions. The most commonly implemented functions include provision of interventions (24/29, 83%) either as a digitalized therapeutic intervention or as support for mood expression; tracking (19/29, 66%) of moods, thoughts, or behaviors for supporting the intervention; and screening (9/29, 31%) to inform the decision to use the app and its intervention. Some apps include overtly negative content. Conclusions Currently available top-ranked apps for depression on the major marketplaces provide diverse functionality to benefit users across a range of age groups; however, guidelines and frameworks are still needed to ensure users’ privacy and safety while using them. Suggestions include clearly defining the age of the target population and explicit disclosure of the sharing of users’ sensitive data with third parties. In addition, we found an opportunity for apps to better leverage digital affordances for mitigating harm, for personalizing interventions, and for tracking multimodal content. The study further demonstrated the need to consider potential risks while using depression apps, including the use of nonvalidated screening tools, tracking negative moods or thinking patterns, and exposing users to negative emotional expression content.

Leveraging Implementation Science to Understand Factors Influencing Sustained Use of Mental Health Apps: a Narrative Review

“…However, consumer ratings of health apps are poor indicators of clinical effectiveness and usability, calling into question the value of app ratings altogether (BinDhim et al 2015 ; Gordon et al 2020 ; Singh et al 2016 ). For example, 72% of the 29 most popular depression apps contained no information regarding suicide prevention, and some of these apps contained potentially harmful negative content (Qu et al 2020 ). An additional study of top-ranked depression and smoking cessation apps found that while 92% of apps transmitted user data to third parties, the majority did not clearly disclose this information to users (Huckvale et al 2019 ).…”

“…This is concerning, as most MH apps in app stores have little to no empirical backing. Approximately 3% of available depression and anxiety apps provide information regarding testing or effectiveness (Marshall et al 2019;Sucala et al 2017); when restricted to the 29 highest-rated depression apps, this rate only increased to 7% (Qu et al 2020). This has led to the development of multiple online libraries intending to curate effective MH apps (Marshall et al 2019).…”

Biosensing and Actuation—Platforms Coupling Body Input-Output Modalities for Affective Technologies

“…Ethics simply concerns what is good , with a utilitarian perspective dealing with the greatest good for the greatest number of people. To assist in ethical decisions and practices, ethical frameworks outline key concepts such as beneficence and nonmaleficence, justice, responsibility, autonomy, privacy and confidentiality, and respect for the rights and dignity of others [ 13 , 14 , 94 , 95 , 96 , 97 ]. By reflecting on these ethical principles and standards, designers and researchers can ensure that their processes, technological developments, and research are done ethically and for the greater good.…”

Actionable health app evaluation: translating expert frameworks into objective metrics

“…Comparison with current standards for app use and functionality indicates that the questions of this database are robust and flexible enough to cover nearly all use cases. A recent exploration of the characteristics, functionality, and ethical concerns of top apps for depression evaluated functionality across three different categories of use—screening, tracking and intervention—that correspond closely with our proposed questions covering various app features 41 . The NICE guidelines propose recommendations for using digital and mobile health interventions among European health systems 42 .…”