‘Help for trauma from the app stores?’ A systematic review and standardised rating of apps for Post-Traumatic Stress Disorder (PTSD)

Abstract

Background: Mobile health applications (apps) are considered to complement traditional psychological treatments for Post-Traumatic Stress Disorder (PTSD). However, the use for clinical practice and quality of available apps is unknown. Objective: To assess the general characteristics, therapeutic background, content, and quality of apps for PTSD and to examine their concordance with established PTSD treatment and self-help methods. Method: A web crawler systematically searched for apps targeting PTSD in the British Google Play and Apple iTunes stores. Two independent researchers rated the apps using the Mobile App Rating Scale (MARS). The content of high-quality apps was checked for concordance with psychological treatment and self-help methods extracted from current literature on PTSD treatment. Results: Out of 555 identified apps, 69 met the inclusion criteria. The overall app quality based on the MARS was medium (M = 3.36, SD = 0.65). Most apps (50.7%) were based on cognitive behavioural therapy and offered a wide range of content, including established psychological PTSD treatment methods such as processing of trauma-related emotions and beliefs, relaxation exercises, and psychoeducation. Notably, data protection and privacy standards were poor in most apps and only one app (1.4%) was scientifically evaluated in a randomized controlled trial. Conclusions: High-quality apps based on established psychological treatment techniques for PTSD are available in commercial app stores. However, users are confronted with great difficulties in identifying useful high-quality apps and most apps lack an evidence-base. Commercial distribution channels do not exploit the potential of apps to complement the psychological treatment of PTSD.

Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

“…The mean quality of nine applications advertising themselves as tools for self-help EMDR therapy for PTSD was recently rated as 2.91 using the Mobile Application Rating Scale German Version (MARS-G), indicating 'poor' quality. 54 To our knowledge, the quality of internet websites providing these tools has yet to be rated.…”

Mobile Health App Database - A Repository for Quality Ratings of mHealth Apps

“…Furthermore, works can be found that deal with the userfriendly development of mHealth apps, thus increasing their quality by design [30]- [32]. Research that are utilizing the MARS are also all in this second category [16], [33], [34]. The number of works based on the MARS show its general applicability.…”

“…Currently, MHAD comprises freely available ratings of 1112 apps. That means, for all of the 1112 apps, the procedure including two reviewers (as described above or in [16]) for the final rating was accomplished. These ratings are categorized -as already mentioned -with the following numbers for each category maintained so far: mindfulness: 192, anxiety: 104, depression: 39, support children and young people: 13, cancer: 75, PTSD: 82, pain: 218, support the elderly: 77 and sports: 312.…”

“…As the MARS has proven its feasibility and psychometric quality in existing works and evaluations [14]- [16], the authors of the current work decided to develop a database solution that shall support making the MARS expert ratings for mHealth apps available to the public more easily and comprehensively. This is necessary, since consumers are particularly vulnerable right now, since the mHealth market is not well regulated and most of the currently available mHealth apps are not scientifically evaluated [15]- [17].…”

Validation of the Mobile Application Rating Scale (MARS)

“…A recent meta-analysis of randomized trials reported small to moderate pooled effects of MHA for improving depression, anxiety, stress levels, and quality of life [ 6 , 8 ]. However, the number of evidence-based MHA on the MHA market is surprisingly small [ 3 , 4 , 9 , 10 ]. The lack of evidence-based MHA in combination with the rapidly growing MHA market highlight that patients and health care providers need better guidance to identify high-quality MHA that meet patients’ needs [ 11 ].…”