Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality

Abstract

BackgroundWith continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality.ObjectiveOur aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content.MethodsA systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed.ResultsOf the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%).ConclusionsIn general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public.

Mental health: There’s an app for that

“…When a team of Australian researchers reviewed 82 commercially available smartphone apps for people with bipolar disorder 12 , they found that some presented information that was "critically wrong". One, called iBipolar, advised people in the middle of a manic episode to drink hard liquor to help them to sleep, and another, called What is Biopolar Disorder, suggested that bipolar disorder could be contagious.…”

A systematic review of the psychometric properties, usability and clinical impacts of mobile mood-monitoring applications in young people

“…iTunes). Thus, there is a need for more research to assess the evidence for apps that are freely downloaded and used by youth, and whether their use can be incorporated into clinical care (Nicholas et al 2015).…”

Internet use by patients with bipolar disorder: Results from an international multisite survey

“…Many health websites attract a global audience (Leon and Fontelo, 2006) and are available in multiple languages. There is considerable international investment in web-based initiatives to improve care for bipolar disorder relating to patient education, self-management, and support forums Hidalago-Mazzei et al, 2015;Leitan et al, 2015;Lauder et al, 2015;Nicholas et al, 2015;Parikh and Huniewicz, 2015).…”