Smartphone Apps for the Treatment of Mental Disorders: Systematic Review

Abstract

Background Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.

Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

“…In the recent years, a significant change has taken place in health care delivery system due to the availability of smartphones and smartphone applications [ 18 ]. The use of mobile technology can help to reduce a number of barriers for mental health care such as providers’ workload, lack of qualified personnel, geographical and attitudinal barriers to seek treatment [ 19 ]. The use of mobile devices in healthcare (also called m-Health) consists of interventions that use mobile phones and other digital devices (e.g.…”

Digital technology in psychiatry: towards the implementation of a true person-centered care in psychiatry?

“…These unforeseen circumstances are paving the way for a radical shift towards more digital care in psychiatry. Although the use of digital technology has already been growing quite substantially over the last years [2], its added value suddenly has become irrefutable. As we can expect an even stronger acceleration of this field in months and years to come, now, it seems to be the proper time to carefully consider what direction this field should be heading in.…”

“…Several steps can be taken to accelerate the implementation process. First, there is a lack of good-quality empirical studies to demonstrate efficacy and effectiveness of digital tools [2]. The evidence base thus needs to be strengthened.…”

“…A second important question is what digital technology can or should bring to the field of mental health care. Most studies to date are mainly aimed at transferring existing psychological therapies to the people's daily life [2]. Most smartphone apps deliver Cognitive-Behavioral Therapy in real life, outside the clinical setting.…”

“…Most smartphone apps deliver Cognitive-Behavioral Therapy in real life, outside the clinical setting. Although this may lower the threshold for treatment, making this more cost-effective and available for a larger group of people, the question remains whether digital technology can contribute in bringing a more radical change to mental health care [2,3].…”