Mobile health for mental health
Mobile health, also known as mHealth, uses text messaging and applications (apps) on mobile devices (e.g., cell phones, tablets) to deliver health care services and support to individuals with mental health concerns such as depression, anxiety, stress, post-traumatic stress disorder (PTSD), and substance abuse. Text messaging interventions range from educational information to automated reminders or supportive messages sent to individuals participating in longer-term treatment1. Mobile apps may deliver elements of cognitive behavior therapy (CBT)2, link a user to a medical professional, or allow patients to regularly self-monitor their emotional state and share that information with a provider3, 4, 5. In some cases, smartphone apps and text message software have been integrated into electronic health records (EHRs)6. Some apps include Health Insurance Portability and Accountability Act (HIPAA) compliant messaging systems for secure patient contact with providers7; however, many apps are not regulated by HIPAA and may collect data for internal purposes or share it externally8.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved mental health
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced drug and alcohol use
Reduced post-traumatic stress
Reduced tobacco use
What does the research say about effectiveness?
There is some evidence that mobile health (mHealth) interventions improve mental health, particularly anxiety and depression-related outcomes in the short-term9, 10, 11, 12, 13, 14, 15. However, additional evidence is needed to confirm effects, particularly over the long-term10, 11, 12.
Mental health mobile applications (apps) that are based on elements of cognitive behavioral therapy (CBT) or provide self-management and monitoring can improve mental health11, 12, 13, 15, particularly anxiety9, 16, and may also improve depression self-management10. However, many apps that aim to deliver CBT do not provide all components of CBT2.
Overall, apps reduce anxiety, depression, and stress more than no intervention; however, effect sizes vary11. Apps appear to reduce the severity of post-traumatic stress disorder (PTSD) symptoms among both general and military populations17, 18. Additional evidence is needed to determine the effectiveness of apps for self-management of PTSD for adults and for anxiety for youth19, 20. More evidence is also needed to determine effects of apps for suicide prevention21. An assessment of DBT Coach, an app combined with face-to-face dialectical behavioral therapy (DBT), suggests apps can reduce substance use for adults with borderline personality disorder15. mHealth phone support from health professionals has been shown to reduce postnatal depression; however, effects on anxiety are inconclusive14.
mHealth has been shown to have greater effects on mental health when combined with support from a mental health professional13. Apps combined with psychotherapy and other behavioral interventions can improve treatment outcomes7; apps combined with treatment or used alone may reduce anxiety16.
mHealth interventions such as text messaging and apps can reduce use of methamphetamines and opioids by adults22 and tobacco and alcohol use by young adults23. In high risk populations, such interventions may reduce alcohol and drug use5. Text assessments combined with personalized feedback can reduce binge drinking by young adults in the short-term4. Contact through calls or texts appears to increase medication adherence for adults with dependence on alcohol or illicit drugs22; such contact may also increase medication adherence following hospital discharge24.
Mood monitoring apps may identify mental health and substance use problems among youth25. However, additional research is needed to determine effectiveness of mHealth apps at treating mental health problems in children and adolescents26.
Research suggests that text messaging and app-based interventions are acceptable to patients, including those with severe mental health problems4, 27, 28 and youth with substance abuse issues25, as long as security and privacy considerations are addressed29. Older adults diagnosed with or at risk of cognitive or mental disorders may use mHealth apps to assess their mental health status and share it with providers30.
Experts suggest consumers use caution when purchasing apps as most have not yet been validated1, 19, 20; high app turnover rates and frequent updates make it difficult for providers to recommend quality apps31. Experts also suggest that apps include methods to respond to emergency situations32, app designs protect user privacy and secure information2, 32, and researchers, patients, and providers each play a role in app development12, 33.
Implementation Examples
There are more than 10,000 mental health apps available34. The American Psychiatric Association provides guidelines for psychiatrists and other mental health providers to select useful, safe, and effective apps35. The Anxiety and Depression Association of America offers reviews and ratings of 19 mental health apps, considering ease of use, effectiveness, personalization, availability of feedback, and strength of research evidence36.
The U.S. Department of Veterans Affairs (VA) provides several mobile apps designed for treatment and self-care for veterans, military service members, and their families, such as PTSD Coach, PTSD Family Coach, Mindfulness Coach, and VetChange37.
The Healthcare Information and Management Systems Society’s mHealth Roadmap provides guidance to hospitals and health care providers on implementing mobile and mHealth methods38.
Implementation Resources
ADAA-MH app - Anxiety and Depression Association of America (ADAA). Find help: ADAA reviewed mental health apps.
APA-MH app - American Psychiatric Association (APA). Mental health apps: Why rate mental health apps?
Footnotes
* Journal subscription may be required for access.
1 Frank 2018 - Frank E, Pong J, Asher Y, Soares CN. Smart phone technologies and ecological momentary data: Is this the way forward on depression management and research? Current Opinion in Psychiatry. 2018;31(1):3-6.
2 Stawarz 2018 - Stawarz K, Preist C, Tallon D, et al. User experience of cognitive behavioral therapy apps for depression: An analysis of app functionality and user reviews. Journal of Medical Internet Research. 2018;20(6):e10120.
3 Hilty 2017 - Hilty DM, Chan S, Hwang T, Wong A, Bauer AM. Advances in mobile mental health: Opportunities and implications for the spectrum of e-mental health services. mHealth. 2017;3:34.
4 Berrouiguet 2016 - Berrouiguet S, Baca-García E, Brandt S, Walter M, Courtet P. Fundamentals for future mobile-health (mHealth): A systematic review of mobile phone and web-based text messaging in mental health. Journal of Medical Internet Research. 2016;18(6):e135.
5 Kazemi 2017 - Kazemi DM, Borsari B, Levine MJ, et al. A systematic review of the mHealth interventions to prevent alcohol and substance abuse. Journal of Health Communication. 2017;22(5):413-432.
6 Perri-Moore 2016 - Perri-Moore S, Kapsandoy S, Doyon K, et al. Automated alerts and reminders targeting patients: A review of the literature. Patient Education and Counseling. 2016;99(6):953-959.
7 Lindhiem 2015 - Lindhiem O, Bennett CB, Rosen D, Silk J. Mobile technology boosts the effectiveness of psychotherapy and behavioral interventions: A meta-analysis. Behavior Modification. 2015;39(6):785-804.
8 Rosenfeld 2017 - Rosenfeld L, Torous J, Vahia IV. Data security and privacy in apps for dementia: An analysis of existing privacy policies. American Journal of Geriatric Psychiatry. 2017;25(8):873-877.
9 Firth 2017 - Firth J, Torous J, Nicholas J, et al. Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders. 2017;218:15-22.
10 Firth 2017a - Firth J, Torous J, Nicholas J, et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: A meta-analysis of randomized controlled trials. World Psychiatry. 2017;16(3):287-298.
11 Rathbone 2017a - Rathbone AL, Prescott J. The use of mobile apps and SMS messaging as physical and mental health interventions: Systematic review. Journal of Medical Internet Research. 2017;19(8):e295.
12 Rathbone 2017b - Rathbone AL, Clarry L, Prescott J. Assessing the efficacy of mobile health apps using the basic principles of cognitive behavioral therapy: Systematic review. Journal of Medical Internet Research. 2017;19(11):e399.
13 Versluis 2016 - Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF. Changing mental health and positive psychological well-being using ecological momentary interventions: A systematic review and meta-analysis. Journal of Medical Internet Research. 2016;18(6):e152.
14 Cochrane-Lavender 2013 - Lavender T, Richens Y, Milan SJ, Smyth RM, Dowswell T. Telephone support for women during pregnancy and the first six weeks postpartum. Cochrane Database of Systematic Reviews. 2013;(7):CD009338.
15 Donker 2013 - Donker T, Petrie K, Proudfoot J, et al. Smartphones for smarter delivery of mental health programs. Journal of Medical Internet Research. 2013;15(11):e247.
16 Lui 2017 - Lui JHL, Marcus DK, Barry CT. Evidence-based apps? A review of mental health mobile applications in a psychotherapy context. Professional Psychology: Research and Practice. 2017;48(3):199-210.
17 Roy 2017 - Roy MJ, Costanzo ME, Highland KB, et al. An app a day keeps the doctor away: Guided education and training via smartphones in subthreshold post traumatic stress disorder. Cyberpsychology, Behavior, and Social Networking. 2017;20(8):470-478.
18 Van Ameringen 2017 - Van Ameringen M, Turna J, Khalesi Z, Pullia K, Patterson B. There is an app for that! The current state of mobile applications (apps) for DSM-5 obsessive-compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders. Depression and Anxiety. 2017;34(6):526-539.
19 Rodriguez-Paras 2017 - Rodriguez-Paras C, Tippey K, Brown E, et al. Posttraumatic stress disorder and mobile health: App investigation and scoping literature review. JMIR mHealth and uHealth. 2017;5(10):e156.
20 Bry 2018 - Bry LJ, Chou T, Miguel E, Comer JS. Consumer smartphone apps marketed for child and adolescent anxiety: A systematic review and content analysis. Behavior Therapy. 2018;49(2):249-261.
21 De la Torre 2017 - de la Torre I, Castillo G, Arambarri J, López-Coronado M, Franco MA. Mobile apps for suicide prevention: Review of virtual stores and literature. JMIR mHealth and uHealth. 2017;5(10):e130.
22 Tofighi 2017 - Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature. Drug and Alcohol Review. 2017;36(4):477-491.
23 Mason 2015a - Mason M, Ola B, Zaharakis N, Zhang J. Text messaging interventions for adolescent and young adult substance use: A meta-analysis. Prevention Science. 2015;16(2):181-188.
24 Bright 2018 - Bright CE. Integrative review of mobile phone contacts and medication adherence in severe mental illness. Journal of the American Psychiatric Nurses Association. 2018;24(3):209-222.
25 Dubad 2018 - Dubad M, Winsper C, Meyer C, Livanou M, Marwaha S. A systematic review of the psychometric properties, usability and clinical impacts of mobile mood-monitoring applications in young people. Psychological Medicine. 2018;48(2):208-228.
26 Grist 2017 - Grist R, Porter J, Stallard P. Mental health mobile apps for preadolescents and adolescents: A systematic review. Journal of Medical Internet Research. 2017;19(5):e176.
27 Firth 2016 - Firth J, Cotter J, Torous J, et al. Mobile phone ownership and endorsement of “mhealth” among people with psychosis: A meta-analysis of cross-sectional studies. Schizophrenia Bulletin. 2016;42(2):448-455.
28 Berry 2016 - Berry N, Lobban F, Emsley R, Bucci S. Acceptability of interventions delivered online and through mobile phones for people who experience severe mental health problems: A systematic review. Journal of Medical Internet Research. 2016;18(5):e121.
29 Proudfoot 2010 - Proudfoot J, Parker G, Pavlovic DH, et al. Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress. Journal of Medical Internet Research. 2010;12(5):e64.
30 Moussa 2017 - Moussa Y, Mahdanian AA, Yu C, et al. Mobile health technology in late-life mental illness: A focused literature review. The American Journal of Geriatric Psychiatry. 2017;25(8):865-872.
31 Larsen 2016 - Larsen ME, Nicholas J, Christensen H. Quantifying app store dynamics: Longitudinal tracking of mental health apps. Journal of Medical Internet Research mHealth and uHealth. 2016;4(3):e96.
32 Torous 2018 - Torous J, Nicholas J, Larsen ME, et al. Clinical review of user engagement with mental health smartphone apps: Evidence, theory and improvement. Evidence-Based Mental Health. 2018;21:116-119.
33 Kassianos 2017 - Kassianos AP, Georgiou G, Papaconstantinou EP, Detzortzi A, Horne R. Smartphone applications for educating and helping non-motivating patients adhere to medication that treats mental health conditions: Aims and functioning. Frontiers in Psychology. 2017;8:1769.
34 Torous 2017 - Torous J, Roberts LW. Needed innovation in digital health and smartphone applications for mental health: Transparency and trust. JAMA Psychiatry. 2017;74(5):437-438.
35 APA-MH app - American Psychiatric Association (APA). Mental health apps: Why rate mental health apps?
36 ADAA-MH app - Anxiety and Depression Association of America (ADAA). Find help: ADAA reviewed mental health apps.
37 US VA-Mobile apps - U.S. Department of Veterans Affairs (U.S. VA). PTSD: National Center for PTSD. Mobile applications.
38 HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.
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