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, posttraumatic stress disorder (PTSD), and substance abuse. Text messaging interventions range from provision of educational information to automated reminders or supportive messages sent to individuals participating in longer term treatment (). Mobile apps can deliver cognitive behavior therapy (CBT), link a user to a medical professional, or allow patients to regularly self-monitor their emotional state and easily share that information with a provider (Hilty 2017, Berrouiguet 2016, ). Text message software and smartphone apps can be integrated into electronic health records (EHRs) (Perri-Moore 2016); some apps include Health Insurance Portability and Accountability Act (HIPAA) compliant messaging systems for secure patient contact with providers ().

Expected Beneficial Outcomes (Rated)

  • Improved mental health

Other Potential Beneficial Outcomes

  • Reduced drug and alcohol use

  • Reduced post-traumatic stress

  • Reduced tobacco use

Evidence of Effectiveness

There is strong evidence that mobile health (mHealth) interventions improve mental health in the short-term (Firth 2017a, , Rathbone 2017a, Rathbone 2017b, Lui 2017, Versluis 2016, Cochrane-Lavender 2013, Donker 2013), particularly anxiety (Lui 2017, , Rathbone 2017a, Versluis 2016, Donker 2013) and depression-related outcomes (Firth 2017a, Rathbone 2017a, Versluis 2016, Cochrane-Lavender 2013, Donker 2013). Additional evidence is needed to confirm long-term effects (Firth 2017a, Rathbone 2017a, Rathbone 2017b, Lui 2017).

Mental health mobile applications (apps) that are based on cognitive behavioral therapy (CBT) or provide self-management and monitoring can improve mental health (Rathbone 2017b, Rathbone 2017a, Versluis 2016, Donker 2013), particularly anxiety (, Lui 2017) and depression self-management (Firth 2017a). Overall, apps are more effective at reducing anxiety, depression, and stress than no intervention (Rathbone 2017a). Apps appear to reduce the severity of post-traumatic stress disorder (PTSD) symptoms among both general and military populations (, ). However, additional evidence is needed to determine the effectiveness of apps for self-management of PTSD for adults and for anxiety for youth (Rodriguez-Paras 2017, ); additional evidence is also needed to determine effects of apps for suicide prevention (De la Torre 2017).  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 disorder (Donker 2013). mHealth phone support from health professionals has been shown to reduce postnatal depression; however, effects on anxiety are inconclusive (Cochrane-Lavender 2013).

mHealth has been shown to have greater effects on mental health when combined with support from a mental health professional (Versluis 2016). Apps combined with psychotherapy and other behavioral interventions can improve treatment outcomes (); apps added to treatment or used alone may also reduce anxiety (Lui 2017).

mHealth interventions such as text messaging and apps can reduce use of methamphetamines and opioids by adults () and tobacco and alcohol use by young adults (Mason 2015a). Such interventions may also have the potential to reduce alcohol and drug use in high risk populations (). Text assessments combined with personalized feedback can reduce binge drinking by young adults in the short-term (Berrouiguet 2016). Contact through calls or texts appears to increase medication adherence for adults with dependence on alcohol or illicit drugs (); such contact may also increase medication adherence following hospital discharge ().

Mood-monitoring apps may identify mental health and substance use problems among youth (Dubad 2018). However, additional research is needed to determine effectiveness of mHealth apps at treating mental health problems in children and adolescents (Grist 2017).

Research suggests that text messaging and app-based interventions are acceptable to patients, including those with severe mental health problems (Firth 2016, Berry 2016, Berrouiguet 2016) and youth with substance abuse issues (Dubad 2018), as long as security and privacy considerations are addressed (Proudfoot 2010). 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 providers (Moussa 2017).

Experts suggest caution when purchasing apps as most have not yet been validated (, Rodriguez-Paras 2017, ). Experts also suggest that researchers, patients, and providers each have roles in the development of apps (Rathbone 2017b, Kassianos 2017).

Impact on Disparities

No impact on disparities likely

Implementation Examples

There are more than 3,000 mental health apps available (Chan 2014). The American Psychiatric Association provides guidelines for psychiatrists and other mental health providers to select useful, safe, and effective apps (APA-MH app). 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 evidence (ADAA-MH app).

The US Department of Veterans Affairs 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 VetChange (VA-Mobile apps).

The Healthcare Information and Management Systems Society’s mHealth Roadmap provides guidance to hospitals and health care providers on implementing mobile and mHealth methods (HIMSS Mobile Health Roadmap).

Implementation Resources

APA-MH app - American Psychiatric Association (APA). Mental health apps: Why rate mental health apps?

ADAA-MH app - Anxiety and Depression Association of America (ADAA). Find help: ADAA reviewed mental health apps.

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.

Chan 2014 - Chan SR, Torous J, Hinton L, Yellowlees P. Mobile tele-mental health: Increasing applications and a move to hybrid models of care. Healthcare. 2014;2(2):220-233.

APA-MH app - American Psychiatric Association (APA). Mental health apps: Why rate mental health apps?

ADAA-MH app - Anxiety and Depression Association of America (ADAA). Find help: ADAA reviewed mental health apps.

VA-Mobile apps - US Department of Veterans Affairs (VA). PTSD: National Center for PTSD. Mobile applications.

Date Last Updated

Jun 28, 2018