Mobile health for mental health
Mobile health, also known as mHealth, uses text messaging and 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 misuse. 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.
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 in the short-term, particularly anxiety and depression6, 7, 8, 9, 10, 11, 12. However, additional evidence is needed to confirm effects over the long-term, as well as among different populations, for various mental health concerns, and how mHealth interventions compare to in-person treatment8, 9, 13.
Overall, mental health mobile apps reduce anxiety, depression, and stress more than no intervention; however, effect sizes vary8. Apps may also reduce symptom severity and disability for adults with bipolar disorder, schizophrenia, or major depressive disorder14. Mental health mobile apps that are based on elements of cognitive behavioral therapy (CBT) or that provide self-management and monitoring can improve mental health8, 9, 10, 12, particularly anxiety15, 16, and may also improve depression self-management13. CBT features a wide range of components, all of which may not be included in an individual app; many apps based on CBT may also include aspects of other therapies2.
mHealth has been shown to have greater effects on mental health when combined with support from a mental health professional10. Apps combined with psychotherapy and other behavioral interventions can improve treatment outcomes17, including reduced anxiety16. For example, combining face-to-face therapy and DBT Coach, an app which provides dialectical behavioral therapy (DBT), appears to reduce substance use for adults with borderline personality disorder18.
mHealth interventions can reduce the use of methamphetamines and opioids by adults19, tobacco and alcohol use by young adults20, and may reduce alcohol and drug use in high risk populations5. For example, a study of young adults identified as hazardous drinkers during emergency department visits suggests that text message drinking assessments with real-time feedback may reduce binge drinking in the short-term21. Contact through voice calls or texts appears to increase medication adherence for adults dependent on alcohol or illicit drugs19, and for individuals living with severe mental illness following hospital discharge22.
Mood monitoring apps may identify mental health and substance use problems among youth23, yet additional research is needed to determine the effectiveness of mHealth apps at treating mental health problems in children and adolescents6, 24, including anxiety25. Additional evidence is also needed to determine the effectiveness of apps for self-management of post-traumatic stress disorder (PTSD) among adults generally26, although one study among military service members and their families suggests apps may reduce the severity of PTSD27. More evidence is also needed to determine the effectiveness of mHealth apps for suicide prevention28 and how they may support treatment of borderline personality disorder29.
Text messaging and app-based interventions are largely acceptable to patients, including those with severe mental health problems4, 14, 30, 31, youth with substance abuse issues23, pregnant and postpartum women32, and veterans33.
Experts suggest consumers use caution when purchasing apps, as most have not been clinically validated1, 7, 25, 26, 34 even though hundreds of studies on feasibility, acceptability, effectiveness, and engagement are conducted every year6; high app turnover rates make it difficult for providers to recommend quality apps35. For example, a survey of apps recommended by mental health providers at various college campuses discovered that nearly 30% were no longer available and others had not been updated within the last 6 months, suggesting apps may be outdated, no longer maintained, or unsupported by current cell phone software34. Given that many apps do not yet have sufficient evidence of impact, some experts have concerns about the use of apps without provider support36. Additionally, privacy concerns are often noted by both current patients and potential users32, 37, 38. Some apps include Health Insurance Portability and Accountability Act (HIPAA) compliant messaging systems for secure patient contact with providers17; however, many apps are not regulated by HIPAA39 and may collect data for internal purposes or share it externally with third parties34, 39.
Experts suggest app designs protect users’ privacy and secure information40 and that apps include methods to respond to emergency situations40. Researchers, patients, and providers should all play a role in app development to maximize usability and likelihood of effectiveness9, 41, 42, 43. App features which may support user engagement include goal setting, educational information, data visualizations, personalized content and feedback, reminders, and self-monitoring functions44.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact mobile health (mHealth) interventions have on disparities in mental health care access and outcomes among individuals who experience barriers to mental health care. More research is needed to confirm which types of mHealth are most effective and appropriate for those who experience marginalization or other barriers to accessing digital health interventions36, 50.
Available evidence suggests individuals with less money or education and individuals with complex life circumstances, such as those experiencing homelessness or emergency situations, may experience fewer benefits from digital health interventions than those with greater advantages36. Additionally, communities that are rural or economically disadvantaged may face increased barriers to accessing mHealth interventions, such as limited internet access, the high costs of smartphones41, 51, and cultural barriers presented by programs not adapted to user needs41. However, mHealth interventions have the potential for customization to meet the needs of diverse populations41, 52, and can be tailored to local resources, culture, and language41. Also, access to smartphones continues to grow in some rural communities41.
Disparities in mental health outcomes exist in the U.S. within racially, ethnically53, gender54, and geographically41 diverse civilian populations, as well as among service members and veterans, compared with those at less risk because of their identity, military service status53, or community type41.
Experts recommend creating mHealth interventions that are culturally tailored for individuals from a specific minoritized background41, 52.
People with mental health concerns, including those with serious mental illness, appear to use smartphones and mobile technologies at rates similar to the general population14.
What is the relevant historical background?
Barriers in access to care for mental illness are a problem worldwide, and estimates for the U.S. suggest that less than half of individuals with mental illness receive treatment55.
As early as 2011, smartphones and mobile apps were being evaluated for possible integration into behavioral health care services56. As of 2022, thousands of mHealth apps are available for immediate download6.
The Federal Communications Commission Lifeline Program, originally created to increase access to landlines for people with low incomes was extended to mobile phones in 2005 and broadband services in 201657, which could broaden access to mHealth programs14. As of 2022, the majority of people in the U.S. without broadband access are rural residents58; a strong digital divide also exists between urban and suburban areas with high incomes and rural and urban areas with low incomes, suggesting household income may affect access more than geography59, 60, 61.
As of January 2024, 97% of Americans own a mobile phone; 90% have smartphones62; mobile phone and data use by Hispanic consumers, previously less likely to be mobile users, has largely caught up to other consumers52.
Equity Considerations
- Who has access to mental health services in your community and who does not? How could mobile health (mHealth) for mental health interventions help remove barriers (e.g., health insurance coverage, transportation) so more people can access services?
- Who is choosing which forms of mHealth interventions to offer and how are those decisions being reached? Which mental health needs are the focus? Which patient groups? Is there guidance available to teach patients to use smartphones for services?
- How are health care providers, community members, and policymakers engaged in efforts to expand broadband services? What partnerships are possible and which local resources may support access to smartphones for mHealth use?
Implementation Examples
As of 2023, there are more than 10,000 mental health apps available45. The American Psychiatric Association (APA) provides guidelines for psychiatrists and other mental health providers to select useful, safe, and effective apps46. The Anxiety and Depression Association of America collaborated with MindApps.org to provide interactive searching of mental health apps which have been examined according to the APA’s App Evaluation Model for ease of use, effectiveness, personalization, availability of feedback, and strength of research evidence47, 48.
The U.S. Department of Veterans Affairs (VA) provides several mental health 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, CBT-I Coach, and Insomnia Coach49.
Implementation Resources
‡ Resources with a focus on equity.
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?
Mindapps.org - M-Health Index & Navigation Database (Mindapps.org). App library.
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 Goldberg 2022 - Goldberg SB, Lam SU, Simonsson O, Torous J, Sun S. Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials. PLOS Digital Health. 2022;1(1):e0000002.
7 Wang 2018d - Wang K, Varma DS, Prosperi M. A systematic review of the effectiveness of mobile apps for monitoring and management of mental health symptoms or disorders. Journal of Psychiatric Research. 2018;107(September):73-78.
8 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.
9 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.
10 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.
11 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.
12 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.
13 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.
14 Ben-Zeev 2021 - Ben-Zeev D, Chander A, Tauscher J, et al. A smartphone intervention for people with serious mental illness: Fully remote randomized controlled trial of CORE. Journal of Medical Internet Research. 2021;23(11):1-16.
15 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.
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 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.
18 Rizvi 2011 - Rizvi SL, Dimeff LA, Skutch J, Carroll D, Linehan MM. A pilot study of the DBT Coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behavior Therapy. 2011;42(4):589-600.
19 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.
20 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.
21 Suffoletto 2012 - Suffoletto B, Callaway C, Kristan J, Kraemer K, Clark DB. Text-message-based drinking assessments and brief interventions for young adults discharged from the emergency department. Alcoholism: Clinical and Experimental Research. 2012;36(3):552-560.
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.
23 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.
24 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.
25 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.
26 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.
27 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.
28 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.
29 Xie 2022 - Xie Q, Torous J, Goldberg SB. E-mental health for people with personality disorders: A systematic review. Current Psychiatry Reports. 2022;24(10):541-552.
30 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.
31 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.
32 Varma 2023 - Varma DS, Mualem M, Goodin A, et al. Acceptability of an mHealth App for monitoring perinatal and postpartum mental health: Qualitative study with women and providers. JMIR Formative Research. 2023;7:1-11.
33 Betthauser 2020 - Betthauser LM, Stearns-Yoder KA, McGarity S, et al. Mobile app for mental health monitoring and clinical outreach in veterans: Mixed methods feasibility and acceptability study. Journal of Medical Internet Research. 2020;22(8):1-13.
34 Melcher 2020a - Melcher J, Torous J. smartphone apps for college mental health: A concern for privacy and quality of current offerings. Psychiatric Services. 2020;71(11):1114-1119.
35 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.
36 Philippe 2022 - Philippe TJ, Sikder N, Meng AJ, et al. Digital health interventions for delivery of mental health care: Systematic and comprehensive meta-review. JMIR Mental Health. 2022;9(5):e35159.
37 Melcher 2020 - Melcher J, Camacho E, Lagan S, Torous J. College student engagement with mental health apps: Analysis of barriers to sustained use. Journal of American College Health. 2022;70(6):1819-1825.
38 Torous 2018a - Torous J, Wisniewski H, Liu G, Keshavan M. Mental health mobile phone app usage, concerns, and benefits among psychiatric outpatients: Comparative survey study. JMIR Mental Health. 2018;5(4):1-11.
39 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.
40 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.
41 McCarthy 2024 - McCarthy MJ, Wicker A, Roddy J, et al. Feasibility and utility of mobile health interventions for depression and anxiety in rural populations: A scoping review. Internet Interventions. 2024;35(January):100724.
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44 Oakley-Girvan 2022 - Oakley-Girvan I, Yunis R, Longmire M, Ouillon JS. What works best to engage participants in mobile app interventions and e-Health: A scoping review. Telemedicine and e-Health. 2022;28(6):768-780.
45 King 2023 - King DR, Emerson MR, Tartaglia J, Nanda G, Tatro NA. Methods for navigating the mobile mental health app landscape for clinical use. Current Treatment Options in Psychiatry. 2023;10(2):72-86.
46 APA-MH app - American Psychiatric Association (APA). Mental health apps: Why rate mental health apps?
47 ADAA-MH app - Anxiety and Depression Association of America (ADAA). Find help: ADAA reviewed mental health apps.
48 Mindapps.org - M-Health Index & Navigation Database (Mindapps.org). App library.
49 US VA-Mobile apps - U.S. Department of Veterans Affairs (U.S. VA). PTSD: National Center for PTSD. Mobile applications.
50 Hensel 2019 - Hensel JM, Ellard K, Koltek M, Wilson G, Sareen J. Digital health solutions for indigenous mental well-being. Current Psychiatry Reports. 2019;21:68.
51 Connolly 2018 - Connolly SL, Miller CJ, Koenig CJ, et al. Veterans’ attitudes toward smartphone app use for mental health care: Qualitative study of rurality and age differences. JMIR mHealth and uHealth. 2018;6(8).
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