Pros and cons of mental-health apps
People use apps for everything from eating disorders to psychosis. Should they?
“There’s an app for that.”
The phrase is so ubiquitous that it’s a meme and trademarked by Apple Inc.
In fact, there are more than 165,000 mobile applications available for health care, with the largest category for people with mental-health disorders, managing everything from addiction to depression and schizophrenia.
Although in wide use, the efficacy of most of these programs — software designed for use with a mobile device — has not undergone rigorous scientific review, said Peter Yellowlees, a UC Davis professor of psychiatry and expert in using technology in clinical settings.
“While patients have access to an exponentially increasing number of apps, the research literature has not kept pace,” Yellowlees said. “But this lack of data has not held back the high level of industry and consumer interest.”
Only 14 apps for bipolar or major depressive disorder were examined in a recent literature review. And only seven apps had been reviewed for people with psychosis. Those studies found that there was little efficacy, safety or clinical outcome data in the published literature.
But that has not dampened demand.
Mental-health apps are here to stay
The American Psychiatric Association is considering how to provide guidance to psychiatric providers, while the U.S. Food and Drug Administration has stated that it will not approach the monumental task.
A recently published commentary in the Journal of Clinical Psychiatry identifies two options for psychiatrists to choose from when considering apps and other consumer devices for clinical care.
They can decide to not use apps and counsel their patients against using them, because of the limited evidence regarding their utility and efficacy.
But a more real-world approach would be to accept that patients already are using mobile psychiatry apps, and that they are here to stay.
Patients already are bringing apps, sleep-tracking devices and activity-monitoring devices to psychiatrists to ask for a professional opinion on their use, in the same way that many patients bring Internet resources and Google searches to physicians for second opinions.
"The framework presented here is important, as it offers a flexible tool that clinicians and patients can use together to make more informed decisions about whether to use or not use a smartphone app or other mobile health technology,” said John Torous, commentary first author and clinical fellow in psychiatry at Beth Israel Deaconess Medical Center and the Harvard Medical School.
“While both patients and clinicians know the right questions to ask about a new medication or pill, sometimes they may not be aware of all the best questions to ask about an app. With this framework we hope to guide them towards a more informed discussion,” said Torous, who also chairs the American Psychiatry Association Workgroup on Smartphone App Evaluation.
The “ASPECTS” of selecting apps
The commentary recommends a framework that psychiatrists should consider when evaluating all “ASPECTS” of an app: whether the app is Actionable, Secure, Professional, Evidence-Based, Customizable and TranSparent.
Actionable – App should collect valuable and clinically useful data that can be seamlessly integrated with electronic health records to complement clinical practices.
A recommended framework evaluation should include all 'ASPECTS" of an app: Actionable, Secure, Professional, Evidence-based, Customizable and TranSparent.
Secure — Laws mandate that health information be secure, among them the Health Insurance Portability and Accountability Act (HIPAA), and patient data should be encrypted in case the mobile device is stolen or hacked.
Professional — Apps should be in line with professional standards for clinical use, including legal and ethical standards.
Evidence-Based — Apps with little or limited data may be risky to use. There are already documented cases in which apps designed for reduction in alcohol intake led to increased alcohol use. Caveat emptor — let the buyer beware.
Customizable — One size does not fit all where apps are concerned. Patients and clinicians are more likely to be invested in and adhere to using something they evaluated and selected together.
TranSparent — Apps should openly report how data is collected, stored, analyzed, used and shared. Uncertainty about how an app uses health-care data leads to uncertainty in any conclusions or recommendation the app may offer.