The Impact of Current Mental Health Smart Phone Applications: A Systematic Review and Meta-Analysis

Purpose:  The purpose of this systematic review and meta-analysis is to determine the power of mental health smartphone applications (apps) in the treatment of mental health disorders.  Apps can help clinicians to intervene in mental health treatment and prevent critical incidents from occurring in the lives of individuals struggling with mental disorders.  In order for clients to better perform psychotherapeutic homework assignments and to maintain relationship-building skills taught during weekly therapeutic sessions, smartphone apps using cognitive and behavioral theories can extend treatment of mental health challenges in new and innovative ways.  Utilization of an effective evidence-based app treatment may offer a range of potential mental health benefits.  Benefits include increased reach, availability and rapid access to a consistent, cost-effective treatment.  Mobile apps also offer huge potential to gather precise, objective, sustained, and ecologically valid data on the real-world behaviors and experiences of millions of people, without them having to come into clinics.  The app may be useful in treating those who attempt to retreat into isolation when suffering from mental health disorders.  One particular use could be intervention during times of crisis, helping those who may be contemplating suicide to stay alive.  

Method:  Researchers completed a comprehensive search of multiple databases and mental health journals using pre-specified mental health terms and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.  Despite rapid growth of mobile mental health apps, there is a paucity of research-based literature that rigorously tests mobile apps for their efficacy, usefulness, and sustainability with specific attention to client privacy and regulatory compliance.  We retrieved 187 articles from 2010-14.  Upon final evaluation, 14 articles met criteria and provided sufficient data to compute an effect size.  Using Biostat's Comprehensive Meta-Analysis II (CMAII) for pre-post studies, combining all mental health condition outcomes, we found a significant overall effect size of (d = 1.022, p< .000, k = 9).  Looking at specific outcome variable categories, we found large, statistically significant effect sizes for lower depression scores (d = 1.474, p < .002, k = 6) and lower anxiety scores (d = 1.613, p < .004, k = 5).

Implications:  We evaluated the benefits and challenges of smartphone mental health interventions and have shown that several research-based apps are effective ways to assess and treat multiple mental health disorders. This information will help clinicians, researchers, and users integrate information technology into treatment.  Face-to-face treatment for anxiety, depression, and other mental health treatments can benefit from using smartphones as an adjunct to regular treatment which, in the case of behavioral activation treatments, could facilitate activity scheduling and homework. Increased homework compliance, a crucial element of treatment, may also reduce the number of face-to-face sessions. The high penetration of smartphones and strong client interest in mental health apps suggests that clinicians now have another modality to provide educational information, self-management interventions, and therapy materials to their clients.