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      Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

      review-article
      , B Psych (Hons) 1 , , , PhD 1 , 2 , , BA (Hons), PhD 3 , , BBSc(Hons), PhD(Psych) 4
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Mental Health
      JMIR Publications Inc.
      mobile phones, mental health, smartphones, apps, mobile apps, depression, anxiety, cognitive behavior therapy, cognitive behavioral therapy, clinical psychology

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          Abstract

          Background

          The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.

          Objective

          To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.

          Methods

          A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.

          Results

          Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.

          Conclusions

          Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

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          Most cited references318

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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                Author and article information

                Contributors
                Journal
                JMIR Ment Health
                JMIR Ment Health
                JMH
                JMIR Mental Health
                JMIR Publications Inc. (Toronto, Canada )
                2368-7959
                Jan-Mar 2016
                01 March 2016
                : 3
                : 1
                : e7
                Affiliations
                [1] 1School of Psychology and Monash Institute of Cognitive and Clinical Neurosciences Faculty of Medicine, Nursing and Health Sciences Monash University ClaytonAustralia
                [2] 2Cognitive Behaviour Therapy Research Unit, School of Psychological Sciences Faculty of Medicine, Nursing and Health Sciences Monash University ClaytonAustralia
                [3] 3Psychology Department Faculty of Health University of Canberra CanberraAustralia
                [4] 4Centre for Positive Psychology Melbourne Graduate School of Education University of Melbourne ParkvilleAustralia
                Author notes
                Corresponding Author: David Bakker david.bakker@ 123456monash.edu
                Author information
                http://orcid.org/0000-0002-0343-1100
                http://orcid.org/0000-0001-9559-4160
                http://orcid.org/0000-0002-4227-0231
                http://orcid.org/0000-0002-4236-8538
                Article
                v3i1e7
                10.2196/mental.4984
                4795320
                26932350
                76222426-1264-494f-92df-d0b7f7ec6b58
                ©David Bakker, Nikolaos Kazantzis, Debra Rickwood, Nikki Rickard. Originally published in JMIR Mental Health (http://mental.jmir.org), 01.03.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and license information must be included.

                History
                : 4 August 2015
                : 9 October 2015
                : 18 October 2015
                : 16 November 2015
                Categories
                Review
                Review

                mobile phones,mental health,smartphones,apps,mobile apps,depression,anxiety,cognitive behavior therapy,cognitive behavioral therapy,clinical psychology

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