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      Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study

      research-article
      , MBI, MD 1 , , , BS 1 , , MS 2 , , MD 1
      (Reviewer), (Reviewer)
      JMIR Mental Health
      JMIR Publications
      smartphone, digital health, mobile phone, mental health, schizophrenia, depression, psychiatry, apps

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          Abstract

          Background

          Despite the popularity of mental health apps, it is unknown if they are actually used by those with mental illness. This study assessed whether differences in clinic setting may influence the use of mental health apps and which factors influence patient perception of apps.

          Objective

          The objective of this study was to gain an understanding of how individuals with mental illness use their mobile phones by exploring their access to mobile phones and their use of mental health apps.

          Methods

          A single time point survey study was conducted over a 2-week period in February 2018 at two nearby outpatient psychiatry clinics: one serving largely mood and anxiety disorder patients with private insurance staffed by both faculty and residents and the other serving largely psychotic disorder patients in a state Department of Mental Health (DMH) setting. A total of 25 patients at the state DMH clinic also consented for a single time point observation of apps currently installed on their personal mobile phone.

          Results

          A total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10%. Verifying current apps on patients’ mobile phones at the state DMH clinic confirmed that approximately 10% had mental health apps installed. Patients at both clinics were most concerned about privacy of mental health apps, although those at the state DMH clinic viewed cost savings as the greatest benefit while those at the private clinic reported time as the greatest benefit.

          Conclusions

          High interest in mental health apps does not automatically translate into high use. Our results of low but similar rates of mental health app use at diverse clinics suggests DMH patients with largely psychotic disorders are as interested and engaged with apps as those in a private insurance clinic treating largely mood and anxiety disorders. Results from our study also highlight the importance of understanding how actual patients are using apps instead of relying on internet-based samples, which often yield higher results due to their likelihood of being selected.

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          Most cited references16

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          The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials.

          The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.
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            Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

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              • Record: found
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              • Article: not found
              Is Open Access

              Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials.

              Various psychological interventions are effective for reducing symptoms of anxiety when used alone, or as an adjunct to anti-anxiety medications. Recent studies have further indicated that smartphone-supported psychological interventions may also reduce anxiety, although the role of mobile devices in the treatment and management of anxiety disorders has yet to be established.
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                Author and article information

                Contributors
                Journal
                JMIR Ment Health
                JMIR Ment Health
                JMH
                JMIR Mental Health
                JMIR Publications (Toronto, Canada )
                2368-7959
                Oct-Dec 2018
                16 November 2018
                : 5
                : 4
                : e11715
                Affiliations
                [1 ] Division of Digital Psychiatry Department of Psychiatry Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA United States
                [2 ] Department of Biostatistics Harvard TH Chan School of Public Health Boston, MA United States
                Author notes
                Corresponding Author: John Torous jtorous@ 123456bidmc.harvard.edu
                Author information
                http://orcid.org/0000-0002-5362-7937
                http://orcid.org/0000-0002-9931-2447
                http://orcid.org/0000-0003-3544-363X
                http://orcid.org/0000-0002-5945-888X
                Article
                v5i4e11715
                10.2196/11715
                6269625
                30446484
                ae763216-a413-4a51-9e2c-d2cd4a2f9e79
                ©John Torous, Hannah Wisniewski, Gang Liu, Matcheri Keshavan. Originally published in JMIR Mental Health (http://mental.jmir.org), 16.11.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), 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
                : 27 July 2018
                : 12 September 2018
                : 18 September 2018
                : 19 September 2018
                Categories
                Original Paper
                Original Paper

                smartphone,digital health,mobile phone,mental health,schizophrenia,depression,psychiatry,apps

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