Development of a smartphone application for eating disorder self-monitoring.

OBJECTIVE This case report aims to (1) describe the development and refinement of a smartphone application for eating disorder self-monitoring; (2) characterize its users in terms of demographic and clinical characteristics; and (3) explore its feasibility and utilization as a self-monitoring tool. METHOD We developed a mobile phone application through which people with eating disorders can self-monitor meals, emotions, behaviors, and thoughts. The application also included positive reinforcement, coping skill suggestions, social support, and feedback components. The app was made available on two Internet app stores. Data include number of downloads and subsequent usage statistics, consumer ratings on app-stores are used as indicators of satisfaction, anonymous aggregate demographic data and Eating Disorder Examination Questionnaire scores from 57,940 individuals collected over a two-year period. RESULTS The app demonstrated population-level utilization with over 100,000 users over a two-year period. Almost 50% percent of users stated that they are not currently receiving clinical treatment and 33% reported they had not told anyone about their eating disorder. A surprising number of people with severe problems are using the app. DISCUSSION Smartphone apps have the capacity to reach and engage traditionally underserved individuals with eating disorders at a large scale. Additional work is indicated for the evaluation of the clinical effectiveness of applications for specific user groups and in clinical treatment contexts.

[1]  S. Bauer,et al.  Use of text messaging in the aftercare of patients with bulimia nervosa , 2003 .

[2]  H. Christensen,et al.  Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review , 2013, Journal of medical Internet research.

[3]  V. Patel,et al.  The global dissemination of psychological treatments: a road map for research and practice. , 2014, The American journal of psychiatry.

[4]  S. Shiffman,et al.  Patient compliance with paper and electronic diaries. , 2003, Controlled clinical trials.

[5]  A Ehlers,et al.  Mind the gap: Improving the dissemination of CBT. , 2009, Behaviour research and therapy.

[6]  S. Bauer,et al.  Aftercare intervention through text messaging in the treatment of bulimia nervosa--feasibility pilot. , 2006, The International journal of eating disorders.

[7]  E. Obiodu,et al.  An Empirical Review of the Top 500 Medical Apps in a European Android Market , 2012 .

[8]  W. Agras The consequences and costs of the eating disorders. , 2001, The Psychiatric clinics of North America.

[9]  G. Wilson,et al.  Stepped care treatment for eating disorders. , 2000, Journal of consulting and clinical psychology.

[10]  W. Carpenter,et al.  DSM-5 status of psychotic disorders: 1 year prepublication. , 2012, Schizophrenia bulletin.

[11]  Lora E Burke,et al.  Self-monitoring dietary intake: current and future practices. , 2005, Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation.

[12]  S. Corrigan,et al.  Outcome of psychoeducation for HIV risk reduction. , 1994, AIDS education and prevention : official publication of the International Society for AIDS Education.

[13]  Claudia Avina THE USE OF SELF-MONITORING AS A TREATMENT INTERVENTION , 2008 .

[14]  J. Mond A voice for all in mental health research , 2012, Journal of mental health.

[15]  B. Rodgers,et al.  Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. , 2006, Behaviour research and therapy.

[16]  D. Ben-Zeev,et al.  Comparing retrospective reports to real-time/real-place mobile assessments in individuals with schizophrenia and a nonclinical comparison group. , 2012, Schizophrenia bulletin.

[17]  Illhoi Yoo,et al.  Data Mining in Healthcare and Biomedicine: A Survey of the Literature , 2012, Journal of Medical Systems.

[18]  A. Haines,et al.  The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review , 2013, PLoS medicine.

[19]  C. Fairburn,et al.  Eating disorder examination questionnaire: norms for young adolescent girls. , 2001, Behaviour research and therapy.

[20]  J. Lavender,et al.  Eating Disorder Examination Questionnaire (EDE-Q): norms for undergraduate men. , 2010, Eating behaviors.

[21]  H. Hoek,et al.  Incidence, prevalence and mortality of anorexia nervosa and other eating disorders , 2006, Current opinion in psychiatry.

[22]  Peter Musiat,et al.  Personalised computerised feedback in E-mental health , 2012, Journal of mental health.

[23]  G. Andersson,et al.  Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis , 2009, Cognitive behaviour therapy.

[24]  A. Miles,et al.  Evidence-based healthcare, clinical knowledge and the rise of personalised medicine. , 2008, Journal of evaluation in clinical practice.

[25]  A. Przeworski,et al.  A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? , 2011, Clinical psychology review.

[26]  Marsha M. Linehan,et al.  A Valence-Dependent Group-Specific Recall Bias of Retrospective Self-Reports: A Study of Borderline Personality Disorder in Everyday Life , 2006, The Journal of nervous and mental disease.

[27]  Stephanie Bauer,et al.  Technology-enhanced monitoring in psychotherapy and e-mental health , 2012, Journal of mental health.

[28]  E. Stice,et al.  Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. , 2013, Journal of abnormal psychology.

[29]  D. Feaster,et al.  Predicting protected sexual behaviour using the Information-Motivation-Behaviour skills model among adolescent substance abusers in court-ordered treatment , 2002, Psychology, health & medicine.

[30]  C. Vandelanotte,et al.  Website-delivered physical activity interventions a review of the literature. , 2007, American journal of preventive medicine.

[31]  R. Nelson-Gray,et al.  An overview of self-monitoring research in assessment and treatment. , 1999 .

[32]  Heleen Riper,et al.  Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis , 2006, Psychological Medicine.

[33]  Russell A. McCann,et al.  mHealth for mental health: Integrating smartphone technology in behavioral healthcare. , 2011 .

[34]  H. Hoek,et al.  Review of the prevalence and incidence of eating disorders. , 2003, The International journal of eating disorders.

[35]  C. Fairburn,et al.  Cognitive Behavioral Therapy for Eating Disorders , 2010, The Psychiatric clinics of North America.

[36]  Shana Nichols,et al.  Food for thought: Will adolescent girls with eating disorders self-monitor in a CBT group? , 2003, The Canadian child and adolescent psychiatry review = La revue canadienne de psychiatrie de l'enfant et de l'adolescent.

[37]  B. Löwe,et al.  Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. , 2012, The International journal of eating disorders.

[38]  Anthony F Jorm,et al.  Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. , 2011, Clinical psychology review.

[39]  K. Merikangas,et al.  Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. , 2011, Archives of general psychiatry.

[40]  Jane Burns,et al.  Mental health of young people in the United States: what role can the internet play in reducing stigma and promoting help seeking? , 2009, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[41]  A. Bandura SOCIAL COGNITIVE THEORY , 2008 .

[42]  S. Bauer,et al.  Mobile therapy: Use of text-messaging in the treatment of bulimia nervosa. , 2010, The International journal of eating disorders.