Smartphone applications for depression: a systematic literature review and a survey of health care professionals’ attitudes towards their use in clinical practice

Smartphone applications (“apps”) may contribute to closing the treatment gap for depression by reaching large populations at relatively low costs. The general public seems open towards the use of apps for mental disorders but less is known about the attitudes of health care professionals. Therefore, the aim of this study was to examine the available evidence on the effectiveness of apps for depression and to explore the attitudes of health care professionals towards their use in practice. A systematic literature search was performed aimed at studies utilizing smartphone applications for depression. In addition, a survey was conducted to explore health care professionals’ attitudes towards using these treatment apps in clinical practice. Twelve articles were identified in the systematic literature review. All included trials reported a decline in depressive symptoms after the intervention periods. In the survey, 72 health care professionals participated. Significant differences were found between the level of technology experience and how much the health care professional would consider the use of mobile applications in clinical practice. Survey participants reported openness towards therapeutic app use but very little knowledge and experience in the field. Apps appear to be a promising self-management tool for reducing depressive symptoms. Despite some concerns, health care professionals’ attitudes towards the use of smartphone applications in clinical practice are quite positive. The provision of information on the potential benefits of e-health interventions as well as the training of professionals in the application of new technologies may increase health care professionals’ awareness and knowledge about mobile apps for the treatment of mental disorders.

[1]  Per Carlbring,et al.  Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial , 2014, BMJ Open.

[2]  A. Alavi,et al.  Opportunities and Challenges , 1998, In Vitro Diagnostic Industry in China.

[3]  I. Levav,et al.  Treatment gap in mental health care. , 2004, The Israel journal of psychiatry and related sciences.

[4]  Miranda Olff,et al.  Mobile mental health: a challenging research agenda , 2015, European journal of psychotraumatology.

[5]  Rebecca C Rossom,et al.  IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety , 2017, Journal of medical Internet research.

[6]  M. Faurholt-Jepsen,et al.  Methodological Challenges in Randomized Controlled Trials on Smartphone-Based Treatment in Psychiatry: Systematic Review , 2019, Journal of medical Internet research.

[7]  Michelle G. Craske,et al.  Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis , 2010, PloS one.

[8]  C. Bischoff,et al.  Wirkungen smartphonegestützter psychosomatischer Rehabilitationsnachsorge (eATROS) bei depressiven Patienten , 2015, Verhaltenstherapie.

[9]  J. Dirmaier,et al.  Internetbasierte Interventionen in der Behandlung psychischer Störungen , 2016, Der Nervenarzt.

[10]  Bart Verkuil,et al.  Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis , 2016, Journal of medical Internet research.

[11]  C. Rummel-Kluge,et al.  Utilization of e-mental-health and online self-management interventions of patients with mental disorders—A cross-sectional analysis , 2020, PloS one.

[12]  W. Gaebel,et al.  European Psychiatric Association (EPA) guidance on the quality of eMental health interventions in the treatment of psychotic disorders , 2016, European Archives of Psychiatry and Clinical Neuroscience.

[13]  T. Richardson,et al.  Clinicians' Attitudes Towards the Use of Computerized Cognitive Behaviour Therapy (cCBT) with Children and Adolescents , 2010, Behavioural and Cognitive Psychotherapy.

[14]  S. Sarkar,et al.  Psychotherapeutic Applications of Mobile Phone-based Technologies: A Systematic Review of Current Research and Trends , 2017, Indian journal of psychological medicine.

[15]  David C. Atkins,et al.  The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial , 2016, Journal of medical Internet research.

[16]  J. Schultz,et al.  Acceptance and Expectations of Medical Experts, Students, and Patients Toward Electronic Mental Health Apps: Cross-Sectional Quantitative and Qualitative Survey Study , 2019, JMIR mental health.

[17]  M. Beutel,et al.  Ready for eHealth? Health Professionals’ Acceptance and Adoption of eHealth Interventions in Inpatient Routine Care , 2017, Journal of health communication.

[18]  F. Wahle,et al.  Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild , 2016, JMIR mHealth and uHealth.

[19]  Psychotherapeuten und Internet , 2013, Psychotherapeut.

[20]  Gavin Andrews,et al.  Acceptability of Internet Treatment of Anxiety and Depression , 2011, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[21]  I. Myin-Germeys Digital technology in psychiatry: towards the implementation of a true person-centered care in psychiatry? , 2020, European Archives of Psychiatry and Clinical Neuroscience.

[22]  V. Arolt,et al.  Einstellungen gegenüber eHealth-Angeboten in Psychiatrie und Psychotherapie , 2016, Der Nervenarzt.

[23]  G. Riley,et al.  Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability , 2013, Journal of medical Internet research.

[24]  G. Andersson,et al.  Attitudes towards digital treatment for depression: A European stakeholder survey , 2017, Internet interventions.

[25]  C. Donovan,et al.  Australian mental health worker attitudes towards cCBT: What is the role of knowledge? Are there differences? Can we change them? , 2015 .

[26]  Toshi A Furukawa,et al.  Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial , 2017, Journal of medical Internet research.

[27]  G. Andersson,et al.  Self-Guided Psychological Treatment for Depressive Symptoms: A Meta-Analysis , 2011, PloS one.

[28]  M. Hautzinger,et al.  Attitudes Towards Internet Interventions Among Psychotherapists and Individuals with Mild to Moderate Depression Symptoms , 2017, Cognitive Therapy and Research.

[29]  Heleen Riper,et al.  Barriers and facilitators for the implementation of blended psychotherapy for depression: A qualitative pilot study of therapists' perspective , 2018, Internet interventions.

[30]  Gavin Andrews,et al.  CBT for depression: a pilot RCT comparing mobile phone vs. computer , 2013, BMC Psychiatry.

[31]  John Torous,et al.  The efficacy of smartphone‐based mental health interventions for depressive symptoms: a meta‐analysis of randomized controlled trials , 2017, World psychiatry : official journal of the World Psychiatric Association.

[32]  J. Francis,et al.  Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework , 2017, BMC Health Services Research.

[33]  P. Cuijpers,et al.  Internet and mobile interventions for depression: Opportunities and challenges , 2017, Depression and anxiety.

[34]  Beth Patterson,et al.  There is an app for that! The current state of mobile applications (apps) for DSM‐5 obsessive‐compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders , 2017, Depression and anxiety.

[35]  W Gaebel,et al.  Epa Guidance on Emental Health Interventions in the Treatment of Posttraumatic Stress Disorder (Ptsd) , 2017, European Psychiatry.

[36]  Alishia D. Williams,et al.  Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. , 2018, Clinical psychology review.

[37]  G. Andersson,et al.  Attitudes towards the use of computerized cognitive behavior therapy (cCBT) with children and adolescents: A survey among Swedish mental health professionals , 2014 .

[38]  Geoffrey Tabo Olok,et al.  Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: a cross-sectional study , 2015, BMC Medical Informatics and Decision Making.

[39]  Nir Menachemi,et al.  EHR and other IT adoption among physicians: results of a large-scale statewide analysis. , 2006, Journal of healthcare information management : JHIM.

[40]  R. Lencer,et al.  [Attitudes towards using eHealth in psychiatry and psychotherapy : A pilot survey at the DGPPN Congress 2014]. , 2016, Der Nervenarzt.

[41]  Helen Christensen,et al.  Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial , 2013, BMC Psychiatry.

[42]  C. Marker,et al.  Attitudes toward psychological telehealth: current and future clinical psychologists' opinions of internet-based interventions. , 2013, Journal of clinical psychology.

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

[44]  I. Levav,et al.  The treatment gap in mental health care. , 2004, Bulletin of the World Health Organization.

[45]  Lori Wozney,et al.  A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression , 2016, PloS one.

[46]  Kyriaki G. Giota,et al.  Mental Health Apps: Innovations, Risks and Ethical Considerations , 2014 .

[47]  B. Löwe,et al.  Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER) , 2020, BMJ Open.

[48]  Päivi Lappalainen,et al.  Feasibility of a Personal Health Technology-Based Psychological Intervention for Men with Stress and Mood Problems: Randomized Controlled Pilot Trial , 2013, JMIR research protocols.