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BackgroundAn increasing number of mental health apps (MHapps) are being developed for youth. In addition, youth are high users of both technologies and MHapps. However, little is known about their perspectives on MHapps. MHapps might be particularly well suited to reach the youth underserved by traditional mental health resources, and incorporating their perspectives is especially critical to ensure such tools are useful to them.ObjectiveThe goal of this study was to develop and pilot a process for eliciting youth perspectives on MHapps in a structured and collaborative way. We also sought to generate learnings on the perspectives of Latinx youth on MHapps and their use in ways that might facilitate discovery, activation, or engagement in MHapps, especially in Latinx populations.MethodsWe created a series of focus groups consisting of 5 sessions. The groups introduced different categories of MHapps (cognitive behavioral therapy apps, mindfulness apps, and miscellaneous apps). Within each category, we selected 4 MHapps that participants chose to use for a week and provided feedback through both between-session and in-session activities. We recruited 5 youths ranging in age from 15 to 21 (mean 18, SD 2.2) years. All the participants identified as Hispanic or Latinx. After completing all 5 focus groups, the participants completed a brief questionnaire to gather their impressions of the apps they had used.ResultsOur focus group methodology collected detailed and diverse information about youth perspectives on MHapps. However, we did identify some aspects of our methods that were less successful at engaging the youth, such as our between-session activities. The Latinx youth in our study wanted apps that were accessible, relatable, youth centric, and simple and could be integrated with their offline lives. We also found that the mindfulness apps were viewed most favorably but that the miscellaneous and cognitive behavioral therapy apps were viewed as more impactful.ConclusionsEliciting youth feedback on MHapps is critical if these apps are going to serve a role in supporting their mental health and well-being. We refined a process for collecting feedback from the youth and identified factors that were important to a set of Latinx youth. Future work could be broader, that is, recruit larger samples of more diverse youth, or deeper, that is, collect more information from each youth around interests, needs, barriers, or facilitators or better understand the various impacts of MHapps by using qualitative and quantitative measures. Nevertheless, this study advances the formative understanding of how the youth, particularly Latinx youth, might be viewing these tools.

BackgroundAs the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance.ObjectiveThis study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals.MethodsA mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores.ResultsWe found low agreement between the participants' and professionals' ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants' star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible.ConclusionsAs reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps.

With more than 10,000 mental health apps available, consumers and clinicians who want to adopt such tools can be overwhelmed by the multitude of options and lack of clear evaluative standards. Despite the increasing prevalence of curated lists, or app guides, challenges remain. Organizations providing mental health services to consumers have an opportunity to address these challenges by producing guides that meet relevant standards of quality and are tailored to local needs. This column summarizes an example of the collaborative process of app guide development in a publicly funded mental health service context and highlights opportunities and barriers identified through the process.

With more than 10,000 mental health apps available, consumers and clinicians who want to adopt such tools can be overwhelmed by the multitude of options and lack of clear evaluative standards. Despite the increasing prevalence of curated lists, or app guides, challenges remain. Organizations providing mental health services to consumers have an opportunity to address these challenges by producing guides that meet relevant standards of quality and are tailored to local needs. This column summarizes an example of the collaborative process of app guide development in a publicly funded mental health service context and highlights opportunities and barriers identified through the process.

BackgroundSupporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them.ObjectiveTo address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts.MethodsWe interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short.ResultsUsers of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood.ConclusionsAlthough people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations.

BackgroundSupporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them.ObjectiveTo address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts.MethodsWe interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short.ResultsUsers of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood.ConclusionsAlthough people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations.

BackgroundAccompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically.ObjectiveThe objective of this study was to systematically examine whether there was a COVID-19 pandemic-related increase in the self-reported use of digital mental health tools and other technologies to manage mental health.MethodsWe analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects.ResultsHigher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types.ConclusionsFindings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy.

BackgroundAccompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically.ObjectiveThe objective of this study was to systematically examine whether there was a COVID-19 pandemic-related increase in the self-reported use of digital mental health tools and other technologies to manage mental health.MethodsWe analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects.ResultsHigher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types.ConclusionsFindings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy.

BackgroundMobile apps have become popular resources for mental health support. Availability of information about developers' data security procedures for health apps, specifically those targeting mental health, has not been thoroughly investigated. If people are to use and trust these tools for their mental health, it is crucial we evaluate the transparency and quality around the data practices of these apps. The present study reviewed data security and privacy policies of mobile apps for depression.MethodsWe reviewed mobile apps retrieved from iTunes and Google Play stores in October 2017, using the term "depression", and evaluated the transparency of data handling procedures of those apps.ResultsWe identified 116 eligible mobile phone apps. Of those, 4% (5/116) received a transparency score of acceptable, 28% (32/116) questionable, and 68% (79/116) unacceptable. Only a minority of the apps (49%) had a privacy policy. The availability of policies differed significantly by platform, with apps from iTunes more likely to have a policy than from the Google Play store. Mobile apps collecting identifiable information were significantly more likely to have a privacy policy (79%) compared to those collecting only non-identifiable information (34%).ConclusionThe majority of apps reviewed were not sufficiently transparent with information regarding data security. Apps have great potential to scale mental health resources, providing resources to people unable or reluctant to access traditional face-to-face care, or as an adjunct to treatment. However, if they are to be a reasonable resource, they must be safe, secure, and responsible.

BackgroundMobile apps have become popular resources for mental health support. Availability of information about developers' data security procedures for health apps, specifically those targeting mental health, has not been thoroughly investigated. If people are to use and trust these tools for their mental health, it is crucial we evaluate the transparency and quality around the data practices of these apps. The present study reviewed data security and privacy policies of mobile apps for depression.MethodsWe reviewed mobile apps retrieved from iTunes and Google Play stores in October 2017, using the term "depression", and evaluated the transparency of data handling procedures of those apps.ResultsWe identified 116 eligible mobile phone apps. Of those, 4% (5/116) received a transparency score of acceptable, 28% (32/116) questionable, and 68% (79/116) unacceptable. Only a minority of the apps (49%) had a privacy policy. The availability of policies differed significantly by platform, with apps from iTunes more likely to have a policy than from the Google Play store. Mobile apps collecting identifiable information were significantly more likely to have a privacy policy (79%) compared to those collecting only non-identifiable information (34%).ConclusionThe majority of apps reviewed were not sufficiently transparent with information regarding data security. Apps have great potential to scale mental health resources, providing resources to people unable or reluctant to access traditional face-to-face care, or as an adjunct to treatment. However, if they are to be a reasonable resource, they must be safe, secure, and responsible.

Mental health apps offer unique opportunities for self-management of mental health and well-being in mobile, cost-effective ways. There is an abundance of apps available to consumers, but selecting a useful one presents a challenge. Most available apps are not supported by empirical evidence and thus consumers have access to a range of unreviewed apps, the benefits of which are not known or supported. While user ratings exist, and are likely to be considered by consumers when selecting an app, they do not actually yield information on app suitability. A possible alternative way for consumers to choose an app would be to use an app review platform. A number of attempts have been made to construct such a platform, and this paper introduces PsyberGuide, which offers a step towards providing objective and actionable information for publicly available mental health apps.