Are smartphone-based mental health apps any good for depression?

In the latter quarter of what seems to be the worst year ever, 2020, it seems the opportunities for slipping into clinical depression are exponentially increasing. The latest statistics show bereavement, isolation, loss of income and fear; all triggers for mental health conditions, are on the rise. If you want to see how the depression burden is increasing and how it is shared amongst us globally, even without COVID, click on the play button below.

So what can we do to avoid slipping into melancholy during this crisis? Techniques with the most robust evidence to reduce potential depressive symptoms have been shown to primarily be non-pharmacological:

• Exercise – 3+ times a week get heart rate above resting and maintain.
• Adequate sleep – by exposing yourself to sunlight you can reset your Circadian Rhythm whilst exercise will help you sleep.
• Reduce Overstimulation – anti rumination, reduce caffeine intake do more mindfulness and meditation.
• Social interaction – self-therapy, counselling, increase social contact.
• Sunlight – running outside as below can bolster Vitamin D3 as above.
• Healthy diet – supplementation of Vitamin D3 / Omega, ↓ intake of alcohol.

After the above have been exhausted, it is usual that the next step is an antidepressant medicine. Antidepressant usage is skyrocketing year-on-year in every single country³, a handful of people criticize the use of psychotropic drugs which produce mild-to-severe side-effects, cause overdependence or resistance, and are self-limiting. For some, meditation retreats are no more than expensive trips for which vacating time out of a busy life and responsibilities gets difficult while for others, traditional forms of psychotherapy take longer to show results, produce negative patient outcomes, aren’t available throughout and are expensive. Although, depression and other mental diseases can be treated by various strategies, between 76% and 85% of people in low- and middle-income countries do not seek or receive treatment⁴.

But could iPhone / Android (mHealth) apps have enough evidence behind them to be added to this list? We all now create shoppings list apps to aid our poor memory and play the latest version of Candy Crush to cure our boredom so why not an app for curing depression?

Smartphone-based mental health apps represent a unique opportunity to expand the availability and quality of mental health treatment. The number of mobile health (mHealth) apps focused on mental health has rapidly increased; a 2015 World Health Organization (WHO) survey of 15,000 mHealth apps revealed that 29% focus on mental health diagnosis, treatment, or support. Unfortunately, a meta-analysis review published in late 2019 has shown that “mHealth apps cannot be recommended based on the current level of evidence.” However, can some new apps buck this trend? In this article, we will look at three new mHealth apps, Tetr, Misu and Wuju and see if any of their therapeutic claims stand up to scrutiny.

Misu

A recent study of mobile usage and depression found that:

“Participants with depression were found to have fewer saved contacts on their devices, spend more time on their mobile devices to make and receive fewer and shorter calls, and send more text messages than participants without depression.”

Depression screening using mobile phone usage metadata⁷.

There is definitely a link between the use of technology and depression scores, Misu sets out to address this with some clever technology. Misu installs on your computer and works in the background tracking short-lived emotions via facial micro-expressions and organizes an emotional history alongside which apps are used. The intention is to reveal to users how various apps influence their mind and helps a person become aware of his/her mood patterns and preferences. I have been using it for a number of weeks and here is how my happiness rates alongside the various OSX programs I use.

Misu claims the app has an 86% accuracy rate of being able to predict someone’s mood, this came from calibrating the AI with 1⁄4 million people volunteers having their photos captured.

Wuju

Wuju is the brainchild of Eli Finer. Built from Eli’s long, struggle with depression, this app comprises diversified moods with his narration and music in the background which produces a less AI-based visual healing experience and simulates in-person therapy but with a setting of the patient’s choice.

Wuju intends to halt extraordinary runaway thoughts but also uncovers the most mundane and ordinary sensations to heal the uncontrolled minds. While this app can heal transient emotional injuries in a short time, it collects data to evaluate the progress in people’s behaviour which allows for the app’s further improvement. In Eli’s latest tweet, he provided stats as evidence for the app’s effectiveness. Remarkably, there was a maximum drop in anger by 89%, resistance by 74% from 138 samples, shame by 85% and other emotions also showed a significant decrease⁵. It is claimed that For 50% of its users, it worked extremely well and moderately well for a further 25%⁶.

Tethr

Due to an overused idea that men are strong-minded goliaths devoid of sentimental thoughts, they do not disclose their mental health problems nor seek support. In England, 1 in 8 men suffer from mental health problems that are left untreated⁸. To break this conventional image, Tethr , a mhealth app turns to the needs and wellness of the marginalized gender and helps men replenish their internal peace. It engages male peers to share their hollow experiences and consists of mhealth hotlines, coaching and articles for men which make it an effective tool.

Beyond the effectiveness of these apps, the questions get trickier. How do these apps manage users’ privacy and data? MHealth Apps are not only effective in their use but also address their users’ privacy by explaining how this app uses their data and has led to the satisfaction of their users. Do these apps provide the best treatment out of all the mental illness methods? While different techniques work for different patients, mHealth apps are devoid of almost every problem relating to drug treatments and traditional psychotherapies. With increasing consumption of antidepressants in children and older adults along with people who do not receive traditional treatment either because of stigmatization or inaccessible conventional treatments, mhealth apps provide a promising solution and strategy to overcome these barriers. Presently, the smartphone usage is ubiquitous and current covid-19 dynamics have led to an increase in the use of these digital interventions which are easily accessible and inexpensive, have a time-saving user-friendly interface, and are becoming a day-to-day custom for their avid users. Furthermore, they provide supplementary treatment to traditional therapy and are used in combination with these techniques to explore the entire spectrum of mind.

are antidepressant medicines, all of which have been carefully scrutinized in randomised controlled trials before they can be sold to the public as the majority of drugs can cause both harm and good. In the app world, Google and Apple tend to think little harm can occur by using an unproven depression app and do not to delve into medical claims. The NHS on the other hand (the UK national health service) has done a great job of making a list of “Approved Apps” we intend to do the same.

Mobile apps have significant potential to deliver high-efficacy mental health interventions. Given the global shortage of psychiatrists and the lack of mental health care access in rural regions, apps have emerged as a viable tool to bridge the mental health treatment gap. However, the majority of the apps that are currently available lack clinically validated evidence of their efficacy and as such cannot be fully recommended by health care practitioners. Given the number and pace at which mobile Health (mHealth) apps are being released, further robust research is warranted to develop and test evidence-based programs. It has been mentioned elsewhere in the scientific literature⁸, but to reiterate, we implore mHealth organizations, and others, come together to set universal standards for mental health app quality control, and that those standards include at a minimum the review of data security, app effectiveness, usability, and data integration.

References

1. Global Burden of Disease Study 2019 (GBD 2019) Results. Global Burden of Disease Collaborative Network. [Online] Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020, October 2020. [Cited: November 7, 2020.] http://ghdx.healthdata.org/gbd-results-tool..
2. Antidepressant Drugs Market to Reach $15.98 Bn by 2023, Globally at 2.1% CAGR, Says Allied Market Research. https://www.prnewswire.com/. [Online] PR Newswire, 11 21, 2018. [Cited: 11 7, 2020.] https://www.prnewswire.com/news-releases/antidepressant-drugs-market-to-reach-15-98-bn-by-2023-globally-at -2-1-cagr-says-allied-market-research-873540700.html.
3. Something startling is going on with antidepressant use around the world. https://www.businessinsider.com/. [Online] Business Insider, 2 4, 2016. [Cited: 11 7, 2020.] https://www.businessinsider.com/countries-largest-antidepressant-drug-users-2016-2.
4. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet. [ Online] 9 8, 2007. [Cited: 11 2, 2020.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847360/.
5. Finer, Eli. [Online] 10 9, 2020. [Cited: 11 7, 2020.] https://twitter.com/finereli/status/1314784540703899648. 6. Wuju App. Wuju. [Online] [Cited: 11 7, 2020.] http://wujuapp.com/#:~:text=Unlimited%20trial,moderately%20well%20for%20further%2025%25. 7. How Misu Works. Misu. [Online] [Cited: 11 7, 2020.] https://www.misu.app/how-misu-works.
6. Survey of people with lived experience of mental health problems reveals men less likely to seek medical support. www.mentalhealth.org.uk/. [Online] 2016. [Cited: 11 7, 2020.] https://webarchive.nationalarchives.gov.uk/20180328130852tf_/http://content.digital.nhs.uk/catalogue/PUB2174 8/apms-2014-full-rpt.pdf/.
7. Rouzbeh Razavi, Amin Gharipour, Mojgan Gharipour, Depression screening using mobile phone usage metadata: a machine learning approach, Journal of the American Medical Informatics Association, Volume 27, Issue 4, April 2020, Pages 522–530, https://doi.org/10.1093/jamia/ocz221
8. Torous J, Andersson G, Bertagnoli A, Christensen H, Cuijpers P, Firth J, et al. Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry 2019 Feb;18(1):97-98