We share some of our most intimate data with mental health apps, but there’s surprisingly little proof of what they give us in return.
Many medical experts are starting to find problematic the lack of clear science backing up apps that promise to help with everything from low mood to depression.
Bruce Bolam, program director at VicHealth, oversaw a recent review of more than 300 health and wellbeing apps.
While he praised the dynamism of a “free market of smartphone apps,” Bolam explained that while many apps scored top marks when it came to design and gamification, the science behind their treatment method was a lot weaker.
For example, their top scoring mental well being app What’s Up? Scored four stars for functionality but only two-and-a-half for its potential to affect behavioural change. The majority of apps were given a behaviour change rating of one star or less, out of five.
“In terms of actually providing proven tools to support behaviour change, there is a fairly big gap between what most apps do and what the science would say is best practice,” he told Mashable.
A recent study of suicide prevention apps undertaken by the Black Dog Institute found that of the 49 iOS and Android apps with interactive content reviewed, few followed “high quality evidence-based practice.”
A small number of apps even contained potentially harmful content, encouraging risky behaviour such as self-harm.
David Bakker, the founding director of the app MoodMission, who also works at Monash University’s School of Psychological Sciences, insisted it was important that each mood-boosting strategy be supported by scientific literature.
Unlike almost most health-related apps on the market, Mood Mission is currently undergoing a randomised controlled trial comparing the app’s efficacy against two other apps and a control condition.
“Any psychologist should be able to justify what they’re doing with their clients by saying ‘this is what the research says,'” Bakker said. “The same thing should really happen with apps.”
Are bad apps dangerous?
As we become more comfortable talking about mental health, the increase in people looking for help via apps is not necessarily a bad thing.
“Apps can afford people things like anonymity,” suggested Jennifer Nicholas, a researcher at the Black Dog Institute. “They’re not as stigmatising, they’re low cost, and they’re pretty convenient.”
Nevertheless, if these apps are the first point of contact for people who need help, she feared they could be discouraged from turning to professionals and lose trust in treatment if the product doesn’t work.
“For the rest of us who are, as Freud would say, ‘commonly miserable,’ a smartphone app can be the beginning of a pathway to finding more evidence-based help,” Bolam added.
Mindfulness or resilience apps can be useful, but he warned against any app that presents itself as a cure. “Can they help some individuals? Absolutely, Could they also put some individuals at risk or down the wrong track? Well, potentially.”
Despite his study, Bolam is optimistic about the place of app technology in healthcare and the potential for developers to improve.
“I think to some extent it’s a bit of a historical inevitability,” he said. “If we look at other areas of medical technology, things that start off quite fringe or experimental, eventually we do tend to see them integrated into longer term health studies.”
What should we do about it?
When looking for help online, it’s hard to find what you need among the immense array on the iOS and Android app stores.
MoodMission’s Bakker acknowledged it would be difficult to find a balance between strict app efficacy guidelines and innovation, but suggested there should be some form of accreditation from trusted mental health bodies.
“There are lots of physical health medical apps out there that don’t have any evidence either, but Google or Apple allow them on the store,” he said. “So having some sort of tick of approval that you can see … I think that would be very powerful.”
Nicholas agreed that the app stores currently do little to help to consumers differentiate between apps that are evidence-based and those that are not. “Right now, perhaps there’s an assumption that if it’s in the app store, then it works,” she said.
While she recognised the challenge of putting thousands of apps through a validation process, she suggested the “medical” category could be reserved for apps that provide proof of their efficacy.
A Google spokesperson told us that while developers are not given specific guidelines by category, apps publishing misleading or potentially harmful content are prohibited.
Apple pointed to its developer guidelines, which stipulate that “medical apps that could provide inaccurate data or information, or that could be used for diagnosing or treating patients may be reviewed with greater scrutiny.”
For now though, developers have little incentive to do better. “Success is measured by number of downloads and star ratings on the app store, not health incomes,” Nicholas said.