Do you use a mental health app? New study says your data can be shared

Do you use a mental health app?  New study says your data can be shared

If you’re among the nearly 36% of Americans who report symptoms of anxiety or depression, you may have used — or thought about using — a mental health app for support.

But with thousands of mental health smartphone apps on the large and growing market, you may be wondering how good the apps actually are. And can you trust them?

Despite many available options, new research suggests that the market is not optimally serving consumers due to limited innovation, evidence-based interventions and good privacy controls.

The new study published this week in JAMA Network Open aims to systematically assess available mental health apps based on critical measures such as clinical validation and privacy practices. Researchers also examined degrees of innovation and the relationship between app privacy measures and app popularity.

Researchers analyzed 578 apps related to mental health across 105 dimensions, using an app evaluation framework established by the American Psychiatric Association.

The study only included apps that cost $10 or less to download and based evaluations on free, basic versions of the apps or free trials, as well as app descriptions in the app store, rather than on in-app purchases or paid subscriptions to unlock full sets of features. Most of the apps (88%) included in the study were free to download, but only 39% were completely free.

Lack of differentiation leads to lost opportunities

The study revealed a lack of evidence and innovation among the apps evaluated.

Most apps are not based on clinical evidence, with only 15% of apps offering studies showing their effectiveness or feasibility. Researchers did not evaluate the quality of the studies even where they were available.

In addition, there was little variation – or innovation – among app studies.

Most apps shared similar features. The most common app features were psychoeducation (41%), goal setting (38%) and mindfulness (38%). Apps used most by user surveys (45%), diary entries (34%) and microphones (21%) to collect input. Other top features of the app included mood and symptom tracking, journaling, and deep breathing.

Most often, apps provided notifications (68%), data summaries (61%) and information resources (50%). A small minority (15%) of the apps collected passive data, such as biofeedback such as step counts and heart rates, or geolocation.

“Most apps offer very basic symptom tracking, journaling, mindfulness exercises or basic information about mental illness,” said Dr. John Torous, MBI, director of digitalpsych.org at Beth Israel Deaconess Medical Center in Boston and the study’s senior author. “Few are using the unique nature of smartphones to deliver new interventions or resources.”

The most common conditions the apps addressed were tobacco use (33%), stress and anxiety (28%), mood disorders considered not serious (20%). Very few apps are made for people with serious mental illnesses, with only 2% addressing things like schizophrenia. For-profit app makers were disproportionately less likely to offer apps for serious conditions.

This lack of focus on more serious mental health conditions represents a missed opportunity, according to Torous.

“Ideally, apps can help those with the highest needs and thus patients with severe mental illness,” he said. “Our team does research and clinical care with apps for this population and has seen firsthand how helpful they can be for patients. Seeing the lack of apps that people with severe mental illness can download and easily use today highlights a key gap in the market that the field must fill.”

Consumers may overlook privacy concerns

The analysis showed that consumer ratings have little, if any, correlation with app reliability.

Researchers established a privacy score for each app based on criteria including the presence of a privacy policy, reporting of security measures in place, explicit explanations of the use and purpose of collecting user data, the ability of users to delete data, and the ability for users to opt out of data collection.

Researchers then analyzed the relationship, if any, between the privacy scores they assigned each app and other measures, such as user ratings of the app and popularity, as measured by the number of downloads where the data was available.

Researchers found that among 412 Android apps with available data, the number of downloads was correlated with privacy scores. In other words, the more popular an app, the better the privacy and security measures or vice versa.

However, user ratings of Android mental health apps were not correlated with privacy scores. Among Apple apps, there was also no correlation between App Store ratings and privacy scores. (The Apple App Store does not publish the number of downloads per app, according to the study.) There was no statistically significant difference in privacy scores between Apple and Android apps.

The study authors suggest that the lack of correlation between privacy scores and consumer ratings indicates that consumers may not be aware of or focused on privacy features.

While most apps (77%) had a privacy policy, these policies were written in over 12th-grade reading level, which means that the reader must have completed education beyond upper secondary in order to understand the policy.

More worryingly, researchers found that nearly half (44%) of apps shared users’ personal health information with third parties.

According to Torous, the fact that mental health apps are sharing user data is not new, but he said that we may be approaching the limits of consumer patience for such practices.

“We’re seeing increasing evidence that most mental health apps are not good stewards of people’s personal or private health data,” Torous said.

What you can do

Before signing up for a new mental health app, or to check out apps you already use, consumers can visit mindapps.org to evaluate apps on dimensions such as cost, features, privacy and clinical evidence. According to Torous, there are 600 apps in the database and growing.

Aside from doing their homework on existing apps, consumers may also want to demand better from app developers.

“The fact that we’re seeing less innovation, few evidence-based apps, many duplicative simple apps and more privacy concerns in the market suggests we need to rethink how we ensure the next generation of apps is more useful,” Torous said. – The potential is still there, but we are still waiting.

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