The COVID-19 public health crisis led to a surge in mental disorders and a boom in mental health mobile apps. While mental disorders were already widespread pre-pandemic, the COVID-19 pandemic has brought new challenges, with an upsurge in anxiety, depression and other problems affecting people of all ages and backgrounds. One figure sums it up: a survey conducted by the Center for Disease Control and Prevention in June 2020 revealed that 40% of those surveyed had reported experiencing mental health or substance abuse issues during the pandemic.
Today, the advent of digital applications and biomarkers is opening up new ways of intervening to improve care. So, as digital tools multiply, Alcimed reviews 4 categories of applications and their results to date, as well as their limits and anticipated future challenges.
The World Health Organization estimates that one in four people will experience a mental health problem at some point in their lives, and that one in eight, or 970 million people, were living with a mental disorder in 2019.
These figures highlight the scale of the prevalence of mental disorders, and underscore the need for innovative approaches to meet these challenges.
Mental health apps have proliferated, with downloads up 40% worldwide and 85% in France alone between the end of December 2019 and the end of March 2020. To better understand this ecosystem, we propose a classification into four main, but not mutually exclusive, categories.
Mindfulness and meditation apps are designed to help individuals practice relaxation and mindfulness techniques. They offer a variety of guided meditations, breathing exercises and other techniques designed to reduce stress and improve mental well-being.
Among the 280 mindfulness and meditation apps available on the iTunes Store are Headspace, the only meditation app to have been scientifically studied, with 2 million subscribers and 65 million downloads, and Calm, with 4 million users and over 100 million downloads. The popularity of these apps is significant when we consider the alarming previously mentioned figures on the prevalence of mental health issues in the world population.
CBT is a type of therapy that focuses on identifying and modifying negative thought and behavior patterns. For example, in the case of insomnia, CBT helps patients to understand how their internal beliefs can lead to recurring negative emotions that prevent sleep and how to restructure these cognitive biases or automatic thoughts to be able to fall asleep more easily.
Among the most popular CBT apps are MoodKit, which offers over 200 activities designed to overcome users’ negative thought patterns, Sanvello, with over 3 million users, and Happify, with over 500,000 downloads.
Tracking apps enable users to monitor and record their daily emotions and state of mind, to better understand their mental health. They tend to use diary entries, mood trackers and other tools to help users track their emotions over time; the main aim being to help users become aware of their emotions, detect trends and changes, and facilitate a better understanding of their mental and emotional states.
Among the most popular mood-tracking apps are Moodfit, which was voted best mental health app in 2020, 2021 and 2022 by the mental health website Verywell mind, Daylio and Mood Tools, which offers tools such as a safety plan to follow in the event of psychological distress.
Support applications offer individuals a community of people going through similar experiences or connect them with specialized counselors. They provide a space where individuals can share their stories, connect with others and receive emotional support.
Among the most popular peer support apps are TalkLife, with over 2.5 million users, Peer Collective, voted the best peer support app in 2021 by Verywell mind, and HeyPeers.
Mental health apps are part of the vast and fast-growing field of mobile health: estimates put the figure at 17.6% growth per year by 2028, reaching a value of $166.2 billion.
The integration of AI into these digital tools is envisioned as a key factor behind these projections and 3 key reasons for using AI algorithms demonstrate this connection:
Digital tools offer new perspectives for mental health support and management, but they also have important limitations to consider. Understanding these limitations is crucial to ensure a comprehensive and appropriate approach to mental well-being.
We have identified 4 major limitations of digital mental health solutions:
In terms of concrete and demonstrated impact, the landscape is very limited. Only 5% of applications have even been studied, so effectiveness has not been proven for almost all currently available platforms. In addition, in 2020, it was estimated that only 3-4% of all mental health apps were evidence-based.
However, there is growing evidence showing positive impacts of digital tools. For example, a meta-analysis of ten randomized control trials found that smartphone-based interventions resulted in moderate improvements in anxiety and depression symptoms in youth.
One of the difficulties in demonstrating the effectiveness of new mobile mental health tools is that their use remains at the user’s discretion and is difficult to control. For example, according to a study conducted on 93 applications, consistent user engagement is low with a median percentage of weekly active use of only 4% across all studied apps. One interesting fact is that the same study showed a difference in engagement between meditation apps (1.6%), mood tracking (6.3%) and peer support (17%).
While there are currently between 10,000 and 20,000 mental health applications available on mobile platforms, not all are positively perceived by psychologists. Indeed, some fear that these tools replace therapy while others perceive them only as support at home during or after a professional follow-up. In addition, not all available apps are monitored or approved by a government agency. For example, the US Food and Drug Administration only regulates those apps classified as “digital therapeutics”, a class of apps which must scientifically demonstrate the therapeutic benefits of their use.
While mobile apps may be useful in managing symptoms and improving well-being, they are not designed to replace the expertise and advice of licensed professionals. Indeed, the efficacy of a professionally guided CBT web session has been shown to be higher than an unguided digital session, a result that shows the importance of including professionals in digital care.
In addition, the use of these digital tools could delay the search for appropriate care or miss critical warning signs, especially since people with serious mental illnesses may need more intensive treatment than that provided by an app and may need in-person therapy or medication management.
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Digital tools can be particularly useful for people living in rural areas, as they often have limited access to in-person mental health care, for people facing financial constraints or for people with busy schedules, as they can benefit from the convenience of an app they can access at any time.
However, some populations may still face barriers to access. For example, seniors may lack digital literacy or may not have access to smartphones or other necessary devices.
Finally, there are concerns about the confidentiality and security of the information collected on these apps. Since people share sensitive information on these services, it is essential to ensure that it is protected from unauthorized access or misuse.
As such, the regulatory landscape is still evolving, with ongoing debates on issues such as data ownership, informed consent and accountability.
Regulations have also evolved in response to the COVID-19 crisis. For example, the Food and Drug Administration published a guidance document in response to the public health mental health emergency, stating that it would not require regulatory approval for low-risk applications. As a result, since over 10,000 apps are now available on mobile devices, more research is needed to ensure these tools provide quality, evidence-based clinical support.
Mental health is a complex and urgent problem, and digital solutions can play an important role in its solution. In addition, the integration of AI will open new opportunities and avenues for development in the future. However, it is important to approach these solutions with a critical eye, understanding both their advantages and limitations. Apps can be a valuable tool to track symptoms, provide self-help resources and connect individuals with licensed professionals. However, they are not a substitute for traditional mental health care, and privacy and security concerns must be addressed. Ultimately, some of the key issues in digital mental health are improving care and data generation while ensuring that the quality of care remains customizable and high. Alcimed is here to support all stakeholders in this rapidly growing field. Do not hesitate to contact our team!
About the author,
Zoé, Consultant in Alcimed’s Healthcare team in France
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