Research question

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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An Assessment of Mental Health Applications for the Treatment of Psychological Disorders in

Adults Living in the United States

Florida International University

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Background

In the past year, mental illness has become a common condition in the United States, with

44.7 million adults diagnosed (Chiauzzi & Newell, 2019). From those diagnosed Chiauzzi &

Newell (2019) determined that 10.4 million Americans have a severe mental illness such as

major depression, anxiety disorders, and schizophrenia, but only 6.7 million received treatment

in the past year. Although with the emergence of mental health apps, it poses a unique

opportunity to broaden the availability and capacity of mental health treatment. There are

currently over 300,000 health apps available worldwide, with mental health accounting for the

most significant proportion of the disease-specific app market (Chiauzzi & Newell, 2019). With

the extensive use of mobile phones, mental health apps look to be an increasingly popular

approach to help individuals self-manage their mental health conditions.

Young adulthood

Young adulthood is a distinctive developmental period because it is when the most severe mental

health conditions typically occur. Generally, the onset age of many mental health disorders is

most often in adolescence. However, a review of epidemiological studies revealed the 12-month

prevalence of any psychiatric disorder is more than 40% in people aged 18–29 years, which is

higher than any other age range, especially for anxiety disorders and mood disorders (Arnett,

Žukauskienė, & Sugimura, 2014). Additionally, depression has increasingly become a concern in

young adulthood, as with suicidal thoughts, attempts, and deaths. When comparing adolescents,

young adults aged 18-25 are at a higher rate of severe psychological distress, and are more likely

to think about, plan for, and attempt suicide (National Research Council et al., 2015). Yet only a

quarter of young adults with these experiences receive treatment or services, and they are more

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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likely than older adults and adolescents to drop out of or discontinue treatment (National

Research Council et al., 2015).

Mobile mental health apps

Mental health apps are a promising method to expand the availability and quality of mental

health treatment by targeting a wide range of psychological disorders and varying in design and

functionality (Chandrashekar, 2018). The National Institute of Mental Health (NIMH) classifies

mental health apps into six categories based on functionality: self-management, cognition

improvement, skills-training, social support, symptom tracking, and passive data collection

(Chandrashekar, 2018). Mental health apps also span all stages of clinical care provisions,

including immediate crisis intervention, prevention, diagnosis, primary treatment, a supplement

to in-person therapy, and post-treatment condition management (Price et al., 2013). Hence,

mobile apps seem to be the preferred choice when treating psychological disorders because when

compared to other platforms, they're easier to use and require little effort.

Purpose of the Study

The purpose of conducting this study will be to identify how mental health apps treat

psychological disorders in young adults living in the United States. This study aims to

understand if such apps make mental health care more accessible and its long-term effects. There

have been numerous studies regarding the effectiveness of mental health applications; however,

many of these studies focused on the efficacy of readily available mental health apps and did not

take in to the user's ages or its long-term effects. For instance, an article by Torous, Wisniewski,

Liu, and Kashavan (2018) surveyed mental health app usage, but the study only lasted two

weeks. In another study by Larsen et al. (2019), it focused on the efficacy of the mental health

apps but did not include how patients perceive the app.

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Research Question

In which ways mental health applications may treat psychological disorders among

young adults living in the United States?

Statement of Problem

In the last decade, mental health disorders have significantly increased in young adults

living in the U.S. (Twenge, Cooper, Joiner, Duffy, & Binau, 2019). In a study conducted by

Twenge et al. (2019), it revealed that the rate of young adults reporting symptoms of major

depression in the past 12 months increased 63 percent from 2009 to 2017, and the rate of young

adults with suicidal thoughts or other suicide-related outcomes increased 47 percent from 2008

to 2017. There was also a 71 percent increase in young adults experiencing severe psychological

distress in the past 30 days, from 2008 to 2017 (Twenge et al., 2019). As more young adults in

the U.S. experience mental illnesses, smartphone apps have become a suitable option for

individuals because it provides psychological interventions that are readily available and

affordable (Weisel et al., 2019). However, despite the accessibility of mental health apps, user

engagement is critical to determine if these apps are practical and successful. Many studies

currently focus on the number of individuals using mental health apps rather than examining how

individuals are using these apps, and if it provides any clinical significance (Zhang et al., 2019).

Thus, with the young adult population experiencing the most psychological distress and mental

health apps becoming increasingly popular, more in-depth research is needed to determine if

users are engaging in these apps and if they are clinically meaningful.

Significance of the Study

This research is essential to understanding how mental health apps treat mental health

disorders among young adults living in the United States. This study is necessary and relevant to

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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gain a better understanding if having better access to mental health services can reduce mental

health disorders in this population. With over 10,000 mental health apps available, it's essential

to understand the full capability of these apps (Henson, Wisniewski, Hollis, Keshavan, &

Torous, 2019). Moreover, this study would allow for more information to determine how to help

individuals affected with a mental illness. According to the National Institute of Mental Health,

among the 44.7 million adults living with a mental illness in the United States, only 43.1%

received mental health treatment (Henson, Wisniewski, Hollis, Keshavan, & Torous, 2019).

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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Literature Review

The following literature review will evaluate related and existing evidence regarding the

treatment of mental health disorders with mobile apps. The purpose will be to gain a better

understanding of how mental health apps treat mental disorders in young adults living in the

United States.

Treating Mental Health Disorder with Mobile Apps

Wasil, Venturo-Conerly, Shingleton, & Weisz (2019) conducted their study out of concern that

millions of users are relying on smartphone applications for the treatment of mental health

disorders, but little was known if these apps include evidence-based therapies. Thus, Wasil et al.

(2019) conducted a study to examine if 27 popular mental health applications contained elements

of empirically supported treatments. The study concluded that while mental health apps have a

promising role in expanding access to mental health services, some evidence-based treatment

practices were rarely used in these mental health apps (Wasil et al., 2019). These days

technology is continuously expanding, and mobile technology is explicitly being adopted at an

increasing rate (Wang, Varma, & Prosperi, 2018). By 2020, it's predicted that there will be 6.1

billion mobile phone users and an additional 3 billion smartphone users globally (Wang, Varma,

& Prosperi, 2018).

Therefore, mental health apps could be a compelling platform for monitoring and managing

mental health disorders. However, a randomized control trial is needed to determine whether

mental health apps offer any benefit to its users. Arean et al. (2016) conducted a randomized

control trial to identify usability and clinical outcomes of three separate self-guided mobile apps.

Arean et al. (2016) also realized the potential that mobile health apps had at overcoming barriers

to mental health care, but little was known whether patients were using these apps as expected

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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and the impact it would have on mental health outcomes. For the study, Arean et al. (2016)

enrolled 626 participants with mild or moderate depression and randomly assigned them to 1 of 3

self-guided mobile apps. The final results of the trial determined that mobile apps had the most

significant impact on individuals with a moderate level of depression (Arean et al., 2016).

For this reason, it's feasible for mobile apps to treat mental health disorders. However, Arean et

al. (2016) study only focused on addressing one type of mental health disorder. Mental health

disorders can range from generalized anxiety disorder (GAD), panic disorder, phobias, social

anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder

(PTSD) (U.S. Department of Health & Human Services, 2015). Given that Arean et al. (2016)

chosen demographic were individuals diagnosed with depression, finding additional studies that

did not focus on treating a specific mental disorder was challenging. For instance, Rodriguez-

Paras et al. (2017) conducted a study to examine the legitimacy and availability of mobile apps

for the treatment of post-traumatic stress disorder (PTSD). The nature of the study consisted of

two parts: (1) reviewing available PTSD apps through the app stores and (2) conducting a

systematic review of the literature to determine PTSD app usage and validity (Rodriguez-Paras

et al., 2017). The result from Rodriguez-Paras et al. (2017) study revealed there were a lot of

apps available to aid in the diagnosis and treatment of PTSD symptoms. Still, more research

needed to be done toward understanding PTSD app usage and effectiveness (Rodriguez-Paras et

al., 2017).

Meanwhile, Sucala et al. (2017) conducted a systematic review to assess the quality of mobile

apps for the treatment of anxiety. This study identified 52 anxiety apps for review and reported

67.3% of the apps developed did not involve input from health care professionals, and only 3.8%

of the apps were rigorously tested (Sucala et al., 2017). Thus, when comparing Rodriguez-Paras

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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et al. (2017) and Sucala et al. (2017) study, it demonstrated that current literature focused more

on mobile app's effectiveness in treating one mental health disorder, rather than multiple mental

health disorders. Also, Rodriguez-Paras et al. (2017) and Sucala et al. (2017) study both

concluded that mental health apps lacked credible evidence to treat mental health disorders;

however, neither took into consideration the user's perspective. Mental health apps were

designed as a user-centered application, and more literature is needed to understand the efficacy

of mental health apps outside experimental trials. Similar to Arean et al. (2016) study, which

determined that mobile health apps positively impacted individuals with moderate levels of

depression.

Additionally, the current literature could stand to incorporate studies focused on how the young

adult population engages with mental health apps. Within the young adult population, the

prevalence of any psychiatric disorder is higher in individuals aged 18-29 years (Arnett,

Žukauskienė, & Sugimura, 2014). Young adults aged 18-25 also have a higher chance of

experiencing severe psychological distress, but only a quarter will seek treatment and will be

more likely to drop out or discontinue treatment than older adults and adolescents (National

Research Council et al., 2015). Hence, it would be beneficial to study how the young adult

population engages with mental health apps because it could potentially reveal which mental

health disorder responds better with mental health apps. Also, this type of research might be able

to clarify the issue of adherence and possibly present an opportunity to develop a new

intervention.

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Methods

The purpose of this research is to determine if mental health apps can treat psychological

disorders among young adults living in the United States. The primary goal of this quantitative

study is to identify the effectiveness of using mental health apps in treating mental health

disorders.

Research Design

The effectiveness of mental health applications in the treatment of psychological disorders in

adults will be assessed using a crossectional, descriptive study design.

Participants

The participants of this research will only be young adults between the age of 18 and 29. Young

adulthood is frequently defined as the time from age 18 to 25; however, others have argued that

young adulthood can persist to as late as age 29 (Scales et al., 2015) Hence, having participants

between the age of 18 and 29 seems like an appropriate classification for young adulthood. In

addition to the age requirement, the participants must have a known history of mental illness.

The expected number of participants the research will survey is 30 young adults with a mental

health disorder.

Instrumentation

The participants will be asked to complete a 48-question questionnaire via Survey Monkey. The

survey will be divided into five sections: (1) general demographic; (2) technology ownership and

use; (3) mental health application assessment; (4) reasons for not using the apps; and (5) interest

in mental health app features. Appendix A shows the survey questionnaire created by Lipschitz

et al. (2019) to determine the adoption of mobile apps for depression and anxiety. This survey

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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was adapted to assess the variables of this study. The addition of section 3 was added to

determine if the participants found using mobile apps effective in treating their mental health

disorder. Meanwhile, sections 4 and 5 were explicitly based on Lipschitz et al. (2019)

questionnaire because the survey questions reveal why some young adults are not utilizing

mental health apps to treat mental health disorders, and it presents an opportunity to develop new

interventions. The questionnaire used in this research study can be located in Appendix A.

Procedures

For the research study to being, a survey will be generated via Survey Monkey. Once the surveys

are created, the survey link will be shared via social media, which will include Facebook,

Twitter, and Instagram. The study will be conducted over three weeks to gather the results.

Additionally, participation in this research will be voluntary, and the participants who will

partake in the survey will be advised before the start of the study that their participation is

voluntary. No personal or identifiable information will be required of them besides their age,

gender, and if they have a mental disorder.

Data Analysis

Once the survey is completed, the data will be aggregated into tables based on participant

demographics, technology use, mental health assessment, factors for not using mental health

apps, and interest in specific mental health app features. The question on Survey Monkey would

also require an answer before being able to move on; to avoid missing data during the research.

If there are any missing data from the questions asked, statistical techniques will be implemented

to work around the missing data. After the data has been appropriately sorted, the data from the

demographics, technology use, and mental health assessment should reveal if mobile health apps

can treat mental health disorders in young adults. Meanwhile, the results from the factors for not

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using mental health apps and interest in specific mental health app features should provide

insight into how to increase adherence to mental health apps for the treatment of mental health

disorders.

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References

Arean, P. A., Hallgren, K. A., Jordan, J. T., Gazzaley, A., Atkins, D. C., Heagerty, P. J., &

Anguera, J. A. (2016). The Use and Effectiveness of Mobile Apps for Depression:

Results From a Fully Remote Clinical Trial. Journal of Medical Internet

Research, 18(12). Retrieved from https://www.jmir.org/2016/12/e330/

Arnett, J. J., Žukauskienė, R., & Sugimura, K. (2014). The new life stage of emerging adulthood

at ages 18–29 years: implications for mental health. The Lancet Psychiatry, 1(7), 576.

Retrieved from https://www-clinicalkey-com.ezproxy.fiu.edu/#!/content/playContent/1-

s2.0-S2215036614000807?returnurl=null&referrer=null

Chandrashekar, P. (2018). Do mental health mobile apps work: evidence and recommendations

for designing high-efficacy mental health mobile apps. MHealth, 4, 6. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897664/

Chiauzzi, E., & Newell, A. (2019). Mental Health Apps in Psychiatric Treatment: A Patient

Perspective on Real World Technology Usage. JMIR Mental Health, 6(4). Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658296/

Henson, P., Wisniewski, H., Hollis, C., Keshavan, M., & Torous, J. (2019). Digital mental health

apps and the therapeutic alliance: initial review. BJPsych Open, 5(1). Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381418/

Larsen, M. E., Huckvale, K., Nicholas, J., Torous, J., Birrell, L., Li, E., & Reda, B. (2019). Using

science to sell apps: Evaluation of mental health app store quality claims. Npj Digital

Medicine, 2(1). Retrieved from https://www.nature.com/articles/s41746-019-0093-

1#citeas

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Lipschitz, J., Miller, C. J., Hogan, T. P., Burdick, K. E., Lippin-Foster, R., Simon, S. R., &

Burgess, J. (2019). Adoption of Mobile Apps for Depression and Anxiety: Cross-

Sectional Survey Study on Patient Interest and Barriers to Engagement. JMIR Mental

Health, 6(1). Retrieved from https://mental.jmir.org/2019/1/e11334/

National Research Council, Institute of Medicine, Children, Y. F., Committee on Improving the

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Bonnie, R. J. (2015). Investing in the Health and Well-Being of Young Adults. Retrieved

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Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero,

K. J. (2013). MHealth: A Mechanism to Deliver More Accessible, More Effective Mental

Health Care. Clinical Psychology & Psychotherapy, 21(5). Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926903/

Rodriguez-Paras, C., Tippey, K., Brown, E., Sasangohar, F., Creech, S., Kum, H.-C., … Benzer,

J. K. (2017). Post-traumatic Stress Disorder and Mobile Health: App Investigation and

Scoping Literature Review. JMIR MHealth and UHealth, 5(10). Retrieved from

https://mhealth.jmir.org/2017/10/e156/

Scales, P. C., Benson, P. L., Oesterle, S., Hill, K. G., Hawkins, J. D., & Pashak, T. J. (2015). The

dimensions of successful young adult development: A conceptual and measurement

framework. Applied Developmental Science, 20(3). Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176765/

Sucala, M., Cuijpers, P., Muench, F., Cardoș, R., Soflau, R., Dobrean, A., … David, D. (2017).

Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and

Anxiety, 34(6). Retrieved from

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https://onlinelibrary.wiley.com/doi/full/10.1002/da.22654?casa_token=r5VV7nyjEDUA

AAAA%3AhsNJXgGPC72AJwxKZKgGVyG1tRdhiZKTmFLqMvk6ihFP8RrJR-

p7A0GPjK_Kan6DCySNlDV9ZL0K1A0

Torous, J., Wisniewski, H., Liu, G., & Keshavan, M. (2018). Mental Health Mobile Phone App

Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269625/

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period,

and cohort trends in mood disorder indicators and suicide-related outcomes in a

nationally representative dataset, 2005–2017. Journal of Abnormal Psychology, 128(3),

185–199. Retrieved from https://psycnet-apa-org.ezproxy.fiu.edu/fulltext/2019-12578-

001.html

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major-types-of-anxiety-disorders/index.html

Wang, K., Varma, D. S., & Prosperi, M. (2018). A systematic review of the effectiveness of

mobile apps for monitoring and management of mental health symptoms or

disorders. Journal of Psychiatric Research, 107. Retrieved from https://www-

sciencedirect-com.ezproxy.fiu.edu/science/article/pii/S0022395618308288

Wasil, A. R., Venturo-Conerly, K. E., Shingleton, R. M., & Weisz, J. R. (2019). A review of

popular smartphone apps for depression and anxiety: Assessing the inclusion of

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evidence-based content. Behaviour Research and Therapy, 123. Retrieved from

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Weisel, K. K., Fuhrmann, L. M., Berking, M., Baumeister, H., Cuijpers, P., & Ebert, D. D.

(2019). Standalone smartphone apps for mental health—a systematic review and meta-

analysis. Npj Digital Medicine, 2(1). Retrieved from

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Zhang, R., Nicholas, J., Knapp, A. A., Graham, A. K., Gray, E., Kwasny, M. J., … Mohr, D. C.

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https://www.jmir.org/2019/12/e15644

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APPENDIX A

Questionnaire

Section 1: General Demographics

What is your age? _______ years

What is your sex?

□ Male

□ Female

Do you currently have any of the following health conditions?

□ Depression

□ Anxiety & panic disorder

□ Obsessive-compulsive disorder (OCD)

□ Post-traumatic stress disorder (PTSD)

□ Attention-deficit/hyperactivity disorder (ADHD)

□ Bipolar disorder

□ Schizophrenia

□ Other_________

Section 2: Current Technology Ownership and Use

Do you have a smartphone? □ Yes □ No

Do you have a tablet? □ Yes □ No

Do you ever use apps on your smartphone or tablet? □ Yes □ No

Have you ever used an app to help you manage a mental health disorder? □ Yes □ No (If NO continue to section 4 and 5)

Section 3: Mental Health App Assessment Read the questions below and mark the answer best represents your opinion:

Strongly agree

Agree

Neither

agree

nor

disagree

Strongly

disagree

Disagree

I use this app more than once a □ □ □ □ □

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week.

I integrated this app as part of my

daily routine. □ □ □ □ □

I forget to use the app when I am

experiencing psychological

distress.

□ □ □ □ □

The app is engaging. □ □ □ □ □ The app presents the

content/information in a unique

and interesting way.

□ □ □ □ □

The contents of the app is

appropriate for the targeted

audience.

□ □ □ □ □

The overall look of the app is

visually appeasing and easy to

read.

□ □ □ □ □

The app provided an accurate

description of its function □ □ □ □ □

There are measurable and

achievable goals that app want me

to achieve.

□ □ □ □ □

The content presented in the app is

well written and relevant in

treating my mental health disorder.

□ □ □ □ □

The information within the app is

comprehensive but concise. □ □ □ □ □

The app uses charts, graphs,

images or videos that are clear and

correct.

□ □ □ □ □

The information presented in the

app come from a reliable source. □ □ □ □ □

The app provides evidence-based

practices. □ □ □ □ □

I would recommend this app to

someone who is experiencing

psychological distress.

□ □ □ □ □

I think I will continue using this

app for the next 12 months. □ □ □ □ □

I am satisfied with this app. □ □ □ □ □ This app increased my

understanding on the importance

of addressing my mental health.

□ □ □ □ □

This app has increased my

knowledge and understanding of

my mental health.

□ □ □ □ □

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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This app has changed my attitude

toward improving my mental

health.

□ □ □ □ □

This app has motivated me to

address my mental health. □ □ □ □ □

Using this app improved my

mental health symptoms. □ □ □ □ □

Section 4: Reasons for Choosing to Use/Not Use Mental Health Apps

Below are some reasons people may choose not to use mobile apps for mental health disorder.

Which reasons are true for you?

Yes No

□ □ don't’t think an app can help me to get better.

□ □ don't’t know how to find an app that would help.

□ □ don't’t use apps at all.

□ □ don't’t think I have a problem with mental health disorder

□ □ I am already in treatment for mental health disorder andon't’t see the need for an app

□ □ I am concerned about protecting my privacy with having my information in an app like this.

□ □ It would be embarrassing to have an app like this on my phone.

□ □ I tried an app like this before and did not like it because it was difficult to use.

□ □ I tried an app like this before and did not like it because it was not personalized enough.

□ □ I tried an app like this before and it did not help.

Below are some reasons why people may decide to start using mobile apps for a mental health

disorder. Which reasons are true for you?

Yes No

□ □ I might use and app for these problems if I saw proof that it worked.

Section 5: Interest in Specific Mental Health App Features

Would you be interested in an app that allowed you to do any of the following?

Yes No

□ □ Track your mood/stress/anxiety/PTSD symptoms

□ □ Learn more about your mental health conditions.

□ □ Learn about how to change negative/self-critical thinking

USING HEALTH APPS TO TREAT PSYCHOLOGICAL DISORDERS

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□ □ Get involved in more activities.

□ □ Help you improve your social skills.

□ □ Help you learn to get better sleep.

□ □ Connect with a community of people with similar mental health problems.

□ □ Increase your physical activity