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App Advisor

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The expanding use of mobile health (mHealth) technologies is unprecedented in the history of medicine. Every month, companies and researchers release new smartphone apps, smart watches, and sensor technologies for the health care market. Psychiatry has been no exception to this trend. There has also been growing patient, clinical, government, and payer interest in the potential of mHealth technologies for psychiatric clinical care. Psychiatrists, clinical psychologists, psychotherapists, and other mental health clinicians are increasingly faced with questions regarding the efficacy and risks of mobile and online apps.

APA is helping psychiatrists and other mental health professionals navigate these issues by pointing out important aspects you should consider when making an app selection and determining whether an app works for you and your patients. The material provided here covers: (1) why it is critical to assess an app, (2) how to evaluate an app, and (3) an opportunity to seek additional guidance on apps and/or the evaluation process. It is not intended to provide a recommendation, endorsement, or criticism of any particular app, but rather serves as a tool for you to do your own evaluation of any app you might be considering. The goal is that in using this methodology, you will be able to make your own educated decision about particular apps and their suitability for your practice.

 

Why Rate Mental Health Apps?

Across all of health care, interest is increasing in the use of digital tools like wearable sensors and smartphone apps 1. Psychiatry and mental health are no exception, and there are thousands of apps targeting mental health conditions that are directly available for patients to download and use.

Apps offer interesting possibilities for mental health with the potential to help monitor symptoms and even deliver adjunctive treatments. For example, many apps offer to help track mood symptoms and access to therapy inspired exercises and lessons. Currently, there are apps targeting all major psychiatric illness and therapeutic modalities.

Use Caution When Choosing Apps

Many of the claims by mental health apps have never actually been studied or evaluated in feasibility or clinical trials 2,3. The FDA has taken a largely hands-off approach to regulating these apps, and there is currently little-to-no overnight of mental health apps 4. This can leaves the user to distinguish a useful, safe, and effective app from an unhelpful, dangerous, and ineffective one.

How can an app be dangerous or cause harm?. There are many ways an app can be dangerous or cause harm. A few examples include:

  • By offering incorrect or misleading information to patients.
  • By claiming to offer therapeutic interventions or services but actually be ineffective, leading to belief the patient is treatment refractory.
  • By not being secure, or improperly disclosing or allowing access to the personal health data.
  • By selling patient collected data but not obviously disclosing this information to users.
  • By not actually collecting clinically useful or actionable data.
  • By being a new technology whose use in a clinical setting is still not fully understood.
 

Apps Can Be Appropriate and Useful in Care

The goal of APA's App Advisor is to offer resources to help you and your patients make informed decisions about whether or not to use an app. By asking the right questions and looking for the right information, picking an app can be a more informed process.

The goal of APA's App Advisor is not to report if a particular app is right for you and your patient. Assigning a static rating like '88/100' or 'A+' etc to an app is not useful for two reasons:

  1. Apps often update and change so any static rating is only valid until that app updates, which may often be only a few weeks 5.
  2. The use of an app in clinical care is a clinical decision that depends on the patient at hand and your relationship with that patient. One app may be very useful for one patient but not another—just as one medication or therapy may be very useful for one patient but not another 6.

As a result, the app evaluations on this site reflect the experience on one user at one point in time and serve as samples of how different evaluators experience the product.

 
 

Our Expert Panel


The Model is based on the review of numerous scientific publications on the best ways to evaluate mHealth solutions for clinical practice.

Our Expert Panel includes APA-member psychiatric physicians, other mental health professionals (social workers, nurse practitioners), informaticists, medical students, and patients with lived experience of mental illness. The Panel was assembled after a lengthy application and review process by APA's Committee on Mental Health Information Technology.

The Panel first met in Washington, D.C., at APA's headquarters, where they reviewed the evaluation criteria within the Model, leading to a revised version of APA's original Model, including a streamlined "screener" version, allowing for users to quickly screen-out apps that may not be a good fit for them, without having to use the entire criteria.

 

As Featured On


APA's App Evaluation Model has been adopted by several healthcare organizations and featured in a number of publications. Below is a sample of how the Model is being used:

 
John Torous.jpg
John Torous, M.D., M.B.I.
Stephon-Proctor.jpg
Stephon Proctor, Ph.D.
Darlene-King.jpg
Darlene King, M.D.
Keris-Myrick.jpg
Keris Jan Myrick, M.B.A., M.S., Ph.D.c.
David-Gratzer.jpg
David Gratzer, M.D.
Margaret-Emerson.jpg
Margaret Emerson, D.N.P.
Patrick-Aquino.jpg
Patrick Aquino, M.D.
steven-chan.png
Steven Chan, M.D., M.B.A.
Karen-Fortuna.jpg
Karen Fortuna, Ph.D., M.S.W.
Sonia-Matwin.jpg
Sonia Matwin, Ph.D.
Nicole-Benson.jpg
Nicole Benson, M.D.
Julia-Tartaglia.jpg
Julia Tartaglia

Contact Us

To request more information about app advisor, or to submit a question about our Evaluation Model, contact us at [email protected].


References

  1. IMS Institute for Health Informatics, "Patient Adoption of mHealth: Use, Evidence and Remaining Barriers to Mainstream Acceptance" (.pdf) (September 2015).
  2. Journal of Medical Internet Research, "Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality" (August 2015).
  3. Journal of Medical Internet Research, "Smartphone Apps for Schizophrenia: A Systematic Review" (November 2015).
  4. HealthITBuzz, "Examining Oversight of the Privacy & Security of Health Data Collected by Entities Not Regulated by HIPAA" (July 2016).
  5. Journal of Medical Internet Research, "Quantifying App Store Dynamics: Longitudinal Tracking of Mental Health Apps" (August 2016)
  6. Journal of Medical Internet Research, "Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps" (February 2016).
  7. Psychiatric Services, "Mental Health App Evaluation: Updating the American Psychiatric Association’s Framework Through a Stakeholder-Engaged Workshop" (April 2021)
  8. npj Digital Medicine, "Actionable health app evaluation: translating expert frameworks into objective metrics" (July 2020)

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