Mental health apps are effective, and could help ease the burden of mental ill-health, an Orygen systematic review of 92 randomised controlled trials (RTCs) into the efficacy of mental health apps has found.
However, the study also found that although understanding how people engage with mental health apps is crucial for designing effective supports, there is currently no standardised way of measuring or tracking user engagement or reporting on the use of persuasive design features, such as reminders, rewards and personalisation across studies.
The review, published in NPJ Digital Medicine, analysed data from 92 trials and a total of 16,728 participants,identifying significant positive effects for interventions targeting depression, anxiety, stress, and body image/eating disorders.
Lead author, Orygen Research Fellow Dr Lee Valentine, said growing need for mental health care, alongside the explosion in smartphone ownership, had helped drive the development of innovative digital interventions.
“We know mental health care systems are facing serious challenges, with ever-increasing demand, insufficient funding, understaffing and clinician burnout – and we also know there are significant barriers for people seeking help, such as long waitlists and high costs,” Dr Valentine said.
“Digital mental health represents a seismic shift in how we deliver mental healthcare, with the potential to provide scalable, cost-effective and evidence-based treatment options – but we need to understand why some apps are more likely to keep people engaged.”
Dr Valentine said that despite the proven effectiveness of many mental health apps, engagement – people using the app and engaging with its content over a sustained period of time – was often a challenge.
“You could have the most effective digital mental health intervention in the world, but if people aren’t engaging with it in a meaningful way then they are unlikely to experience the full mental health benefits,” Dr Valentine said.
“One promising direction we explored in this review is the use of persuasive design – an approach that uses technology to influence positive behaviour change – helping to motivate and support users to shift attitudes and behaviours in a positive direction.
“We found that key to better understanding how persuasive design is used, and how it can impact engagement and outcomes, is to have more consistent, standardised ways of applying and reporting on these principles in digital mental health.”
As the development and use of mental health apps grows, the authors propose several next steps to ensure consistent reporting of engagement data, enabling effective comparisons across studies.
They recommend:
Currently, only three-quarters of studies report on engagement, and among those that do, engagement is measured in 25 different ways, making it nearly impossible to compare across studies or determine which features truly support better engagement.
“The key challenge in digital mental health is engagement – so we need to get a better understanding of how apps are using persuasive design principles and how they’re measuring the impact on engagement, so we can understand what works and what doesn’t when it comes to real world use of these interventions,” Dr Valentine said.