Hephsibah Loeb, MD and Ann Chandy, MD
In 2017, the FDA approved the first app for treatment of alcohol, cocaine, marijuana and stimulant use disorders. In a preceding randomized controlled trial, mobile software Therapeutic Education System (TES) was found to reduce dropout from treatment and to increase patients’ rates of abstinence from substance abuse. Another study showed that PRIME-D, a mobile-based treatment for depression, positively affected symptoms of depression and disability. Many individuals seek out self-help apps for psychiatric complaints, although, in general, little evidence exists for evaluation of the most accessible mobile apps for self-help. What are the strengths and weaknesses of digital apps for treatment of mental illness? How should a mental health clinician assess the role and efficacy of mobile apps within a patient’s treatment? Results of TES trial include lower dropout rate and greater abstinence rate from non-opioid substance abuse. Through use of PRIME-D, individuals were found to have improvement in self-reported depression and self-reported disability. Both TES and PRIME-D trials involved a clinician or coach alongside the mobile intervention. Patients in the PRIME-D study who had greater interaction with masters' level mental health coaches were more likely to have greater improvement in mood symptoms. The high level of retention in study was also thought to be related to human support from mental health coaches. Self-help apps for mental health can increase access to care, without barriers such as clinician availability or clinic hours. Lower cost and convenience could increase adherence. Psychoeducational information can be accurately provided, without risk of faulty administration by staff. The potential for a mobile app-based approach to treatment can reduce stigma and thus increase the likelihood of a patient seeking to address mental illness. Significant drawbacks of self-help apps for mental health include the concerns about privacy of data shared on apps. Apps can provide information that is inappropriate, incorrect or that may be misinterpreted by individual users. Apps may not be suitable for emergency situations and may not be easy to use by patients who have serious mental illness. Developed by the American Psychiatric Association, the APA App Evaluation model provides a means for clinicians to evaluate apps for mental health. The model employs a five-tiered system for assessing background information, privacy and security, clinical evidence, ease of use, and potential to share data with the clinical team. In conclusion, evidence from two interventions shows that mobile apps can improve outcomes in patients with non-opioid substance use disorder and depression. Digital apps for mental health can allow increased access to mental health resources; however, also have significant drawbacks related to privacy, the risk of misinformation, and inadequacy in an emergency.
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