Smartphone Mental Health Apps Lack Diverse Features, Consistent Privacy Settings

Erica J. Camacho, MS

Despite there being an abundancy in mental health smartphone apps now available to consumers, the current marketplace offers little variety in its features, nor capability in assuring consumer/patient privacy, according to findings.

In new data from a team of investigators in the Department of Psychiatry at Beth Israel Deaconess Medical Center in Boston, mental health apps on smartphone app marketplaces commonly offered psychoeducation, goal-setting and mindfulness exercises and features—but not too frequently other elements of mental health care. What’s more, investigators observed no correlation between high app marketplace user ratings and pronounced privacy settings on such apps.

Led by Erica Camacho, MS, investigators sought to analyze currently available mental health apps and their association with privacy scores and popularity among users, as well as what their offerings implicate to the status of consumer-level mental telehealth care options today. As they noted, the COVID-19 pandemic and subsequent policy and public health responses led to an increased reliance on digital mental health care options. As such, there are currently >10,000 mental health-related apps on smartphone marketplaces today.

“As there have been more public-facing efforts revealing privacy flaws in many popular mental health apps, and calls for apps to be more evidence-based, it remains unclear if there have been any changes in the mental health apps that most people may be downloading from the Apple App Store and Google Play Store,” they wrote. “Thus, we assessed whether there is an association between popularity metrics and privacy scores for mental health apps.”

The team conducted a cross-sectional analysis of 578 mental heal apps via the M-Health Index and Navigation Database (MIND); apps designed to treat and aid patients with various conditions including depression, schizophrenia, sleep and eating disorders, among others, were included.

Trainer raters were asked to assess each app based on 6 categories:

• App origin and accessibility
• Privacy and security
• Clinical foundation
• Features and engagement
• Inputs and outputs
• Interoperability

Investigators used 5 MIND criteria to determine app privacy scores, including the app having a policy, reporting security measures in place, declaration of data use and purpose, allowing for deletion of data and allowing users to opt out of data collection. They measured correlations between privacy scores and popularity metrics—per star ratings and number of downloads—for each app.

The 578 apps were analyzed across 105 dimensions of MIND. Camacho and colleagues observed psychoeducation (41%), goal setting and habit forming (38%), and mindfulness (38%) as the leading app features. The least common app features were sensor data-derived biofeedback (1%), Acceptance and Commitment Therapy (2%), and Dialectical Behavioral Therapy (2%).

Just 3 in every 10 (30%) of apps allowed users to email or export their data. Common input means included surveys, diary entries, and internal microphones.

The most common types of conditions mental health apps were purported to treat were substance abuse related to smoking or tobacco (33%), stress and anxiety (28%), and nonserious mood disorders (20%). Just 13 (2%) apps were built to address schizophrenia.

Investigators observed a privacy policy among 77% of the included mental health apps. They found no statistically significant correlation between high privacy scores and popularity per Apple App Store or Google Play Store star ratings. However, privacy scores were positively correlated with app download counts on the Google Play Store.

Camacho and colleagues concluded that, despite the currently high demand for remote mental health care, smartphone app marketplaces “lack diversity in their offerings and fail to implement potentially high-impact features.”

“Another challenge to the app space is that easily accessible metrics like star ratings fail to consider privacy capabilities,” they wrote. “Thus, clinicians and patients must discern apps beyond such measures to ensure the discovery of apps that both fit their unique needs and protect their privacy. Publicly available app libraries and validated app evaluation frameworks like MIND are innovative tools to support users in their app selection.”

The study, “Assessment of Mental Health Services Available Through Smartphone Apps,” was published online in JAMA Network Open.