Mental Health Mobile Apps for Preadolescents and Adolescents:A Systematic Review

Background: There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years.  Methods: The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years.  Results: A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate.  Conclusions: Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed

Off the couch and out of the hospital, mobile applications for acceptance and commitment therapy

This paper describes the research and concept development process involved in designing a mobile app for depressed youth learning to practice mindfulness based psychotherapy entitled Acceptance and Commitment Therapy (ACT) program at Trillium Healthcare Centre in Toronto. Our process involved identifying aspects of preexisting mobile applications for mindfulness that may be discouraging for youth with depression and devising strategies to overcome these negative messages within the ACT Application. We propose to present a working prototype of mobile application at the Mobile HCI conference

Academic underachievement and mental disorders in adolescence: Assessment and treatment

Academic underachievement affects many adolescents and is defined as a notable discrepancy between actual and expected achievement, given the student's cognitive ability level. A significant percentage of adolescents suffer from both academic underachievement and mental disorders, putting them at risk for negative psychosocial development. However, there are few treatments available focussing on these adolescents. The present doctoral thesis evaluated the efficacy of the treatment program "SELBST – achievement problems" in a randomised controlled trial (RCT). Furthermore, the added benefit of a specifically designed smartphone app to improve therapy transfer was investigated. Methods: The psychometric properties of the primary outcome, the Academic Problems Checklist, were analysed. A clinically referred sample of n = 60 adolescents aged 11-18 years was randomised into either the experimental group, receiving weekly cognitive behavioural therapy based on the "SELBST – achievement problems" treatment manual including a therapy smartphone app or into the control group, receiving treatment as usual. Results: The revised version of the Academic Problems Checklist consists of a 17-item, semi�structured clinical interview for adolescents, parents, and teachers. The analysis of the psychometric properties of the APC showed it is a short, reliable, and valid instrument for assessing academic underachievement of adolescents with mental disorders using a multi�informant approach. The RCT showed for both groups clinically relevant improvements on the primary outcome of academic underachievement. For the teacher-rated academic underachievement, a statistical superiority of the treatment group compared to the control group was found during the follow-up phase. The treatment group showed significant improvements regarding their grade point average compared to the control group. Statistical superiority of the treatment group was found for the individual problemlist measuring individual academic underachievement problems with large effects in the adolescent and parent rating. Mental health problems improved in both groups, however, there was no statistical superiority of either group. These effects remained largely stable during the follow-up period. The smartphone app was well accepted by the adolescents, however, it showed no statistically significant additional benefit compared to the standard SELBST-treatment. Conclusion: In summary, improvements were found for academic underachievement and mental problems. The treatment satisfaction was high, but the smartphone app provided no significant additional benefit. The study's limitations included the small sample size, the substantial dropout rate in the experimental group, and the technical challenges encountered implementing a smartphone ap

Qualitative Synthese im Kontext einer Meta-Ethnographie - Patientenzentrierte Sichtweise von App-basierten Interventionen bei Depression und Angst

Depression und Angst – zwei eng miteinander assoziierte Krankheitsbilder, die eine steigende Prävalenz in der Bevölkerung aufweisen. Die zunehmende Erkrankungshäufigkeit wirft Versorgungsengpässe auf, die eine Erweiterung bisheriger Therapieansätze erfordern, denn die Nicht-Behandlung der Betroffenen steigert das Risiko der Chronifizierung oder des rezidivierenden Krankheitsverlaufs. Eine innovative Therapiemöglichkeit, die eine langfristige und kontinuierliche Begleitung der Patienten ermöglicht, stellen Mental Health Apps dar. Im Rahmen dieser Synthesearbeit wird das Meinungsbild von App-Nutzern erfasst, um darauf aufbauend Empfehlungen für eine bedürfnisadaptierte App-Entwicklung und einen patientenorientierten App-Einsatz zu erarbeiten. Dies geschieht mittels Meta-Ethnographie, die um verschiedene andere Modelle, teilweise in modifizierter Form, erweitert wurde. Integriert werden unter anderem das ENTREQ – Statement, eine Zusammenführung des SPICE – und SPIDER – Modells, das eMERGe.Project, das CASP – Schema, das PRISMA – Statement und Anteile der Thematischen Synthese. Die Literaturrecherche umfasst die Datenbanken PubMed (MEDLINE), PsycINFO, Web of Science (SSCI), CINAHL, SCOPUS, CENTRAL, Google Scholar, sowie die Durchsicht von Journals, Aufzählungen und Verlinkungen. Anhand der Ein- und Ausschlusskriterien können sechs geeignete Primärstudien ermittelt werden. Die weiterführende Verarbeitung, der in den Primärstudien erwähnten Konzepte, grenzt sieben wiederkehrende Kernthemen ab: Eigenengagement des Patienten, Therapeutisches Konzept der App, Therapeutische Allianz mit dem Behandler, Präsentation der App, Charakteris-tika App-basierter Behandlung, Aspekte, die eine Therapie behindern, sowie Wünsche und Anliegen der Patienten. Aufbauend auf diesen Themen findet eine Weiterentwicklung der Synthese statt, die in einer Grafik zusammengefasst wird und Kausalitätsketten aufzeigt. Das entscheidende Therapieelement ist das Eigenengagement des Patienten, das durch intra- und interpersonelle Faktoren modifiziert wird. Die Persönlichkeit des Einzelnen ist daher differenziert zu erfassen, um die App-Auswahl und das Therapie-konzept individuell abzustimmen. Insgesamt wird eine therapeutische App mehrheitlich befürwortet, sofern diese als Ergänzung zur herkömmlichen Therapie der Depression und Angst verwendet wird. Der geforderten Individualität und Autonomie des Patienten stehen eine zeitgleich gewünschte klare Behandlungsleitlinie und Führung durch den Behandler gegenüber. Diese und weitere Disparitäten zielführend zu lösen, ist eine Herausforderung im Zuge der App-Implementierung. Das Beziehungskonstrukt des therapeutischen Settings zwischen Patient, Behandler, App und App-Entwickler wird abschließend in Form einer die Kernthemen übergreifenden Diskussion und Grafik herausgearbeitet