A call for responsible innovation in mobile mental health:findings from a content analysis and ethical review of the depression app marketplace

Mobile mental health presents many ethical challenges in the wild. These ethical issues and associated values were explored through a content analysis and ethical review of the depression app marketplace. App search and data collection was performed in Google Play Store (UK) and Apple iTunes (UK) between October to November 2018. Iterative data extraction and coding of ethical variables and values were conducted prior to synthetization of issues and themes. Search found 353 unique apps for depression. Analysis uncovered a range of ethical issues including: limited evidence of intervention validity, fidelity, and outcomes; insufficient safeguarding and duty of care; non-multisector development teams; lack of independent certification and regulation; lack of information and transparency for informed user choices; and concerns with privacy, confidentiality, and user permissions. These findings highlighted the presence and absence of ethical values in apps for depression, with most apps failing to reflect many key values. Our findings suggest a need for greater ethical value sensitive design in mobile mental health. This is challenging given the field’s multidisciplinarity and value conflicts. We encourage designers to adopt a responsible innovation approach to creating technologies that meet these ethical demands

A systemic ethical framework for mobile mental health:From design to implementation

The burgeoning field of mobile mental health has brought increased awareness of the need for greater ethical and regulatory frameworks to guide the design, use, and implementation of innovative interventions for vulnerable populations. Mental healthcare has long been guided and regulated by ethical principles and codes of conduct aimed at ensuring standards of practice, professional behaviour, and good and fair delivery of care. Key ethical concepts, such as safety, privacy, and competency, form an integral part of the language and behaviours of mental health practitioners. These issues pervade mobile mental health in much of the same way as traditional mental healthcare. Yet, the multidisciplinary nature of mobile mental health demands a broader conceptualisation and application of these ideas. At its most basic level, mobile mental health unites the fields of mental health, computer science, and human computer interaction. Each of these unique disciplines has its own ethical considerations and standards. There is need for greater integration of all disciplines and a more unified approach to understanding these shared and unique ethical concepts. Without a holistic approach to these critical matters, we risk the development and implementation of mobile mental health which falls short of accepted standards and which pose potential risks to individuals and society. The present research seeks to address this challenge with the development of a systemic ethical framework for mobile mental health. Guided by preliminary review of literature, we conceptualised a systems-based framework capturing the interrelation of pertinent ethical concepts across various disciplines and stakeholder groups, from the fundamental unit of the individual user to practitioners, developers, health agencies, and governance

A content analysis and ethical review of mobile applications for depression:Exploring the app marketplace

BACKGROUND Research investigating commercial mobile applications for depression have shown a range of concerns from limited research evidence, poor treatment fidelity, and issues with privacy and data security. This study advances this work through a content analysis and ethical review of app store listings of apps for depression. Whilst past content analyses and app reviews have highlighted some ethical and safety concerns, there has been no focussed ethical review to consider how these issues may present to potential users who seek to find help and support through the app stores. METHODS We conducted search of the Google Play Store and Apple iOS App Store in October and November 2018. Apps were included in the review if their description mentioned use for depression. Apps were reviewed for treatment information and ethical issues. RESULTS We identified 353 eligible depression apps. Treatment approach varied across apps, with 24 different treatment approaches being described by developers. Treatment strategies also varied, with 34 different strategies being listed. The review showed the use of several non-evidence-based approaches and strategies. Also evident was the continued lack of research evidence for most apps (314/353) and a general lack of transparency in the information provided to potential users. These ethical issues were further explored within the framework of psychological ethical principles, with the review highlighting issues in areas of beneficence/nonmaleficence, fidelity and responsibility, integrity, justice, and respect of person’s rights and dignity. DISCUSSION Despite advances in mobile mental health, commercial mental health apps continue to trail in evidence and practice. There is need for greater research into the efficacy and outcomes of treatment strategies and combinations of approaches. There is also great need for increased transparency of information to help users to make informed and safe choices. Many of the ethical issues discussed can be addressed by presenting potential users with clear and accurate information

Biosensing and Actuation—Platforms Coupling Body Input-Output Modalities for Affective Technologies

Research in the use of ubiquitous technologies, tracking systems and wearables within mental health domains is on the rise. In recent years, affective technologies have gained traction and garnered the interest of interdisciplinary fields as the research on such technologies matured. However, while the role of movement and bodily experience to affective experience is well-established, how to best address movement and engagement beyond measuring cues and signals in technology-driven interactions has been unclear. In a joint industry-academia effort, we aim to remodel how affective technologies can help address body and emotional self-awareness. We present an overview of biosignals that have become standard in low-cost physiological monitoring and show how these can be matched with methods and engagements used by interaction designers skilled in designing for bodily engagement and aesthetic experiences. Taking both strands of work together offers unprecedented design opportunities that inspire further research. Through first-person soma design, an approach that draws upon the designer’s felt experience and puts the sentient body at the forefront, we outline a comprehensive work for the creation of novel interactions in the form of couplings that combine biosensing and body feedback modalities of relevance to affective health. These couplings lie within the creation of design toolkits that have the potential to render rich embodied interactions to the designer/user. As a result we introduce the concept of “orchestration”. By orchestration, we refer to the design of the overall interaction: coupling sensors to actuation of relevance to the affective experience; initiating and closing the interaction; habituating; helping improve on the users’ body awareness and engagement with emotional experiences; soothing, calming, or energising, depending on the affective health condition and the intentions of the designer. Through the creation of a range of prototypes and couplings we elicited requirements on broader orchestration mechanisms. First-person soma design lets researchers look afresh at biosignals that, when experienced through the body, are called to reshape affective technologies with novel ways to interpret biodata, feel it, understand it and reflect upon our bodies

User perspectives and ethical experiences of apps for depression: A qualitative analysis of user reviews

Apps for depression have the potential to innovate mental health care and increase access to treatment. Yet, concerns abound with disparities between academic development of apps and those available direct-to-consumers through the app marketplace. Reviews have highlighted ethical shortcomings of these self-management tools, with a need for greater insight into how ethical issues may be experienced by users. We addressed these gaps by exploring user reviews of apps for depression to better understand user experiences and ethical issues. We conducted a thematic analysis of 2,217 user reviews sampled from 40 depression apps in Google Play and Apple App Store, totalling over 77,500 words. Users reported both positive and negative experiences, with ethical implications evident in areas of benefits, adverse events, access, usability and design, support, commercial models, autonomy, privacy, and transparency. We conclude by presenting an ethical framework for developing apps for depression and navigating their ethical tensions