Systematic assessment of the quality and integrity of popular mental health smartphone apps using the American Psychiatric Association's app evaluation model

Mobile phones are playing an increasingly important role in supporting mental health, by providing confidential, accessible and scalable support for individuals who may not seek or have means of accessing professional help. There are concerns, however, that many apps claiming to support mental health do not meet professional, ethical or evidence-based standards. App store search algorithms favour popularity (reviews and downloads) and commercial factors (in-app purchases), with what appears to be low prioritisation of safety or effectiveness features. In this paper, the most visible 100 apps for “depression”, “anxiety” and/or “mood” on the Google Play and Apple App stores were selected for assessment using the American Psychiatric Association App Evaluation model. This model systematically assesses apps across five broad steps: accessibility, integrity, clinical and research evidence base, user engagement and interoperability. Assessment is hierarchical, with the most fundamental requirements of apps assessed first, with apps excluded at each step if they do not meet the criteria. The relationship between app quality and app store visibility was first analysed. App quality was also compared across four different app function types: mental health promotion or psychoeducation; monitoring or tracking; assessment or prevention; and intervention or treatment. Of the 92 apps assessed (after eight failed to meet inclusion criteria), half failed to meet the first criterion step of accessibility, and a further 20% of the remaining apps failed to meet the second criterion step of security and privacy. Only three of the 10 apps most visible on app stores met the criteria for research/clinical base and engagement/ease of use, and only one app fulfilled all five criterion steps of the evaluation model. Quality did not differ significantly across app function type. There was no significant correlation between app quality and app store visibility, which presents a potential risk to vulnerable consumers. The findings of this review highlight the need for greater accountability of app developers to meet, and report, at least minimum quality and integrity standards for their apps. Recommendations are also provided to assist users and clinicians to make informed choices in their selection of reputable and effective mental health apps

Emotional Responses to Music: Shifts in Frontal Brain Asymmetry Mark Periods of Musical Change

Recent studies have demonstrated increased activity in brain regions associated with emotion and reward when listening to pleasurable music. Unexpected change in musical features intensity and tempo – and thereby enhanced tension and anticipation – is proposed to be one of the primary mechanisms by which music induces a strong emotional response in listeners. Whether such musical features coincide with central measures of emotional response has not, however, been extensively examined. In this study, subjective and physiological measures of experienced emotion were obtained continuously from 18 participants (12 females, 6 males; 18–38 years) who listened to four stimuli—pleasant music, unpleasant music (dissonant manipulations of their own music), neutral music, and no music, in a counter-balanced order. Each stimulus was presented twice: electroencephalograph (EEG) data were collected during the first, while participants continuously subjectively rated the stimuli during the second presentation. Frontal asymmetry (FA) indices from frontal and temporal sites were calculated, and peak periods of bias toward the left (indicating a shift toward positive affect) were identified across the sample. The music pieces were also examined to define the temporal onset of key musical features. Subjective reports of emotional experience averaged across the condition confirmed participants rated their music selection as very positive, the scrambled music as negative, and the neutral music and silence as neither positive nor negative. Significant effects in FA were observed in the frontal electrode pair FC3–FC4, and the greatest increase in left bias from baseline was observed in response to pleasurable music. These results are consistent with findings from previous research. Peak FA responses at this site were also found to co-occur with key musical events relating to change, for instance, the introduction of a new motif, or an instrument change, or a change in low level acoustic factors such as pitch, dynamics or texture. These findings provide empirical support for the proposal that change in basic musical features is a fundamental trigger of emotional responses in listeners

Emotion Regulation Strategy Mediates Both Positive and Negative Relationships Between Music Uses and Well-being

The mediating effects of emotion regulation (reappraisal and suppression) were examined in the relationship between music engagement and well-being. Emotion regulation strategies (Emotion Regulation Questionnaire; Gross & John, 2003) and styles of music engagement (Music Use questionnaire; Chin & Rickard, 2012) were assessed in a large diverse sample of 637 participants. A battery of hedonic and eudaimonic well-being measures (International Positive and Negative Affect Schedule Short Form; Thompson, 2007; Satisfaction With Life Scale; Diener, Emmons, Larsen, & Griffin, 1985; Mental Health Continuum-Short Form; Keyes et al., 2008) was also administered. Results demonstrated that the path of mediation was dependent on the type of emotion regulation strategy utilized, as well as the way in which one engages with music. Findings provide initial evidence that engaging with music for the purposes of cognitive and emotion regulation may enhance well-being primarily through the habitual use of cognitive reappraisal. In contrast, various other aspects of music engagement (music listening, engaged production, and social connection) if coupled with a tendency to regulate emotions and thoughts by expressive suppression may yield undesirable well-being outcomes. This study highlights the important role emotion regulation plays in the complex relationship between music engagement and well-being. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Hemispheric Dissociation of the Involvement of NOS Isoforms in Memory for Discriminated Avoidance in the Chick

Previous research has indicated a role for both the neuronal (nNOS) and endothelial (eNOS) nitric oxide isoforms in memory formation. In addition, two distinct periods of activity of nitric oxide activity, dissociated by hemispheric localization, are implicated following passive avoidance training in the chick. In the present study, we trained black Australorp-white Leghorn chicks on a color discrimination avoidance task. Diphenyleneiodonium chloride (1 μM) or N-propyl-l-arginine (50 μM) was administered into either the left or right hemisphere of the chick brain in an attempt to differentiate the effects of inhibiting eNOS or nNOS, respectively. The memory loss previously observed following administration of diphenyleneiodonium chloride between 10 and 20 min posttraining was found to be lateralized to the right hemisphere, although administration of this agent into the left hemisphere around the time of training was also amnestic. In contrast, N-propyl-l-arginine caused memory loss only when administered to the left hemisphere around the time of training. These findings suggest that activation of both eNOS and nNOS isoforms may be essential for long-term memory consolidation of this task. Further, these two periods of activity are defined temporally and by hemisphere localization, although confirmation with more selective inhibitors when they become available is advised

Military Veterans’ Use of Music-based Emotion Regulation for Managing Mental Health Issues

Veterans commonly report listening to music as a means of self-managing their mental health, yet no research has systematically explored how veterans use music for the purpose of regulating their emotions. In the current study, surveys were completed by 205 Australian veterans (mean age 59.57, SD 0.83), assessing their affective mental health (depression and stress) and related physical and behavioral problems (self-reported general health, alcohol abuse and negative social interactions). Veterans listened to music more in their everyday life than any other leisure activity reported. Music-listening for emotion-regulation purposes significantly contributed to the prediction of depression, perceived stress and negative social interactions, when gender and positive social interactions were controlled. Veterans with mental health problems listened to music for both emotional and cognitive reasons, and the most predictive emotion-regulation strategies used with music were diversion, discharge, and mental work. Music-listening did not however assist prediction of self-reported general health or alcohol abuse. The current findings demonstrate that veterans with higher levels of affective dysfunction listened to music to manage emotional and cognitive problems. Personal music-listening therefore offers substantial promise as a self-management tool to complement professional treatment of affective disorders in this vulnerable population. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Inhibition of the Endothelial Isoform of Nitric Oxide Synthase Impairs Long-Term Memory Formation in the Chick

Previous studies with general inhibitors of nitric oxide synthase have yielded variable and contradictory results with respect to their effects on memory. This may have been due to differential effects of blocking the various isoforms of this enzyme. We show that day-old chicks trained on a single-trial passive-avoidance task suffered significant memory loss from ∼40 min post-training following post-training intracranial administration of a potent inhibitor of eNOS. Administration of a specific nNOS or iNOS inhibitor at the same time had no effect on retention, although a role for either of these isoforms when administered at a different time after learning has yet to be fully investigated. The onset of memory loss following eNOS inhibition is the same as observed following general NOS inhibition, which suggests that amnestic effects observed in previous studies using nonspecific inhibitors may be attributable to blocking the function of eNOS. The findings indicate that eNOS may play a role in memory formation for this task, which is at least distinct from any role that may be played by nNOS