The Promise and Peril(s) of Mental Health Apps

Mental illness is not the cause of gun violence in America. However, those who advance this argument are right to suggest that mental health has been declining. From 1990 to 2017, the prevalence of mental illness around the globe rose by a staggering 30 percent (James et al., 2018). In the first year of the COVID19 pandemic, anxiety and depression increased by another 25 percent globally, according to The World Health Organization.

Mental health apps may offer one tool to address the growing need for mental health services. Analyses of experimental trials show that mental health apps lead to small but significant improvements in mental illnesses like anxiety and depression (Lecomte et al., 2020). But before we download one of the hundreds of mental health apps on the app store, there are a few things we need to consider.

The first problem is that we don’t know how well those apps work compared to established treatments. The existing evidence shows that mental health apps are better than receiving no treatment, but no studies have compared these apps to drug or in-person therapy. Mental health apps can thus lead to a two-tier system of care, whereby people that can afford therapy receive the best treatments, whereas underprivileged and underserved populations receive lesser, digital treatments.

The second problem is that we don’t know how well those apps work in the real world. The real-world effects of an intervention depend not only on how effective it can be in a controlled research setting but also on whether people follow the treatment in their daily lives. Daily Aspirin, for example, can be effective in preventing heart attacks but only if people take their Aspirin pill every day.

An analysis of real-world use of 93 popular mental health apps for anxiety, depression, and emotional well-being found that less than 4 percent of users were still using the app 15 days after downloading it (Baumel et al., 2019). Mental health apps are likely much less effective for the average consumer than shown in the few existing studies.

The third problem is that the apps available to consumers, like you and me, are not the same apps that have shown promise in the scientific literature (Longyear & Kushlev, 2021). There are more than a thousand mental health apps available to consumers on the iPhone and Android app stores (Larsen et al., 2019). By some estimates, two-thirds of those apps make claims that they are effective in treating mental health conditions.

Yet, an analysis of 179 apps for anxiety and depression available to consumers found that only eight had corresponding peer-reviewed scientific evidence supporting their efficacy (Leong et al., 2022). Furthermore, three-quarters of iOS apps for anxiety and worry available to consumers are not even based on any established evidence-based treatments, such as cognitive-behavioral therapy.

It is premature to rely on apps for the treatment of mental health. But it is also premature to abandon this promising new tool for tackling the immense challenge of declining mental health. There are several simple steps we need to take to make apps an effective tool in the treatment of mental illness.

First, to avoid reinforcing a two-tier system of care, we need clear guidelines on when mental health apps should or should not be recommended. For example, apps could be recommended to patients who are waiting to see a mental health specialist but not to patients who cannot afford one (at least until all other options have been exhausted). Second, we need more research on how to promote the continued use of prescribed apps, such as ensuring that physicians schedule regular check-ups with patients to increase accountability.

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Finally, we need to ensure that consumers have the correct information on the efficacy of each app. Nutritional supplements sold in the United States are required to include a disclaimer that their claims for efficacy have not been evaluated by the Food and Drug Administration.

Apple and Google should adopt a similar approach for apps claiming to treat mental illnesses, such as “these claims have not been reviewed by the scientific community.” App stores should also refer consumers to existing online hubs, where they can find information on the scientific evidence supporting—or not supporting—the efficacy of a given app.

Mental illness is not the cause of gun violence, but gun violence is one of the myriads of factors that are contributing to our declining mental health. Mental health apps are not the solution but, combined with adequate support and accurate information, they can be one tool in tackling the immense challenge of our declining mental health.

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