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Categories Insights Tags Behavioral Health, COVID-19, Cybersecurity, Data Analysis, Healthcare, Information Technology, Mental Health, Mobile Applications, National Institute of Mental Health (NIMH), Substance Abuse and Mental Health Services Administration (SAMHSA), Telehealth

Mobile Mental Health Apps: Weighing the Pros and Cons

Mobile Mental Health Apps: Weighing the Pros and Cons

By: Randolph Edmead, MS and Laura LaRue Gertz, MSW, LCSW

As symptoms of stress, anxiety, and depression are increasing during the global COVID-19 pandemic, people may be exploring technology-based strategies to relieve symptoms and to supplement mental health care. Increasingly, telehealth is a service covered by insurance providers. In addition, many people are interested in using mobile apps to supplement their care, track and improve their symptoms, and take proactive steps to improve their mental health through strategies such as stress reduction, relaxation, and cognitive behavioral techniques. Yet individuals may also be wondering how to evaluate if a mobile app is useful, evidence-based, and will safeguard their privacy.

Technology-based strategies such as mobile apps for mental health have many potential advantages. Technology has enormous capacity to gather assessment and monitoring data that can provide valuable insights about symptoms, useful strategies and could lead to more effective treatment. Technology can help overcome access barriers for individuals with mobility issues, for individuals living in rural areas or areas with a shortage of providers, and for individuals who have been reluctant to seek conventional mental health services. And now, mobile access is even more important as individuals may be simultaneously coping with increased symptoms of stress, anxiety, and depression during the pandemic, while experiencing isolation and reduced access to their usual support systems due to physical distancing.

Although there are many potential advantages of mobile apps to supplement mental health care, there are still many barriers and risks, including lack of effectiveness data; challenges with reproducibility, implementation, and dissemination; concerns about the privacy and confidentiality of data and use or misuse of data; and challenges with integration of technology strategies and data into the treatment plan and the health care system. However, there are useful, accessible strategies that can help people assess the safety and usefulness of a mobile app.

The APA App Evaluation Model is an evaluation roadmap to guide informed decision-making in choosing mobile apps in clinical care. The guideline provides a series of questions, organized by levels, that help consumers and providers decide whether to use a mobile app (Torous et al., 2018). This model does not endorse specific apps, but rather promotes a systematic approach to evaluating apps.

The five levels of the APA App Evaluation Model are:

  1. Access and Background: Assesses background information needed prior to evaluation
  2. Privacy and Security: Considers many aspects of app security and privacy
  3. Clinical Foundation: Evaluates any evidence for potential benefits
  4. Usability: Evaluates how usable the app is for the consumer
  5. Data Integration towards Therapeutic Goal: Examines whether the app’s output can be used in a clinically meaningful way

The PsyberGuide, developed through Northwestern University’s Center for Behavioral Intervention Technologies with funding from the One Mind Institute, reviews and rates apps that claim to treat mental health conditions. The publicly available guide helps consumers make informed choices. PsyberGuide provides app ratings based on three metrics:

  1. Credibility: Evaluates the strength of the scientific research for the app, as well as the therapeutic interventions provided by the app
  2. User Experience: Uses the Mobile App Rating Scale (MARS) developed by Stoyanov et al. (2015) to assess the design and user interface
  3. Transparency: Evaluates the clarity of the app’s privacy policy regarding data storage and collection procedures of the app and associated servers

Technology will not replace the human connection that is a central part of the care of individuals experiencing stress, anxiety, and depression. But when technology-based strategies are thoughtfully developed, evaluated, and implemented, they have tremendous potential to augment and expand care, to enhance engagement and treatment, and to improve the quality of life for individuals living with mental health conditions.

Randolph Edmead, MS, Vice President of Federal Government Programs. Randolph Edmead has an extensive background managing large teams in the mental health treatment, substance abuse prevention and treatment, policy, and evaluation service areas. Mr. Edmead has over 18 years of experience developing, implementing, and managing the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Centers for Mental Health Services and Substance Abuse Treatment and Prevention programs; providing curricula and training to SAMHSA and health care providers and staff on leading practices, human resources, accreditation survey support, skills development, and cultural competency; and consulting with healthcare organizations and treatment facilities. Mr. Edmead holds a Master of Science Degree in Clinical Psychology.

Laura LaRue Gertz, MSW, LCSW, Public Health Analyst/Scientific Writer. Laura LaRue Gertz has over 30 years of experience in health and mental health, as a clinician, analyst, writer, researcher, and project manager. She developed literature reviews and reports on evidence-based treatments for individuals with serious mental illness for a federal contract with the SAMHSA Center for Mental Health Services (CMHS). She has also worked on contracts with the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and numerous other U.S Department of Health and Human Services (HHS) agencies. Ms. Gertz holds a Master of Social Work Degree and is a Licensed Clinical Social Worker.

The Bizzell Group (Bizzell) was founded by President & CEO Anton C. Bizzell, M.D., a leading behavioral health expert and former Medical Officer for the U.S. Department of Health and Human Services (HHS). Bizzell’s team of public health experts have created and led comprehensive behavioral health prevention and treatment initiatives and education and training programs. Bizzell’s recent work includes systematic, integrated approaches designed to effect lasting change in health and behavioral health care through work with the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Defense (DOD). Learn more about how Bizzell advances data-driven, research-informed, innovative solutions to solve complex-real-world challenges: https://thebizzellgroup.com/

References

Stoyanov, S. R., Hides, L., Kavanagh, D. J., Zelenko, O., Tjondronegoro, D., & Mani, M. (2015). Mobile app rating scale: A new tool for assessing the quality of health mobile apps. JMIR mHealth and uHealth, 3(1), e27.

Torous, J. B., Chan, S. R., Gipson, S. Y. M. T., Kim, J. W., Nguyen, T. Q., Luo, J., & Wang, P. (2018). A hierarchical framework for evaluation and informed decision making regarding smartphone apps for clinical care. Psychiatric Services, 69(5), 498-500.

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Categories BHARC, Mental Health, Substance Abuse and Mental Health Services Administration (SAMHSA), Substance Use Disorder Tags Behavioral Health, COVID-19, Mental Health, National Institute of Mental Health (NIMH), Special Populations, Thought Leadership

Supporting Teen Mental Health During a Pandemic

Supporting Teen Mental Health During a Pandemic

Written By: Todd W. Mandell, MD and Rhonda Waller, PhD

The global COVID-19 pandemic is casting new urgency on the topic of teen mental health. Adolescence is already a time of significant physical, mental, emotional, and social development. It is normal for teens to experience a wide range of emotions and unpredictable moods. The COVID-19 pandemic has added a new set of  challenges as teens navigate disruptions to their usual school, extracurricular, and social routines due to lockdowns, social distancing restrictions, and uncertainty about the future. According to a review of relevant research published in June 2020, many teens may experience isolation and loneliness which could lead to or exacerbate feelings of depression and anxiety. Currently, there is little data that examines the impact of pandemics such as COVID-19 on teens’ mental health, though some researchers are starting to explore this topic. Oxford University recently initiated a study that will track adolescents’ mental health to identify factors that hinder and promote resilience during the pandemic. In the meantime, we know that rates of teen depression and anxiety have risen during the past decade.

A 2019 study that examined National Survey on Drug Use and Health (NSDUH) data found that from 2005 to 2017, the percentage of adolescents (12 to 17 years old) experiencing at least one major depressive episode increased from 8.7 percent to 13.01 percent—a 52% increase. In 2018, the rate was 14.4 percent—roughly 3.5 million adolescents. The National Institute of Mental Health reports that nearly one-third (32 percent) of adolescents 13-18 years old experience an anxiety disorder. A 2018 study that examined data from the National Survey of Children’s Health (2003, 2007 and 2011-2012) found that anxiety similarly appears to be on the rise.

While there is no conclusive answer for why teen depression and anxiety are rising, some common themes in research include:

  • Increased awareness about mental health issues might increase disclosure of symptoms and identification of mental health disorders.
  • Continuous exposure to social media and news that may have an adverse impact on teen’s mental health.
  • Increased social and academic pressures and expectations for youth may contribute to depression and anxiety.

In addition, health inequities and social determinants of health such as socioeconomic status, education, social support networks, and access to health care can influence adolescent mental health.

The bottom line, however, is that mental health disorders are a real concern for teens—and the COVID-19 pandemic may exacerbate these issues for some youth. Left untreated, mental health disorders can have a lifelong impact on health. Parents, teachers, coaches, and others who interact with teens should stay alert for signs of anxiety and depression. Warning signs and symptoms may include:

  • Loss of interest in activities previously enjoyed
  • Avoiding school, activities, and social interactions with friends and family
  • Changes in grades
  • Trouble sleeping/concentrating
  • Engaging in self-harming or risky behaviors such as substance abuse
  • Chronic physical complaints
  • Sleeping too much or too little
  • Increased irritability or moodiness

The American Academy of Pediatrics’ parenting website offers  practical information from child health experts on how to support teens’ mental health  during the COVID-19 pandemic, including strategies for healthy routines, effective communication, safe virtual connections, family support, and physical and emotional health. However, parents who observe or are concerned about signs of depression or anxiety in their teen should discuss this with their pediatrician or a health care provider. The U.S. Department of Health and Human Services has also compiled a comprehensive list of Resources to Support Adolescent Mental Health. In addition, the National Institute of Mental Health recommends that teens save several emergency numbers in their cell phones to ensure immediate help for themselves or a friend in an emergency—including the non-emergency local police department number, the Crisis Text Line (741741) and the National Suicide Prevention Lifeline (1-800-273-TALK).

From a public health perspective, increased screening for depression and anxiety and access to health care could result in earlier detection and treatment, which is particularly important during the pandemic. Many experts, including the U.S. Prevention Screening Task Force (USPSTF) and the American Academy of Pediatrics, recommend annual screening of teens for depression. Most insurance companies are now covering telehealth visits at the same rate as in-person visits, which may make screening and services more accessible for teens needing treatment. With growing awareness of the effects of the pandemic on mental health, it is now even more important that teens experiencing depression and anxiety get timely screening and treatment to improve their outcomes.

Todd W. Mandell, MD, Senior Associate, Addiction Medicine. Todd Mandell is a board-certified Psychiatrist with added qualifications in Addiction Medicine, and more than 30 years of experience in the field of co-occurring psychiatric and substance use disorders with a focus on direct patient service, program development, and administration. (LinkedIn)

Rhonda Waller, PhD, Senior Associate, Maternal and Child Health. Rhonda Waller is a psychologist with more than 25 years of professional experience in public health, education, and human services with an emphasis on program development, leadership development, capacity building, and training and technical assistance. (LinkedIn)

The Bizzell Group (Bizzell) was founded by President & CEO Anton C. Bizzell, M.D., a leading behavioral health expert and former Medical Officer for the U.S. Department of Health and Human Services (HHS). Bizzell’s team of public health experts have created and led comprehensive behavioral health prevention and treatment initiatives and education and training programs. Bizzell’s recent work includes systematic, integrated approaches designed to effect lasting change in health and behavioral health care through work with the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Defense (DOD). Learn more about how Bizzell advances data-driven, research-informed, innovative solutions to solve complex-real-world challenges: https://thebizzellgroup.com/

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