Mobile mental health apps are flooding the marketplace:

Who is using them and to what effect?

Diego Castaneda DrPH MPH (UCSF) Joaquin Anguera PhD (UCSF)

Patricia Arean PhD (UW)

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Disclosures •  Research funded in part by NIH T32 mechanism •  No financial disclosures

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Today

• Research Context •  (Research Questions)

• Methods • Findings • Summary •  Implications

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What was the number of mobile mental health apps on the market in 2014?

A. 5,000-10,000 B. 20,000-30,000 C. 30,000-40,000 D. What’s a mobile mental health app?

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ANSWER

A. 5,000-10,000 D. What’s a mobile mental health app? Patient Adoption of mHealth, Institute for Health Informatics, 2015

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Research Context

Smith, Aaron, “US Smartphone Use in 2015”, Pew Internet Research

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Research Context •  Last Year •  100% Increase Health Apps •  ~165,000 Health Apps •  ~5,000 Mental Health Apps

•  1054 depression specific apps (Shen, 2015)

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dieg

o.ca

stan

eda@

ucsf

.edu

/@

drM

hlth

Research Questions

•  What is a mental health app (real world def)? •  What mental health apps are actually being used? •  Who is using them?

•  Are they engaged/satisfied with the app ? •  How long are the apps being used for (Longevity)? •  Usability

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Methods •  Cross sectional •  75 item online survey (5-10 min) (REDCAP) •  Social Networks, Craigslist, Flyers •  Lottery incentive ($10 Gift Card)

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Methods •  Cross sectional •  75 item online survey (5-10 min) (REDCAP) •  Social Networks, Craigslist, Flyers •  Lottery incentive ($10 Gift Card)

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Methods

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Total&#&of&Survey&Respondents&as&of&

02/01/15&&&&

N=2019

Data&Cleaning&(Eliminating*Duplicates,*Non4Completers)&Total&Sample&&N=&1404

Answered&“Yes,*I*have*a*Health*App*Downloaded*

On*My*Device”!

N=1863

Recruitment&via&online&and&traditional&methods&

begins&&

3/4/14

Findings-Demographics N=1404 •  Age M=35.2 (S.D. 11.7; Range 18-78)

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Characteristic % of Sample Female 70%

iPhone Device 50%

At least 4 years of college 49%

Download Apps (1 per day) 39%

51%

19%

17%

7% 5%

1% HAPPI Study( N=1404)

Non-Hispanic White

African-American/Black*

Hispanic/Latino

Asian

Mixed

Native American/Alaska/Pacific Islander

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Ethnic/Race Representation

56%

12%

16%

5%

10%

1% US Census 2013

Non-Hispanic White

African-American/Black*

Hispanic/Latino

Asian

Mixed

Native American/Alaska/Pacific Islander

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Ethnic/Race Representation

Income Representation

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61% 16%

23%

What is your yearly household income level? HAPPI Study (N=1404)

<$55,000

$55,000-75,000

>$75,000

Domestic Representation

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What kind of health apps do you have on your device?

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Health App Category! % of Sample on Device!Physical Health! 76%!

Diet Management!!

61%!

Thinking/Cognitive Skills!!

58%!

Mental Health! 34%!!

Medication Adherence! 24%!!

Chronic Disease! 18%!!

What kind of health apps do you have on your device?

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Health App Category! % of Sample on Device!

Mental Health! 34% (483)!!

Who is using mental health apps (significantly)?

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Characteristic! % of Sample! Mental Health App on Device!

African-American*! 12%! 24%!

At least one Chronic Illness (12 conditions)**!

48%! 60%!

Currently receiving mental health care**!

24%! 34%!

App Downloader (At least once per day)**!

39%! 44%!

Chi-Square test of Significance *p<.05, **p<.001

Top Ten Mental Health Apps!

1. WebMD!2. Head Space!3. Period Tracker!4. Self-Anxiety Meditation !5. T2MoodTracker!6. Lumosity!7. Stress Check!8. MyFitness Pal!9. Binaural Beats!10. Relax Lite!

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Top Ten Mental Health Apps!

1. WebMD!2. Head Space!3. Period Tracker!4. Self-Anxiety Meditation !5. T2MoodTracker!6. Lumosity!7. Stress Check!8. MyFitness Pal!9. Binaural Beats!10. Relax Lite!

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16.1%

27.3%

56.6%

0

10

20

30

40

50

60

less than two weeks 2-4 weeks Over 4 weeks

For how long did you use the mental health app you said you used? (% of mental health app users)

N=483

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Usability Index •  5 statements asking about overall usability of app •  Likert Scale- Strongly Disagree-Strongly Agree (0-10)

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Statement! Score (SD)!

Easy to Learn to Use! 7.65 (2.6)!

Enter in Data Easily! 7.43 (2.6)!

Trusted App Confidentiality! 7.16 (2.7)!

Did What it was Supposed ! 7.39 (2.4)!

Functional on Phone! 7.40 (2.4)!

Open Ended Comments

What they Liked! What they Would Change !Ease of use!Tracking (Track) Data!Access to Data!Daily Tracking!!!

Nothing!!Integrated with phone!Costs (too expensive)!Reminders!!!

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Chronic Illness! Under Care of Mental Health Professional!

1. WebMD! WebMD!2. Head Space! Self-Anxiety Meditation !3. Self-Anxiety Meditation ! Head Space!4. S-Health! T2 Mood Tracker!5. GoogleFit! Binaural Beats!6. MyFitness Pal! Calm!7. Period Tracker! Depression!8. Relax Lite ! Lumosity!9. T2 Mood Tracker! MoodScope!10. Binaural Beats! Period Tracker!

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Chronic Illness! Under Care of Mental Health Professional!

1. WebMD! WebMD!2. Head Space! Self-Anxiety Meditation !3. Self-Anxiety Meditation ! Head Space!4. S-Health! T2 Mood Tracker!5. GoogleFit! Binaural Beats!6. MyFitness Pal! Calm!7. Period Tracker! Depression!8. Relax Lite ! Lumosity!9. T2 Mood Tracker! MoodScope!10. Binaural Beats! Period Tracker!

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Summary •  Representative Race/Income •  Minority use similar

•  Unconventional Mental Health Definitions •  Specific Populations •  Engagement (Longevity) and User Satisfaction

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Implications for Clinicians •  Patient/client interest (augment treatments)? •  Special population? •  Chronic illness •  Smartphone + data plan (tech-phillic)

•  Take time to identify several apps to recommend •  Delegate an app search for 1-2 top apps

•  Users are looking for •  Ease of Use •  Integration

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Implications Greater Context

•  Precision Medicine Initiative •  Active Partners

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PMI Working Group, 9/17/2015 http://www.nih.gov/precisionmedicine/09172015-pmi-working-group-report.pdf

“The Future is Already Here..It’s just not very well distributed.”

-William Gibson

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Acknowledgements •  Grace Niu PhD •  Rebecca Willemse BS •  Katrina Roundfield PhD •  Pat Arean PhD •  Joaquin Anguera PhD •  Amy Byers PhD •  Adrian Aguilera PhD •  Cami Rolle BS •  Josh Jordan MS •  Claudine Catledge MS •  Rachel Lewin RN

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