JMIR Publications

ABSTRACT

Background:

In the last decade, there has been a proliferation of mobile apps claiming to support the needs of people living with depression. However, it is unclear what functionality commonly used apps for depression actually provide and for whom they are intended.

Objective:

This paper aims to explore the key features of top-rated apps for depression, including descriptive characteristics, functionality, and ethical concerns for suggesting better-informed design of apps for depression.

Methods:

We reviewed top-rated iOS and Android mobile apps for depression retrieved from app marketplaces in spring 2019. We applied a systematic analysis to review the selected apps, for which data was gathered from the two marketplaces, and through direct use of the apps. We report an in-depth analysis of apps functionality such as screening, tracking, and provision of interventions. Of the initially identified 482 apps, 29 apps met the criteria for inclusion in this review.

Results:

The analysis revealed that depression apps fall short of providing evidence-based interventions (59%, 17/29) and of engaging clinical input into their design (41%, 12/29). In addition, 86% of apps (25/29) present a do not provide a privacy policy which is consistent with their rating, which is alarming as 97% are also rated as suitable for children. Potential for harm was also found, due to the overtly negative content provided by some of the apps. Findings also show that most apps provide multiple functions. The most commonly implemented functions include provision of interventions (83%, 24/29) either as digitalized therapeutic intervention or as support for mood expression, tracking (62%, 9/29) of moods, thoughts or behaviors for supporting the intervention, and screening (28%) to inform the decision to use the app and its intervention.

Conclusions:

We found risks of current top-ranked depression apps given that given the marketplaces’ unrestricted access to children for using most of these apps, which in turn contradicts the age-rating information in the app descriptions, which is further highlighted by the prevalence of apps’ sharing sensitive data with third parties. Yet, none of such claims is available on marketplace. We also found our reviewed 29 top-rated apps seldom leverage digital affordances for mitigating harm, personalizing the interventions, and tracking multimodal content. We have seen potential risks in the app provided functionalities, including inadequate screening by utilizing non-validated screening tools, tracking negative moods or thinking patterns or providing negative content for emotional expression that generated by others without sufficient safeguarding prevention. Current depression apps could also improve by providing personalized intervention that tailored with users’ input.