JMIR Publications

ABSTRACT

Background:

Many people use apps to help understand and manage their depression symptoms. App-administered questionnaires for the symptoms of depression such as the Patient Health Questionnaire 9 are easy to score and implement in an app, but may not be accompanied by important resources and access to support.

Objective:

Our objective was to understand the risks associated with using an app to self-diagnose depression and to investigate other app features that may mitigate these risks.

Methods:

In this observational study, we identified six apps in the Google Play app store that provided a depression assessment as a feature and analyzed qualitatively user comments in the reviews. We separated apps based on those having only a depression assessment vs. those that offered additional supportive features. Three thematic coders used a tagging scheme to identify comments indicating the helpfulness of the app, the presence of suicidal ideation, and how and why the apps were used.

Results:

Of apps that provide only a depression assessment, 9.4% of user comments indicated suicidal ideation or self-harm, representing a 4-fold increase over apps that provided other features in addition to a self-assessment. Users of a multi-featured app were over three times as likely (59% vs. 17%) to indicate the app’s helpfulness to them and frequently mentioned mood tracking, journaling and informational resources over the depression assessment.

Conclusions:

Apps that diagnose depression by self-assessment without context or other supportive features may increase user distress, and ultimately do more harm than good. Depression self-assessments in apps should be implemented with caution and should be accompanied by evidence-based capabilities that establish proper context, increase self-empowerment, and encourage users to seek outside help.