mHealth apps for depression: overcoming the challenges

(This is part 1 of a 3-part series on mHealth apps. Parts 2 and 3 will be released shortly—Editor’s note.)

In the United States, an estimated 21% of adults (52.9 million) have suffered from a mental health disorder in a given year.1 The response to behavioral health needs in American communities is inadequate, which has created a gap between the need for treatment and the provision of care: of the 52.9 million adults with a behavioral health disorder, only about 16.9% (41.4 million people) received hospitalization or outpatient behavioral health services in the year prior to the 2020 study.1

Health care access

For decades, access to behavioral health care providers in the United States has been a concern due to difficulty recruiting and retaining providers and an aging workforce.2 Other barriers to accessing mental health care include cultural factors, stigma, financial/insurance barriers, transportation, childcare, and fear or hesitation due to previous negative experiences .

Access to care has been further negatively impacted by the COVID-19 pandemic, a time when mental health issues have increased and worsened nationwide.3 Although service delivery methods such as telehealth have expanded significantly amid the COVID-19 pandemic, the increase in availability has not been sufficient to meet patient care needs, and the access to mental health care services continued to decline.3

Depression and suicide

Major depressive disorder is one of the most common mental disorders in the United States and it affects individuals throughout their lives. Based on data obtained from the 2020 National Survey of Drug Use and Health (NSDUH), approximately 21 million adults have experienced at least 1 major depressive episode in their lifetime.4 According to the survey results, 14.8 million adults have experienced 1 major depressive episode resulting in significant and severe functional impairment in the past year.4 The prevalence among adolescents (aged 12 to 17) is also of concern. An estimated 17% of adolescents have experienced at least 1 major depressive episode in their lifetime, and according to 2020 data, approximately 12% of adolescents in the United States had a severe depressive episode in the previous year .4

Treatment in adolescent and adult populations is comparatively much lower in prevalence, relative to the number of individuals suffering. It was estimated that among adults with major depression, 66% received treatment in the previous year based on data from the 2020 survey of the adolescent population, only 41.6% received a treatment.4

Linked to many disorders, including major depression, suicide is a devastating consequence of several mental illnesses and distress. Prevalence estimates vary, but nearly one million people worldwide die of suicide each year, and an estimated 16,000,000 attempt suicides.5 These numbers are likely underreported and the true prevalence is much, much higher. About 40% of suicidal people do not have access to medical care or do not seek it.5

Along with this crisis in mental health care, there is currently a rapid expansion of technology across all sectors. One such development is mHealth, which captures the use of mobile phones and other portable devices with functions to manage one’s health, most often using an app.6 The availability and presence of these apps continues to grow, and many of them target a specific disease or condition, or a particular health behavior to provide a framework for monitoring and managing that condition.6

This 3-part series will further assess the mHealth apps available to help with depression. The history of these applications, the use of the applications, the challenges and barriers identified, as well as a global synthesis of best practices based on the best data available at present will be discussed.

Mrs Robinson is a Psychiatric and Mental Health Nurse Practitioner in the Seacoast, New Hampshire area, and Clinical Assistant Professor and Program Director of the Post-Masters Psychiatric and Mental Health Nurse Practitioner Certificate Program, Department of Nursing, University of New Hampshire, Durham. Dr Kalmerten is an Associate Clinical Professor and Director of the Direct Entry Master of Nursing, Evidence-Based Nursing, and Clinical Nurse Leader programs at the University of New Hampshire, Durham. His research interests include the use of health information technologies such as mHealth to support health equity initiatives.

The references

1. Center for Behavioral Health Statistics and Quality – Addiction and Mental Health Services Administration. Highlights from the 2020 National Drug Use and Health Survey. September 2020. Accessed March 8, 2022. https://www.samhsa.gov/data/sites/default/files/2021-10/2020_NSDUH_Highlights.pdf

2. Bishop TF, Seirup JK, Pincus HA, Ross JS. The population of practicing psychiatrists in the United States declined between 2003 and 2013, which may help explain low access to mental health care. Health Affairs (Milwood). 2016;35(7):1271-1277.

3. CMS data shows vulnerable Americans are foregoing mental health care during the COVID-19 pandemic. Medicare and Medicaid Service Centers. May 14, 2021. Accessed February 21, 2022. https://www.cms.gov/newsroom/press-releases/cms-data-shows-vulnerable-americans-forgoing-mental-health-care-during-covid-19 – pandemic

4. National Institute of Mental Health. Major depression. NIMH Mental Health Information Statistics. January 2022. Accessed February 21, 2022. https://www.nimh.nih.gov/health/statistics/major-depression

5. Martinengo L, van Galen L, Lum E, et al. Assessing and managing the suicide risk of suicide prevention and depression apps: a systematic evaluation of adherence to clinical guidelines. BMC Med. 2019;17(1):231-231.

6. McGonigle D, Mastrian K. Nursing Informatics and the Knowledge Base (4th ed.). Jones & Bartlett Learning; 2017.

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