Researchers find lack of standardized measures to evaluate mental health apps

The team's recently published study also found that the bulk of these apps were focused on meditation, mindfulness and relaxation.
By Nazila Hafezi
03:11 pm

A new meta data study published last week in npj Digital Medicine found an overall lack of standardized measures for the quality and effectiveness of mental and behavioral health apps. In the study, researchers suggested the need for up-to-date app guidance for consumers and clinicians alike.

“Our results suggest that there is a growing need for: standardized behavioral health app quality and effectiveness measures, up-to-date behavioral health app guidance for clinicians and consumers, and evidence-based apps that incorporate revealed consumer preferences,” researchers wrote. 

The study also found that the most downloaded apps related to mental and behavioral health are the ones that focus on relaxation, mindfulness and meditation skills.


In the analysis, researchers found that there was no one single framework used to evaluate the most frequently downloaded apps. Among the leaders was The Organization for the Review Care of Health Applications, which reviewed 22 in total. The other two evaluation sites that came to the surface were PsyberGuide, with 19, and MindTools, which evaluated 14. 

Among all the apps included in this study, 19 of the top 25 apps featured meditation, mindfulness, and relaxation skills. These categories accounted for 76% of the entire study set. The most downloaded apps were Peak-Brain Training and Lumosity, both cognitive training apps. Four of the top 25 apps (16%) offered mood or anxiety self-monitoring, while three of the top 25 (12%) offered peer support. In addition, one offered virtual psychotherapy (Talkspace), one featured cognitive behavioral therapy (Happify), one offered support for reducing self-harm behaviors (Calm Harm) and one was a health coach and behavior tracker (Fabulous: Motivate Me).


In order to identify the most downloaded apps and to determine the ratings and rankings, the researchers zeroed in on 441 unique behavioral health apps in their final sample. Apps that were duplicates, discontinued or only available through web browsers were eliminated. The apps with less than 1,000 global downloads were also excluded. Additionally, apps in Apple Store and Google Play that focused on sleep, white noise, nature sounds or general wellbeing were also excluded.

To evaluate these most downloaded and installed apps, the researchers considered public ratings as well as the online rating frameworks with expert reviews. They accounted for wide variability in ratings by incorporating three separate evaluation frameworks.


The mental and behavioral health app store is flooded with a plethora of new platforms for users to choice from. But researchers and clinicians have been increasingly vocal about the need for higher standards and validation. 

“A fun fact is that everyday at least 200 apps get added on the app store. Just in the mental health space there are 1,500 apps,” Dr. Ramya Palacholla, research scientist at Partners HealthCare Pivot Labs, said at an event in April. “We are so passionate about validating solutions because when there are so many different apps —1,500 different apps that claim to do the same thing — then what separates me from the others?"

However, this is hardly the first study to find gaps in validation. In the spring a study was published in Nature Digital Medicine that found a majority of mental apps studied did not provide evidence or peer-reviewed studies to back up their product. In fact, in that study only two out of the 73 apps studied provided evidence from a study using the app.


“Although the behavioral health app market has grown rapidly in recent years, it has been minimally evaluated or regulated and little is known about ‘real world’ usage patterns,” the researchers wrote. “Finally, there is a clear gap between behavioral health research and consumers’ revealed preferences. Successful promotions of evidence-based apps will likely require ongoing, meaningful collaborations between clinicians, thought leaders and digital user experience professionals.”


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