Do consumer mental health apps work for depression, stress, and anxiety?
Do they really make you 28% less sad? Calmer?
Back in May 2020, during the peak of Covid-19, I was reading pretty much every bit of clinical research published on the disease. Each day I would make the rounds through Nature, the Journal of the American Medical Association (JAMA), the New England Journal of Medicine, Health Affairs, and quite a few more.
What became increasingly clear is that the ramifications from Covid-19 will far exceed the lives lost directly from the disease. While there are many effects, at the top of my mind was the long-term impacts on mental health due to unemployment, fear of infection, social isolation, and uncertainty. These are all well-established risk factors for depression, anxiety, and stress.
Mental illnesses like depression, anxiety, and stress, generally, are extremely impactful on the economy, on child wellbeing, on rates of suicide, on incidence and management of physical chronic illness (e.g., diabetes), and on social service utilization. Rates of depression and anxiety have been increasing in the 30 years prior to the pandemic, and thus, Covid-19 has exacerbated an existing epidemic.
Ever curious, I began exploring the ways in which digital health technology could help during a time where face-to-face mental health services are unsafe, or as usual, out of reach for most people due to cost and a limited workforce. By chance, it did not take me long to find a potential solution within my area of expertise.
Mental Health App Advertisements
As Tiktok and Instagram’s reels began to captivate audiences stuck at home, so too did advertisements from companies seizing their time to shine during Covid-19. The growth in eyeballs on phones was ripe for an advertising blitz.
I don’t know about you, but the most frequent advertisements on my screens were from mobile applications that claim to make me happier, or less sad. Or apps that claim to help people struggling with depression and anxiety.
Just like the one to the left from Headspace, the header image from Sanvello, and the advertisement from Calm, below, these advertisements inundated the population during the pandemic.
During a time of great strife, depression, and anxiety, these applications were aggressively spending their combined billion-dollar advertising budgets.
For app companies, more downloads equal more success if their application provides value. Thus, Covid-19 is a time for consumer-focused mental health app companies to acquire new users in search of relief from their mental struggles.
Mental health apps, as opposed to traditional treatments like therapy or medication, are much cheaper and more accessible than current standards of care. They are also able to work in private which removes stigma-related barriers for people who are unlikely to seek help from formal mental healthcare providers. But, do they work, or are they just taking advantage of a distressed population?
Our Research: Do consumer-focused mental health apps work?
TL;DR: Yes they work, but it’s more complicated than that.
To answer this question, I reached out to a research mentor of mine, Dr. Kostadin Kushlev, Professor of Psychology at Georgetown University, and his Lab, Happy Tech Labs, to look into this issue.
We performed a PubMed search for randomized clinical trials that looked at these applications including Headspace, Calm, and Sanvello. In the end, we found about 19 studies that met our criteria and we read them.
We found that the overwhelming majority of apps with studies are effective at reducing symptoms of depression, anxiety, and stress as measured by clinical tools like the PHQ-9, GAD-7, and other validated measures. The results are positive, but there is a need for a certain degree of caution.
The apps were studied in populations that were majority younger, white, and female. This means that the positive effects of app usage may not be generalizable to older, non-white, and male users, thus the marketing claims may overstate the effectiveness in these populations.
Similarly, many of the studies were conducted with small sample sizes when compared to the size of other medical device and pharmaceutical studies required for market approval. Thus, the conclusions to be drawn from the research are not as strong as other treatments that make claims of improving health.
The studies also largely compared the use of the mental health app versus nothing, which does not allow us to understand how effective the apps are compared to talk therapy or medication treatment for mental health conditions.
At the end of the day, many of these applications, especially the most popular ones, have some level of evidence for their claims and effectiveness. It is important, however, for them to be taken with a lesser degree of certainty than conventional treatments for depression, anxiety, and stress.
We wrote a paper communicating the full details of our research that has been accepted at the American Psychological Association’s Practice Innovations Journal. To learn more, you can read the pre-print of the article here.
