Hero

Videos

Slideshows

Articles

Podcasts

Poll

In the previous 2 parts of this series on mHealth apps, we examined the barriers in access to care and what apps are available to assist in treatment of depression and 

. In this installment, we will cover the potential challenges and unintended consequences of utilizing this technology.

Unintended Consequences: Inaccurate Information and Self-Diagnosis

Apps of all kinds in the Android Google Play and Apple Store calculate ratings based on independent user feedback. User feedback is subjective and does not involve a review process or other rigor. An app may have a 5-star rating based on user feedback; however, this rating does not require any third-party verification of the quality, security, efficacy, or validity of the app.

 Given the lack of consistent oversight or regulation, there is no penalty for mHealth apps providing non-evidence-based and/or inaccurate information.

 A lack of reliable oversight means there is no verification of information quality. A study by Stawarz et al

 found that many of the apps with high user ratings had an inconsistent evidence base, demonstrating that priorities to the user that would translate to a higher app rating do not indicate solid validity and sound evidence.

Another potential challenge specifically with mHealth apps for 

 is that of patient self-diagnosis. Patients may self-identify that they are depressed, but in the absence of a full psychiatric evaluation by a trained mental health professional, they could very well meet criteria for a different condition that would require specific intervention and treatment tailored to that disorder. This can lead to negative treatment outcomes and misdirection of efforts supporting treatment of a condition that may not apply to a given consumer.

The clinical utility and efficacy of the data provided within these apps is an important consideration. Currently there is no formal review process for mHealth apps, and that has been an 

. The existing medical research on apps is not very robust, and it is quite far behind relative to how widely mHealth apps are utilized.

 With the existing research being so limited, another factor to consider is that the studies that exist often include very small sample sizes.

 Research conducted on these apps also tends to be short in duration, without longer-range follow-up to evaluate outcomes.

Security of patient data is an important consideration within the context of using mHealth apps for depression. Protected Health Information (PHI) breaches are reported on the news nationally and worldwide every day. All breaches, whether large or small, have the potential for significant impact for individuals, communities, and larger populations. An in-depth study of some mHealth apps found that there was transmission of medical data via unsecured processes, and that privacy policies were lacking relative to the kind of information being obtained from individuals.

The aim of a cross-sectional study by Tangari et al was to evaluate the collection of user data within mHealth apps, and to review the privacy practices of apps and potential risks to customer information.

 It was noted that amongst the top mHealth apps, privacy disclosures to the app user was consistently inadequate. The evaluation of privacy and security of these apps is complex and multifactorial. See the 

 for an overview of the components addressed in the security review of apps.

In the study by Tangari et al, 665 different third parties were identified as being able to access patient information contained within the apps.

 It was noted that a list of some specific third parties had accessed the most data—more when compared with the rest of the third parties obtaining this information. The vast majority of the apps reviewed were able to obtain and share personal information of the apps’ users. The review found that many privacy policy links did not work or were not reliable.

There is significant concern related to patient safety, especially when one’s symptoms are severe and amidst the presence of suicidal thoughts or actions. In the Martinengo et al

 review of suicide prevention apps, the findings demonstrated that none of the apps assessed patient risk or protective factors, or triggers; only one of the evaluated apps inquired about prior history of 

. Individuals with a history of previous self-harm are at a substantially increased risk of suicide when compared with the general population.

 are important, complex processes conducted by highly trained, skilled clinicians in psychiatry and related fields. Evaluating patient risk is complex, even for the most skilled and experienced provider with years of training and expertise in the field. There are numerous risk factors for suicide, and yet the reality of the outcomes of suicide is far more nuanced and complex beyond a list of these potential contributing factors. Significant risk factors for suicide include but are not limited to: prior history of self-harm or suicide attempt,

 family history, psychiatric illness, recent personal loss, and 

, along with other demographic and social factors.

Safety planning is an important tool used by mental health clinicians to work with patients who are dealing with suicidality when these patients are not at an acute phase of requiring inpatient hospitalization. In the review of suicide prevention apps, only 10% the depression apps and only 52% of suicide prevention apps that were reviewed utilized templates to support development of a safety plan for the app’s users.

 Only 4 of the apps reviewed allowed users to share the safety plan with a trusted member of their support system.

Of the 46 suicide prevention apps, only 20% provided users with emergency access to trained mental health care professionals via the app.

 Of the depression management apps reviewed, 24% provided app users with direct access to a crisis line through the app. However, when the crisis contact information was verified during the review process, 9% of the crisis contact information in these apps was incorrect.

Some of the suicide prevention apps utilize chatbots.

 work by identifying key words and phrases to trigger subsequent responses based on various algorithms. In the apps utilizing chatbots, a very concerning statement from a patient stating that they are “sad” and “hopeless” did not prompt a follow-up question that would be triggered by a “worrying statement,” when, in fact, the aforementioned statement is quite concerning and would warrant further evaluation and clinical intervention.

There are unintended consequences of mHealth apps for depression as they exist currently. A lack of external validity measures and exclusive use of user review ratings does not provide patients with information regarding the evidence base or efficacy of content provided within the app. As health care providers, our role is to translate evidence base into terms that patients can understand; the provider may be tasked with trying to do this, but given the aforementioned concerns, providers may be reluctant to do so. A potential opportunity to improve upon this would be facilitating collaboration and partnerships between academic and medical institutions for app development. With the knowledge base and the intimate awareness of security and privacy, these collaborations would be able to facilitate creation of an app that is evidence-based, externally validated, and suitable for use as a tool in collaboration with the 

Privacy of collected data is an additional concern that is not unique to mHealth apps. There is a noted lack of transparency on the part of apps to provide a clear explanation to app users regarding how their data is collected and potentially shared.

 Ideally, the accountability for these policies should be placed on the individual app companies, with some standards and regulation by the app stores that are publishing the tools.

Best Practices to Support Care Using Patient-Facing Technology

To continue to facilitate mHealth apps that are effective, safe, and useful for patients, there are actions that can be taken to strengthen the aforementioned factors and to address some of the concerns outlined previously within this series.

A standardized, external review tool to validate apps would be a helpful framework to provide some added accountability and verification of app content. A tool discussed in one of the reviewed papers is the 

 (MARS), which seeks to confirm interrater reliability and consistency using 2 expert raters to evaluate based on a 23-item scale.

 This scale, like others that have been explored, lacks clear validity and has not been widely utilized to further evaluate its validity and efficacy. Including quality measures in App Store ratings or reviews that have been conducted by field experts, in addition to the existing system of exclusively customer review ratings, would be another way to potentially increase the accountability required for mHealth apps.

As the sheer number of mHealth apps being used to treat depression is expansive and potentially overwhelming to health care providers, further research and review may help guide the 

 and support those who choose to recommend or discuss app use with tehir patients as an adjunct to professional care. Using an evaluative tool such as MARs would provide health care providers with a more efficient way to be able to further encourage or perhaps redirect patients from the use of certain apps to support their mental health.

Ensuring that patients are informed consumers and aware of how their information is being used is imperative. App developers should be transparent in the writing and sharing of privacy policies, and further oversight regarding third-party sharing should be prioritized on a higher national level to remove some of the onus from the individual and to ensure that developers and corporations are accountable.

A best practice would be for supportive app tools to be encouraged when clinically appropriate, with clear guidelines that they are not a replacement or substitution for clinical care. This would be something for the patient and provider to approach as part of collaborative, patient-centered care. There are disclaimers that app users need to acknowledge in order to use these apps, but there should be ongoing check points and redirection to a trained mental health care professional beyond just an initial acknowledgment when first using the app.

With the rapid influx of new technologies, there are many benefits and unintended consequences in the use of mHealth apps in mental health care, there is also a potential role and benefit for well-done mHealth apps to address mental health, and specifically depression and suicidality. However, as a standalone intervention, mHealth tools are not reliable for managing these complex and potentially life-threatening conditions.

 The treatment of depressed and suicidal patients requires a collaborative, team-based approach including the patient, family, friends and a skilled mental healthcare provider in the utilization of different treatment modalities.

There are aspects of existing mHealth apps that may be ineffective, but more importantly there are components that can be potentially harmful. For example, almost 10% of the crisis hotline phone numbers in the apps reviewed by Martinengo et al

 were incorrect. Without a more comprehensive review process or verification mechanism, that kind of error can have potentially serious consequences. Additionally, this lack of oversight or guidance places the onus on individual health care providers and patients/app users. This may further impede the ability to make progress in this modality. Health care providers may be fearful of 

, which may steer providers away from considering the incorporation of app use into their practice.

There are significant and seemingly endless opportunities for how these apps can potentially be utilized to benefit patients and providers, provided this occurs in a safe and evidence-based manner with consideration for privacy of patient information. Ongoing research is needed, along with policy to encourage and promote safe app development and use, and clear, realistic outcomes associated with the app.

is a psychiatric-mental health nurse practitioner in the Seacoast, New Hampshire area, and a clinical assistant professor and program director of the Post-Masters Psychiatric-Mental Health Nurse Practitioner Certificate Program, Department of Nursing, University of New Hampshire, Durham.

 is a Clinical Associate Professor and Director for the Direct Entry Master’s in Nursing, Evidence-Based Nursing and Clinical Nurse Leader programs at the University of New Hampshire, Durham. Her research interests include the use of Health Information Technology such as mHealth in support of health equity initiatives.

Interrater reliability of mHealth app rating measures: analysis of top depression and smoking cessation apps.

2. Martinengo L, Van Galen L, Lum E, et al. 

Suicide prevention and depression apps’ suicide risk assessment and management: a systematic assessment of adherence to clinical guidelines.

3. Stawarz K, Preist C, Tallon D, et al. 

User experience of cognitive behavioral therapy apps for depression: an analysis of app functionality and user reviews.

4. Munoz Ramos R, Ferrer Cheng PG, Jonas SM. Validation of an mHealth app for depression screening and monitoring (psychologist in a pocket): correlational study and concurrence analysis.

Ehealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis.

6. Tangari G, Ikram M, Ijaz K, et al. 

Mobile health and privacy: cross sectional study. 

Predicting suicide following self-harm: systematic review of risk factors and risk scales. 

8. Stern TA, Rosenbaum JF, Fava M, et al. 

Massachusetts General Hospital Comprehensive Clinical Psychiatry

Learn what potential challenges come with mHealth apps and how to overcome them to best fit patient needs. 

Challenges with mHealth Apps for Depression and Suicide Prevention 

In a 2016 review, there were more than 165,000 mHealth apps available to patients on the market.

 A review published just 3 years later noted the availability of 259,000 mHealth apps worldwide.

 Of the rapidly evolving app market, mHealth apps are among the fastest-growing groups, with an annual estimated growth rate of 32.5%.

 mHealth apps focused on mental health are one of the most prominent categories.

 These apps can be obtained for numerous device types and through the Apple iTunes/App Store or Android Google Play App Store.

There is currently no standardized review process to evaluate mHealth apps for quality or accuracy of information.

 There are also no centralized repositories for app reviews and ratings, and no type of standard app rating process or procedure.

 Current rating systems are based solely on app user ratings, which often are focused on design, interface, and usability. The evidence base of the information contained in these apps is not externally reviewed or verified as part of a requirement of implementing an app and getting it on the market.

 Relatively few apps have been through the rigor of a clinical trial.

The United States Food and Drug Administration (FDA) does not offer guidance for mHealth apps, and the FDA has indicated no plans to begin to regulate apps, especially as the FDA has deemed many to be 

 Between the FDA and European regulatory bodies, only 8 mental health apps have been approved.

 The FDA provides minimal guidance related to the post-market management of medical devices, which include mHealth apps, to consider risk management and utilize necessary steps to secure patient information.

 However, there is a lack of ongoing guidance and regulation in this area for app developers to utilize. There is also a lack of clear, consistent privacy policies and transparency with app users about how their information may be used and transmitted to third parties.

 continues to increase. There have been several approaches and foci for these apps. Some of the existing mHealth apps on the market related to depression include a focus on preventing depression, screening for depression, and supporting treatments with depression; there is even a 

 Currently there is no guidance, position statement, or even clear guidelines related to mHealth apps addressing psychiatric conditions from major national professional organizations such as the American Psychological Association and the American Psychiatric Association.

The mHealth apps are not consistently included in the same categories of the app store; some are listed in “Health and Fitness” categories, whereas others are indicated to be within the “Medical” category.

 Studies reviewing health app quality have found that apps are not consistently utilizing evidence-based clinical information or verified decision support tools.

 The inconsistent categorization of these apps further demonstrates the impact of the business and marketing perspectives on this area. The app development world is often approached from a strategic standpoint of business and marketing, which can pose a challenge when apps are potentially looking to address serious medical issues.

 address those currently diagnosed with the medical condition, and a randomized controlled trial by Deady et al

 evaluated the efficacy of a new app to reduce and even prevent depressive symptoms within a working population in Australia. The results were statistically significant in the app’s efficacy during the period of the trial, which included follow-up until 12 months post-baseline assessment.

The reported focus and aims of some of the mHealth apps addressing depression are either to complement traditional psychotherapy or to replace traditional therapy.

 A review and analysis conducted by Stawarz et al

 specifically reviewed apps that indicate a basis on 

 (CBT), which is an evidence-based treatment for depression along with other mental health conditions. However, within the review, there was significant variability in the context and intentions of the apps, along with inconsistent utilization of the evidence-based elements of CBT. As noted by other app reviews, there is an identified glaring gap regarding how

 and other technologies can engage with patients who may be experiencing complex conditions.

Given the numerous barriers to accessing care, especially timely care, there has been some research focused on the potential for apps to be utilized as a 

 A team of researchers conducted a comprehensive assessment of available suicide prevention apps on Google Play and the Apple App Store, and evaluated the suicide prevention content contained within depression management apps.

 Martinengo et al completed a systemic review utilizing descriptive statistics, evaluating the function and reliability of the apps.

 The initial pool of apps screened for use was over 2500 prior to deduplication; after 2 rounds of screening and subsequent systematic assessment, 69 apps were selected to be analyzed in the study.

Within these apps, some used validated, evidence-based tools such as the Patient Health Questionnaire-9 (PHQ-9), and some utilized chatbots to analyze suicidal behavior.

 Some of the apps that address depression symptoms may incorporate 

 or prevention content. Both providers and patients are interested in the potential to effectively utilize these tools to support mHealth apps assisting in managing depression.

In the ever-evolving digital world, interest in utilizing mHealth apps is occurring in patients along with health care providers. If health care providers have their patients ask for an opinion about a particular supplement. For example, if patients ask about a particular supplement, their providers will give an overview of the supplement including the lack of FDA regulation compared to other pharmaceutical medications to inform their shared decision-making. Currently, and for the foreseeable future, patients will ask their health care providers about some of these mHealth apps. As health care providers are busy in an increasingly complex health care environment, chances are providers do not have the time or bandwidth to thoroughly investigate what is available. With the sheer thousands of apps available, it would be impossible to remain current and provide our patients with an informed overview or answer. Providers must be cautious about recommending or endorsing these apps as well, as it can potentiate legal, ethical, or professional risk if the recommendation is in appropriate due to possible negative patient outcomes.

Patients struggling with their mental health, whether they are formally in psychiatric treatment or not, may find that the ability to access help in the palm of their hand is quite appealing. However, the plethora of available apps is likely overwhelming for someone dealing with 

, as one of the prevalent symptoms can be difficulty concentrating and making decisions.

 Often, when faced with so many choices without a prior recommendation, the app user will likely decide which app to utilize based on user review ratings. The user reviews do not take into consideration the validity or reliability of the app content, or whether it is evidence-based. Ratings and reviews are often based on app cost, visually appealing properties, reliability, minimal freezing or crashing of the app, and ease of signup, amongst other factors. There is no requirement or consideration for the scientific validity of the content and interventions within the app. As such, a highly rated app with many downloads may be enticing for someone interested in trial use, regardless of the fact that the app may not be evidence-based and may lack external validity to support its use. The current system of app ratings and oversight lacks transparency from experts to convey this information to consumers.

is a psychiatric-mental health nurse practitioner in the Seacoast, New Hampshire area, and a clinical assistant professor and program director of the Post-Masters Psychiatric-Mental Health Nurse Practitioner Certificate Program, Department of Nursing, University of New Hampshire, Durham. 

2. Munoz Ramos R, Ferrer Cheng PG, Jonas SM. 

Validation of an mHealth app for depression screening and monitoring (psychologist in a pocket): correlational study and concurrence analysis

3. Martinengo L, Van Galen L, Lum E, et al. 

4. Tangari G, Ikram M, Ijaz K, et al. 

Preventing depression using a smartphone app: a randomized controlled trial.

6. Stawarz K, Preist C, Tallon D, et al. 

Diagnostic and statistical manual of mental disorders

How can these mHealth apps help in the treatment of depression? 

Treating Depression and Preventing Suicide: The Impact of mHealth Apps

In the United States, 21% of adults (52.9 million) are estimated to have experienced a mental health disorder within a given year.

 The response to behavioral health needs in US communities is inadequate, which has created a gap between the need for treatment and the delivery of care: Of the 52.9 million adults with any behavioral health disorder, only approximately 16.9% (41.4 million people) received inpatient or outpatient behavioral health services within the year prior to the 2020 study.

For decades, access to behavioral health care providers in the United States has been a concern due to difficulty recruiting and retaining providers and the aging-out of the workforce.

 Other barriers for access to mental health care include cultural factors, 

, financial/insurance barriers, transportation, childcare, and fear or hesitation due to prior negative experiences.

Access to care has been even more negatively impacted by the 

—a time when mental health conditions have increased and worsened nationally.

 Although service delivery methods such as telehealth have grown substantially amidst the COVID-19 pandemic, the increase in availability has not been sufficient to meet the need for patient care, and access to mental health care services has continued to decline.

 is one of the most prevalent mental disorders in the United States, and it impacts individuals throughout the lifespan. Based on data obtained from the 2020 National Survey on Drug Use and Health (NSDUH), approximately 21 million adults have experienced at least 1 major depressive episode in their lifetime.

 Based on the survey findings, 14.8 million adults had experienced 1 major depressive episode resulting in significant, severe functional impairment within the past year.

 The prevalence in adolescents (ages 12 to 17) is concerning as well. An estimated 17% of adolescents have experienced at least 1 lifetime major depressive episode, and, according to the 2020 data, approximately 12% of adolescents in the United States had a severe depressive episode within the previous year.

Treatment in both adolescent and adult populations is comparably quite lower than the prevalence, relative to how many individuals are suffering. It was estimated that of the adults with major depression, 66% received treatment within the prior year based on 2020 survey data with the adolescent population, only 41.6% received treatment.

Linked to numerous disorders, including major depression, 

 is a devastating consequence of several mental illnesses and distress. Estimates of prevalence vary, but almost 1 million people worldwide die each year of suicide, and there are an estimated 16,000,000 suicide attempts.

 These numbers are likely underreported and the actual prevalence is much, much higher. Approximately 40% of individuals experiencing suicidality do not have access to medical care or do not seek it out.

Concurrently with this crisis in mental health care, there is a current rapid expansion of technology across sectors. One of these developments is mHealth, which captures the use of 

 and other portable devices provided with functions to manage one’s health, most often utilizing an application.

 The availability and presence of these apps is constantly growing, and many target a specific illness or condition, or a particular health behavior to provide a framework for monitoring and managing that condition.

This 3-part series will further evaluate mHealth apps that are available to address depression. The history of these apps, the use of the apps, identified challenges and barriers, and an overall synthesis of best practices based on the best available data at this time will be discussed.

1. Center for Behavioral Health Statistics and Quality – Substance Abuse and Mental Health Services Administration. Highlights for the 2020 national survey on drug use and health. 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. 

Population of U.S. practicing psychiatrists declined, 2003–13, which may help explain poor access to mental health care.

3. CMS data shows vulnerable Americans forgoing mental health care during COVID-19 pandemic. Centers for Medicare & Medicaid Services. 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. 

Nursing Informatics and the Foundation of Knowledge

 (4th ed.). Jones & Bartlett Learning; 2017.

How can mHealth apps help overcome barriers to access to care? 

mHealth Apps for Depression: Overcoming Challenges 

. Many patients with psychiatric disorders will tell us that sleep needs to be addressed,” said Colin A. Espie, PhD, Professor of Sleep Medicine in the Nuffield Department of Clinical Neurosciences at University of Oxford, Clinical Director of the Oxford Online Programme in Sleep Medicine, and Cofounder and Chief Scientist of Big Health.

 Associate Editorial Director, Heidi Anne Duerr, MPH, teamed up with Espie to discuss sleep issues and mental health in the session, “How Big Health Are Tackling Wider Mental Health Issues by Addressing Sleep.” Together, they looked at the prevalence of mental health and insomnia across multiple populations.

“Research has shown that it really is important to address both sleep and psychiatric disorders. If sleep is not addressed in patients with depression or 

, then it could very well exacerbate their psychiatric condition and vice versa,” Duerr shared.

Psychopharmacological options are very important to treat sleep disorders, the pair discussed, but so is 

 (CBT) that is associated with addressing sleep issues.

“CBT is not a treatment, but a family of treatments,” said Espie. “It contains bits that deal with the racing mind, the cognitive element of CBT, and addresses our approach to sleep.”

“In the headlines and in the news, we hear that there are shortages of mental health care professionals who can treat patients, including offering CBT to help patients,” continued Duerr.

The potential solution to such shortages? 

 (DTx) may be poised to step in, so long as they are utilized by empathetic doctors who are ready to be there for their patients. According to Espie, mental health treatment must be given the same respect and be held accountable as any other health care, and DTx are no exception.

“We must give them [our patients] treatments that work,” said Espie. He believes DTx must (1) work correctly, and (2) be provided only after they are validated via randomized, placebo controlled trials.

“Digital therapeutics need to be skillfully made, they cannot just be translations,” said Espie. “We need evidence-based treatments that are sophisticated enough to really help people to implement things in their life that make a difference.”

Something investigators should be aware of, Espie noted, is potential placebo effects of DTx. Just as with regular medications, DTx will not be regarded as effective treatments unless they produce benefit beyond placebo.

From the discussion, it is clear that DTx have the potential to improve patient care—and increase the number of patients receiving care. With more evidence-based research, the availability is likely to increase in the near future.

Digital therapeutics may be poised to step up as the next CBT. 

Need Your Sleep: DTx for Treating Comorbid Insomnia and Psychiatric Disorders

, we worked with experts from multiple areas in psychiatry to bring you thoughtful articles about a wide variety of psychiatric issues, from treatment resistance and Lyme disease to delirium diagnosis and the Goldwater Rule. Here are some highlights from our first issue of 2022:

This is the Water: The Social Determinants of Mental Health and the Future of Psychiatry

The social determinants of mental health surround us. You only need to take a look around to see them. For instance, consider the following scenarios.

 “He shot my friend and his little boy as they were going into their house. I had just been walking with my friend when that guy walked right by me and shot them. I had just said goodbye on their front steps and was only about 20 feet away. My friend was a few years older, and I looked up to him. His son was 6. We both knew the guy who shot him, but I have no idea why it happened. I started feeling really depressed a few weeks later and made an appointment at the clinic.” 

Chatbots for Child Mental Health Care: Helpful, But Limited

Childhood: a carefree time for many. However, children today face countless sources of stress: academic pressure, schedules crammed with activities, lack of sleep, bullying, family instability, world events, social media, and more. Mental health issues among children are growing at a dangerous rate, and it is important that we use all of our innovative technologies to help them. 

Lyme Disease in Psychiatry: Controversies, Chronic Symptoms, and Recent Developments

Since its first appearance in a group of children in Old Lyme, Connecticut in the late 1970s, 

 has proliferated throughout the United States and abroad. Only 30,000 to 40,000 cases are reported to the Centers for Disease Control and Prevention (CDC) per year, although recent studies looking at the time period between 2010 and 2018 estimate the actual number to be more than 10 times higher at approximately 476,000. Lyme disease is transmitted when an infected tick bites a human and injects the causative bacteria, 

Doorknob Moments: Why They Happen and How to Use Them

We have all had the experience of a patient dropping a bomb—a critical disclosure that moves the treatment forward—on their way out, with a hand on the doorknob.

When the patient becomes distraught following a shocking revelation, it feels at least unkind and at worst harmful to say, “Sorry, too bad you’re bleeding, but we don’t have time to pack that wound.” What to do? 

. And be sure to stay up-to-date by subscribing to the 

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at 

The experts weighed in on a wide variety of psychiatric issues for the first Psychiatric Times issue of 2022.

From the Pages of Psychiatric Times: January 2022

A new study found that a form of digital cognitive behavioral therapy (dCBT) may help prevent 

 in women for up to 6 months after they give birth.

The study, which was conducted by researchers at the University of California San Francisco (UCSF), tested the efficacy of Sleepio, a self-paced sleep app and form of dCBT, to determine whether treating insomnia would also help prevent depression in postpartum women.

 The study was a follow-up to a study by UCSF researchers in January 2020,

 which found that dCBT treatment helped reduce insomnia and symptoms of anxiety and depression in participants during pregnancy.

“We were curious to see whether the benefits of dCBT for insomnia would maintain after the birth of the child, especially given the demands of having a young infant,” said Jennifer Felder, PhD, lead author of the study; assistant professor of psychiatry; and core research faculty at the UCSF Osher Center for Integrative Health, in a press release. “We were particularly excited to see the benefits lasted to 6 months not just for insomnia, but for mental health more broadly.”

In the study, 105 out of 208 participants were randomized to the dCBT treatment, which involved up to 6 20-minute sessions using the Sleepio app. At 3 months postpartum, 4% of participants who had the dCBT treatment were rated as likely depressed, in comparison to 18% of the remaining participants, who received usual treatments such as medication or general sleep hygiene tips from their providers. According to Felder, part of what set the dCBT treatment apart from usual care is that it was more individualized and addressed common causes of insomnia.

“The magic of the treatment is what happens between sessions—the tactics the participants put into practice, such as keeping a sleep diary, stabilizing their wake time, spending less time in bed tossing and turning, and prioritizing an adequate wind-down before bed,” Felder said in a press release.

With its focus on the connection between postpartum insomnia and depression, the study’s results are significant, as up to 15% of women are affected by postpartum depression; around 38% of pregnant women experience insomnia; and insomnia is associated with a 30% increased risk of pre-term birth.

“I’ve heard patients say, over and over, that their postpartum mental health began to suffer when their insomnia started, suggesting there is a link,” Felder said in a press release. “We know that postpartum can be a vulnerable time for becoming depressed, and it is possible that this intervention may prevent that.”

Digital therapy for prenatal insomnia may prevent postpartum depression

. News Release. University of California San Francisco. December 15, 2021.

2. Felder JN, Epel ES, Neuhaus J, et al. 

Efficacy of digital cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: a randomized clinical trial

 [published correction appears in JAMA Psychiatry. 2020 Jul 1;77(7):768]. 

Study also suggests link between postpartum depression and insomnia.

Research Shows dCBT May Help Prevent Postpartum Depression

The American Psychiatric Association (APA) announced that the My Mental Health Crisis Plan app was named Best Health Care Mobile Application by the 2021 MobileWebAwards.

Developed by SMI Adviser, the My Mental Health Crisis Plan app allows for the creation of a psychiatric advance directive (PAD) that individuals with serious mental illness can use to guide their treatment while they are experiencing a mental health crisis.

 In the app, users can follow an easy, step-by-step process to specify their preferences for treatment, decide who they want to make decisions on their behalf, and share their PAD with their clinicians and other mental health providers.

App allows users with serious mental illness to create and share a psychiatric advance directive.

Digital Therapeutics

Challenges with mHealth Apps for Depression and Suicide Prevention

Treating Depression and Preventing Suicide: The Impact of mHealth Apps

mHealth Apps for Depression: Overcoming Challenges

Need Your Sleep: DTx for Treating Comorbid Insomnia and Psychiatric Disorders

From the Pages of Psychiatric Times: January 2022

Research Shows dCBT May Help Prevent Postpartum Depression

APA, SAMHSA App Named 2021 Best Health Care Mobile Application

Avoiding a Brain Health Innovation Market Failure: Lessons from the Hype Cycle

Prescription Digital Therapeutics and the Hunger for New Treatments

Surveying Attitudes Towards Digital Mental Health