mHealth Apps for Depression: Overcoming Challenges

In the United States, 21% of adults (52.9 million) are estimated to have experienced a mental health disorder within a given year.¹ 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.¹

Access to Care

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.² Other barriers for access to mental health care include cultural factors, stigma, 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 COVID-19 pandemic—a time when mental health conditions have increased and worsened nationally.³ 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.³

Depression and Suicide

Major depressive disorder 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.⁴ 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.⁴ 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.⁴

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.⁴

Linked to numerous disorders, including major depression, suicide 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.⁵ 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.⁵

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 mobile phones and other portable devices provided with functions to manage one’s health, most often utilizing an application.⁶ 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.⁶

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.

Sara Robinson 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. Dr Kallmerten 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.

References

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. Health Affairs (Millwood). 2016;35(7):1271-1277.

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. Suicide prevention and depression apps’ suicide risk assessment and management: a systematic assessment of adherence to clinical guidelines. BMC Med. 2019;17(1):231-231.

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