Talk I gave regarding mobile mental health apps and their potential effect on the way we practice mental health

1. Mobile mental health apps are flooding the
marketplace:
Who is using them and to what effect?
Diego Castaneda DrPH MPH (UCSF)
Joaquin Anguera PhD (UCSF)
Patricia Arean PhD (UW)
diego.castaneda@ucsf.edu/
@drMhlth

2. Disclosures
• Research funded in part by NIH T32 mechanism
• No financial disclosures
diego.castaneda@ucsf.edu/
@drMhlth

3. Today
• Research Context
• (Research Questions)
• Methods
• Findings
• Summary
• Implications
diego.castaneda@ucsf.edu/
@drMhlth

4. What was the number of mobile
mental health apps on the market in
2014?
A. 5,000-10,000
B. 20,000-30,000
C. 30,000-40,000
D. What’s a mobile mental health app?
diego.castaneda@ucsf.edu/
@drMhlth

5. ANSWER
A. 5,000-10,000
D. What’s a mobile mental health app?
Patient Adoption of mHealth, Institute for Health Informatics, 2015
diego.castaneda@ucsf.edu/
@drMhlth

6. Research Context
Smith, Aaron, “US Smartphone Use in 2015”, Pew Internet Research
diego.castaneda@ucsf.edu/
@drMhlth

7. Research Context
• Last Year
• 100% Increase Health Apps
• ~165,000 Health Apps
• ~5,000 Mental Health Apps
• 1054 depression specific apps (Shen, 2015)
diego.castaneda@ucsf.edu/
@drMhlth

8. diego.castaneda@ucsf.edu/
@drMhlth

9. Research Questions
• What is a mental health app (real world def)?
• What mental health apps are actually being used?
• Who is using them?
• Are they engaged/satisfied with the app ?
• How long are the apps being used for (Longevity)?
• Usability
diego.castaneda@ucsf.edu/
@drMhlth

10. Methods
• Cross sectional
• 75 item online survey (5-10 min) (REDCAP)
• Social Networks, Craigslist, Flyers
• Lottery incentive ($10 Gift Card)
diego.castaneda@ucsf.edu/
@drMhlth

11. Methods
• Cross sectional
• 75 item online survey (5-10 min) (REDCAP)
• Social Networks, Craigslist, Flyers
• Lottery incentive ($10 Gift Card)
diego.castaneda@ucsf.edu/
@drMhlth

12. Methods
diego.castaneda@ucsf.edu/
@drMhlth
Total&#&of&Survey&
Respondents&as&of&
02/01/15&
&&&
N=2019
Data&Cleaning&(Eliminating*Duplicates,*Non4Completers)&
Total&Sample&&
N=&1404
Answered&“Yes,*I*have*a*
Health*App*Downloaded*
On*My*Device”!
N=1863
Recruitment&via&online&
and&traditional&methods&
begins&&
3/4/14

13. Findings-Demographics
N=1404
• Age M=35.2 (S.D. 11.7; Range 18-78)
diego.castaneda@ucsf.edu/
@drMhlth
Characteristic % of Sample
Female 70%
iPhone Device 50%
At least 4 years of college 49%
Download Apps (1 per day) 39%

14. 51%
19%
17%
7%
5%
1%
HAPPI Study( N=1404)
Non-Hispanic White
African-American/Black*
Hispanic/Latino
Asian
Mixed
Native American/Alaska/
Pacific Islander
diego.castaneda@ucsf.edu/
@drMhlth
Ethnic/Race Representation

15. 56%
12%
16%
5%
10%
1%
US Census 2013
Non-Hispanic White
African-American/Black*
Hispanic/Latino
Asian
Mixed
Native American/Alaska/
Pacific Islander
diego.castaneda@ucsf.edu/
@drMhlth
Ethnic/Race Representation

16. Income Representation
diego.castaneda@ucsf.edu/
@drMhlth
61%16%
23%
What is your yearly household income level?
HAPPI Study (N=1404)
<$55,000
$55,000-75,000
>$75,000

17. Domestic Representation
diego.castaneda@ucsf.edu/
@drMhlth

18. What kind of health apps do
you have on your device?
diego.castaneda@ucsf.edu/
@drMhlth
Health App Category! % of Sample on Device!
Physical Health! 76%!
Diet Management!
!
61%!
Thinking/Cognitive Skills!
!
58%!
Mental Health! 34%!
!
Medication Adherence! 24%!
!
Chronic Disease! 18%!
!

19. What kind of health apps do
you have on your device?
diego.castaneda@ucsf.edu/
@drMhlth
Health App Category! % of Sample on Device!
Mental Health! 34% (483)!
!

20. Who is using mental health
apps (significantly)?
diego.castaneda@ucsf.edu/
@drMhlth
Characteristic! % of Sample! Mental Health App
on Device!
African-American*! 12%! 24%!
At least one Chronic Illness
(12 conditions)**!
48%! 60%!
Currently receiving mental
health care**!
24%! 34%!
App Downloader (At least
once per day)**!
39%! 44%!
Chi-Square test of Significance *p<.05, **p<.001

21. Top Ten Mental Health Apps!
1. WebMD!
2. Head Space!
3. Period Tracker!
4. Self-Anxiety Meditation !
5. T2MoodTracker!
6. Lumosity!
7. Stress Check!
8. MyFitness Pal!
9. Binaural Beats!
10. Relax Lite!
diego.castaneda@ucsf.edu/
@drMhlth

22. Top Ten Mental Health Apps!
1. WebMD!
2. Head Space!
3. Period Tracker!
4. Self-Anxiety Meditation !
5. T2MoodTracker!
6. Lumosity!
7. Stress Check!
8. MyFitness Pal!
9. Binaural Beats!
10. Relax Lite!
diego.castaneda@ucsf.edu/
@drMhlth

23. 16.1%
27.3%
56.6%
0
10
20
30
40
50
60
less than two weeks 2-4 weeks Over 4 weeks
For how long did you use the mental health app you said
you used? (% of mental health app users)
N=483
diego.castaneda@ucsf.edu/
@drMhlth

24. Usability Index
• 5 statements asking about overall usability of app
• Likert Scale- Strongly Disagree-Strongly Agree (0-10)
diego.castaneda@ucsf.edu/
@drMhlth
Statement! Score (SD)!
Easy to Learn to Use! 7.65 (2.6)!
Enter in Data Easily! 7.43 (2.6)!
Trusted App Confidentiality! 7.16 (2.7)!
Did What it was Supposed ! 7.39 (2.4)!
Functional on Phone! 7.40 (2.4)!

25. Open Ended Comments
What they Liked! What they Would Change !
Ease of use!
Tracking (Track) Data!
Access to Data!
Daily Tracking!
!
!
Nothing!!
Integrated with phone!
Costs (too expensive)!
Reminders!
!
!
diego.castaneda@ucsf.edu/
@drMhlth

26. Chronic Illness!
Under Care of Mental
Health Professional!
1. WebMD! WebMD!
2. Head Space! Self-Anxiety Meditation !
3. Self-Anxiety Meditation ! Head Space!
4. S-Health! T2 Mood Tracker!
5. GoogleFit! Binaural Beats!
6. MyFitness Pal! Calm!
7. Period Tracker! Depression!
8. Relax Lite ! Lumosity!
9. T2 Mood Tracker! MoodScope!
10. Binaural Beats! Period Tracker!
diego.castaneda@ucsf.edu/
@drMhlth

27. Chronic Illness!
Under Care of Mental
Health Professional!
1. WebMD! WebMD!
2. Head Space! Self-Anxiety Meditation !
3. Self-Anxiety Meditation ! Head Space!
4. S-Health! T2 Mood Tracker!
5. GoogleFit! Binaural Beats!
6. MyFitness Pal! Calm!
7. Period Tracker! Depression!
8. Relax Lite ! Lumosity!
9. T2 Mood Tracker! MoodScope!
10. Binaural Beats! Period Tracker!
diego.castaneda@ucsf.edu/
@drMhlth

28. Summary
• Representative Race/Income
• Minority use similar
• Unconventional Mental Health Definitions
• Specific Populations
• Engagement (Longevity) and User Satisfaction
diego.castaneda@ucsf.edu/
@drMhlth

29. Implications for Clinicians
• Patient/client interest (augment treatments)?
• Special population?
• Chronic illness
• Smartphone + data plan (tech-phillic)
• Take time to identify several apps to recommend
• Delegate an app search for 1-2 top apps
• Users are looking for
• Ease of Use
• Integration
diego.castaneda@ucsf.edu/
@drMhlth

30. Implications Greater Context
• Precision Medicine Initiative
• Active Partners
diego.castaneda@ucsf.edu/
@drMhlth
PMI Working Group, 9/17/2015
http://www.nih.gov/precisionmedicine/09172015-pmi-working-group-report.pdf

31. “The Future is Already Here..It’s just not very well
distributed.”
-William Gibson
diego.castaneda@ucsf.edu/
@drMhlth

32. Acknowledgements
• Grace Niu PhD
• Rebecca Willemse BS
• Katrina Roundfield PhD
• Pat Arean PhD
• Joaquin Anguera PhD
• Amy Byers PhD
• Adrian Aguilera PhD
• Cami Rolle BS
• Josh Jordan MS
• Claudine Catledge MS
• Rachel Lewin RN
diego.castaneda@ucsf.edu/
@drMhlth