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There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear.
This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years.
The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years.
A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate.
Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed.
Mental health problems are common in children and young people. Prevalence data suggests that up to 20% of children and young people up to 18 years of age have a diagnosable mental health problem [
Digital technology provides a way of increasing access to evidence-based interventions [
Advantages of mHealth include constant availability, greater access, equity of mental health resources, immediate support, anonymity, tailored content, lower cost, and increasing service capacity and efficiency [
Despite the large number of apps available, the evidence base is scarce, particularly for adolescents. A 2013 review of mobile mental health apps for all ages identified eight papers describing only five apps [
Few apps have been specifically developed for children and adolescents, and the benefit of mental health mobile apps for this population is unclear. Two systematic reviews exploring the evidence for digital health interventions (including computerized CBT, mobile phone apps, and wearable technologies) for children and young people with mental health problems in 2014 and 2016 [
Although important additions to the literature, the systematic reviews only included RCTs and so did not include feasibility studies providing information on acceptability [
Fifteen electronic databases were searched for relevant publications between January 2008 and July 2016, including APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, and Web of Science. Publication databases of key journals were also searched. These included
We included abstracts describing mental health apps for mobile devices (mobile phone or tablet) for use by children and adolescents younger than 18 years. Studies with participants older than 18 years were included if the sample included children younger than 18 years. Mental health problems included depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia. To ensure we were capturing current and emerging evidence, we included conference proceedings, theses, case studies, RCTs, uncontrolled feasibility studies, qualitative studies, articles analyzing apps for adolescents available in app stores, and articles detailing app design and development.
We excluded abstracts if (1) the target population was exclusively adult (ie, older than 18 years); (2) the primary purpose of the app was ecological momentary assessment for research purposes as opposed to an intervention; (3) the app was designed for neurodevelopmental disorders (autism spectrum disorders, Asperger syndrome, and attention-deficit/ hyperactivity disorder), for substance use, health behaviors, or medical problems; (4) the study described an Internet-based intervention accessed via a mobile device or an intervention delivered via mobile device functions (text messaging, multimedia messaging, calls, videoconferencing, sending content to Internet interventions); and (5) the paper was a trial protocol, trial registration, systematic or scoping review, or did not provide any extractable outcome or feasibility data.
Of the 5562 abstracts initially identified, 5438 were excluded on the basis of title, abstract screening, and duplicate removal. The remaining 124 full-text articles were assessed for eligibility with a further 100 being excluded. A total of 24 full-text articles met the inclusion criteria.
The 24 publications included in this review consisted of 12 feasibility studies [
Operating platforms included Android and iOS (n=3 [
Two apps were available from Google Play or iTunes at the time of writing: Mayo Clinic Anxiety Coach (iTunes [
PRISMA flow diagram of results and article selection.
A further six apps, targeted specifically at children or adolescents, were identified in two analysis articles of apps available from Google Play and iTunes [
Ages of those involved in studies ranged from 9 to 30 years with 13 articles including only children and adolescents 18 years or younger [
Characteristics of publications of mental health mobile apps for preadolescents and adolescents included in review (N=24).
Study | Designa | Samplea | App |
Aguirre et al (2013) [ |
App analysis: mobile apps for suicide prevention from Google Play and iOS | 27 apps identified, 3 apps for children and young people | Destructive Issues, Teen Depression, and Teen Hotline |
Kauer et al (2012) [ |
Outcome study: RCT of Mobiletype app vs abbreviated Mobiletype app | N=114 (68 intervention; 46 control) aged 14-24; GP-based recruitment | Mobiletype |
Kennard et al (2015) [ |
App design: semistructured interviews gaining perspectives on a mobile safety plan for suicide prevention | N=10 teens aged 14-17 hospitalized for suicidality; n=10 parents | Safety Plan App |
Kenny et al (2014) [ |
App design: focus groups gaining perspectives on mental health mobile apps and CopeSmart prototype | N=34, aged 15-16, school-based sample | CopeSmart |
Kenny et al (2015) [ |
Feasibility: CopeSmart used to rate mood for 1 week | N=43, aged 15-17, school-based sample | CopeSmart |
Løventoft et al (2012) [ |
Feasibility: describes design workshops and 4-week pilot trial | N=6 (aged 17-24); used psychotropic medication within last 2 years; community recruited | Daybuilder |
Matthews & Doherty (2011) [ |
Feasibility: comprises 3 studies (1) initial design consultations, (2) nonclinical feasibility, (3) feasibility with clinical population | (1) n=6, (2) n=73 (21 app, 51 paper diary), (3) n=9 children seeing a therapist for a range of mental health problems | Mobile Mood Diary |
Matthews et al (2008) [ |
Feasibility: app or paper-based mood charting; instructed to complete one mood entry every day for 2 weeks | N=73 (21 app, 51 paper diary), aged 13-17 years; school-recruited sample | Mobile Mood Diary |
McManama et al (2016) [ |
Feasibility: pilot testing of prototype of app for suicide prevention following acute care discharge; think-aloud protocol | N=20 aged 13-18, history of suicidal thoughts and n=20 parents; outpatient psychiatry dept-recruited sample | Crisis Care |
Nicolas et al (2015) [ |
App analysis: mobile apps (English language) for bipolar disorder from the Australian Google Play and iOS in 2014 | 82 apps identified 3 specifically for children and young people | Primary School Assessments, Preschooler Assessments & Your Child’s Social Health |
Niendam et al (2015) [ |
Feasibility: 4-month trial collecting medication adherence and clinical data using mobile phone app | N=36, aged 14-30; Early Psychosis participants recruited from early intervention programs | No name |
Patwardhan et al (2015) [ |
Feasibility: pilot of REACH app; 30 minutes of app usage with researcher | N=22 (mean age=9.67 years); school-based recruitment | The REACH app |
Pramana et al (2014) [ |
Feasibility: used for 8-16 alongside face-to-face CBT for anxiety | N=9 (aged 9-14), receiving face-to-face CBT for diagnosed anxiety disorder | SmartCat |
Reid et al (2009) [ |
Feasibility: focus group and 1-week trial of Mobiletype; text prompt to complete diary 4 times a day | N=29 (n=11 in focus group, n=18 in study), aged 14-17; school-based recruitment | Mobiletype |
Reid et al (2011) [ |
Outcome study: RCT of Mobiletype app vs abbreviated Mobiletype app | N=114 (68 intervention; 46 control) aged 14-24; GP-based recruitment | Mobiletype |
Reid et al (2012) [ |
Feasibility: youth asked to self-monitor with app at least once a day for 2-4 weeks until next medical review | N=47 (aged 14-19), recruited from health clinic by pediatrician | Mobiletype |
Reid et al (2013) [ |
Outcome study: RCT of Mobiletype app vs abbreviated Mobiletype app | N=114 (68 intervention; 46 control) aged 14-24; GP-based recruitment | Mobiletype |
Scotti (2014) [ |
Feasibility: school-based DBT skills group + mobile or online tracking of skills usage | N=7 (aged 13-18), 2 of which used the app; had eating disorder or body image concerns; school-based recruitment | No name |
Tregarthen et al (2015) [ |
App design: app made available to download and user information recorded | Ages ranged from 13-77 years | Recovery Record |
Veldhuis (2014) [ |
Outcome study: app for body image or neutral app used in laboratory for 30 minutes | N=206 (aged 12-18); school-based recruitment | Pretty |
Verstappen et al (2014) [ |
App design: development of ACT app for youth with depression learning ACT | Mentions “research clients” as a group of 15 “youth” undertaking 3-month ACT program at health center | The ACT app |
Whitehouse et al (2013) [ |
Feasibility: piloting use of psychosocial screening app in a medical hospital setting | N=80 medical patients aged 12-18; recruited in medical clinics before appointments | TickIT |
Whiteside et al (2014) [ |
Outcome study: case studies of two children with OCD using Mayo Clinic Anxiety Coach alongside face-to-face therapy for 3 months | N=2 (10 and 16 years) both diagnosed with OCD; mental health clinic-recruited | Mayo Clinic Anxiety Coach |
Whiteside et al (2016) [ |
App design: user data from downloaders of Mayo Clinic Anxiety Coach | User data: children and adolescents 5-17 downloaded Mayo Clinic Anxiety Coach (likely with parents) | Mayo Clinic Anxiety Coach |
a ACT: acceptance and commitment therapy; app analysis: article on app analysis; app design: article on app design and development; DBT: dialectical behavioral therapy; GP: general practitioner; OCD: obsessive-compulsive disorder; outcome study: study reporting mental health outcomes.
As evident in
To date, Mobiletype is the only mobile app to have undergone a RCT [
Veldhuis [
Whiteside [
Feasibility outcomes of app usage and acceptability were extracted from studies assessing the following apps: CopeSmart [
In the Mobiletype RCT [
Characteristics of mental health mobile apps for preadolescents and adolescents included in review (N=15).
App name | Descriptiona | Main featuresa | OSb | Available to downloadc | Area targetedd |
CopeSmart [ |
App to foster positive mental health in children and young people | Self-monitoring of mood, mood diary, coping tips, and contact details of mental health support services | Android & iOS | NA | Mental well-being |
Crisis Care [ |
App for suicide prevention in children and young people to be downloaded on discharge from acute care | Coping skills (relaxation, behavioral activation, positive affect) and contact details of suicide hotline and adults they trust | Prototype /NR | NA | Suicide prevention |
Daybuilder [ |
A “life management app” for people with depression | Symptom assessment, mood, appetite, and sleep self-monitoring, functions to let the user create events and reminders for what to do to prepare for that event, medication management | Android | NA | Depression |
Mayo Clinic Anxiety Coach [ |
A self-help tool delivering CBT for a range of anxiety disorders | Self-monitoring, symptom assessment, psychoeducation, and treatment based on exposure therapy | iOS | Yes | OCD |
Mobiletype [ |
A “mental health assessment and management app” for children and young people | Self-monitoring tool; prompts users 4 times a day to record mood, stressful events, alcohol use, cannabis use, quality and quantity of sleep, quantity and type of exercise, and diet | Cross- platform | NA | Mental health |
Mobile Mood Diary [ |
App for children and young people in therapy to chart their mood | Self-monitoring of mood, sleep, and energy and a free text diary entry; no password protection or reminders | Cross- platform | NA | Mental health |
Pretty [ |
Gamified app to prevent body image issues in children and young people | App is a series of pictures of models of various sizes and questions asking the user to rate each model’s weight status to be either “extremely thin,” “thin,” “normal,” “big,” or “extremely big;” user gets feedback on whether their response was correct | Android & iOS | NA | Body image |
REACH app [ |
App for anxiety prevention and early intervention in children and young people | Self-monitoring, resources, coping strategies, and CBT skills training | Android | NA | Anxiety |
Recovery Record [ |
A CBT-based app for eating disorders self-monitoring | Self-monitoring of meals and symptoms, goal setting, coping tactics, meal plans, rewards and affirmations, social support, summative feedback | Android & iOS | Yes | Eating disorders |
Safety Plan app [ |
Proposed app to support children and young people transitioning from inpatient to outpatient care | Intended to provide mobile access to pre-agreed safety plan for use in times of crisis and suicidal ideation | Prototype /NR | NA | Suicide prevention |
SmartCAT [ |
App for children and young people with anxiety alongside brief CBT sessions | Skills coach, reward bank, media library, notifications, and secure messaging portal for use with therapist | Android | NA | Anxiety |
The ACT app [ |
App for children and young people with depression attending therapy | Self-monitoring and symptom assessment, skills training, goal setting; based on acceptance and commitment therapy. | Android | NA | Depression |
TickiT [ |
App-based psychosocial screening tool developed for children and young people attending hospital | Patients enter data in waiting room and the tool records response data, generating a report and alerts for clinicians, shifting clinical focus of the meeting | iOS | NA | Depression (screening) |
No name [ |
App for recording medication adherence and symptoms in early psychosis care | Self-monitoring and symptom assessment; designed with daily and weekly surveys assessing symptoms, mood, medication adherence, and social contact | NR | NA | Early psychosis (medication adherence) |
No name [ |
App for recording behaviors and skills practice, adjunct to group DBT | Self-monitoring and tracking of DBT skills and ED behaviors via mobile app or online | NR | NA | Eating disorders |
a CBT: cognitive behavioral therapy; DBT: dialectical behavioral therapy; ED: eating disorders.
b Cross-platform: article reports as JavaME app (Mobile Mood Diary) or “multiple models and firmware” (Mobiletype); NR: not reported; OS=operating system.
c NA: not available to download from Google Play, iTunes App Store, or Microsoft app store.
d Mental health: range of unspecified mental health problems.
In a feasibility trial of Mobile Mood Diary [
Sample sizes were small, but overall app acceptability was good. The majority of CopeSmart users in the feasibility trial [
Feedback from a focus group of nonclinical adolescents (N=34, age 15-16 years) highlighted the importance of apps being discrete and easy to conceal in order to avoid the stigma associated with mental health problems [
A survey [
The aim of this review was to systematically examine the literature on mobile apps for mental health in children and young people. Our review identified 24 papers describing 15 apps or prototypes, two of which were available to download from Google Play or iTunes [
Our conclusion is consistent with previous reviews and highlights that the evidence base has barely increased over the past 4 years [
Although the evidence base is currently lacking, this does not rule out the fact that well-designed, adequately tested, evidenced-based mobile apps could be effective. The evidence base for the clinical effectiveness of mobile apps in adult mental health is slowly emerging [
In terms of acceptability, it has been suggested that apps and eHealth in general are particularly suited for adolescents who are familiar with and regular users of technology [
Therapist perspectives on mobile apps were mixed, with concerns relating to patient security, increased responsibility and workloads, and the need to set clear boundaries between sessions [
App usage, where reported, was moderate and adherence ranged from 65% to 83%, which is comparable to those seen in Internet interventions for depression and anxiety [
This review highlights several methodological concerns about the quality of the research evidence for mental health mobile apps, especially those for adolescents. Sample sizes tend to be small and reporting of demographic data such as gender and age inadequate, particularly in pilot feasibility studies. Few participants have an identified mental health problem and, as such, little is known about the acceptability and use of apps with clinical groups. As far as can be determined, the youngest participant in these studies was 9-years-old, meaning there is no research evidence for the use of mobile apps in children younger than this age. Where reported, symptoms tended to be mild to moderate in severity and, as such, the appropriateness of mobile apps for complex or more severe problems is unknown. Studies tend to be short in duration and there is sparse information on whether positive gains from using mobile apps are maintained. Finally, none of the apps in this review have been evaluated using a suitable RCT comparing a mobile app to an adequate control group. Future research should address these methodological concerns. Given the beneficial role that parent participation and engagement can have in adolescent mental health treatment [
Our review has focused on the academic literature and of the apps identified, two of which were available to download. This contrasts starkly with the large number available from commercial sites and raises questions about the safety, quality, and efficacy of those that are available [
There are several limitations of this review. Firstly, the number of studies was small with generally limited sample sizes. Conclusions that mobile apps are acceptable for youth are therefore tentative. Secondly, the qualitative feedback is based on a small number of young people and therapists and generalizing their views to a wider population should be exercised with caution. This feedback is nevertheless informative and highlights the importance of involving young people in app design. Thirdly, we aimed to reduce publication bias, and although our inclusion criteria were broad, our search was limited to English-language papers. Fourthly, despite aiming for a precise overview of the literature on mobile apps for children and adolescents, a number of publications included adults. The majority of publications utilized teenage and young adult populations with only one study including a participant aged 9 years. As such, our results are limited to preadolescents and adolescents, rather than children. All the articles included in this review originated from work in North America, Northern Europe, and Australia; therefore, these results are limited to the experiences of adolescents in high-income countries. mHealth holds great promise for widening access to mental health treatment in low to upper-middle income countries where the challenges of meeting mental health needs are considerable [
There is an urgent need for methodologically robust, adequately powered research evaluating the safety, efficacy, and effectiveness of mental health apps for children and young people with mental health problems. Well-designed RCTs with adequate power and control groups are needed to demonstrate whether mobile apps for mental health have any clinical benefit for children and young people. Because the development of apps is vastly outpacing the development of the evidence base, future research should also utilize quicker, good-quality designs [
List of databases and search strings used for systematic review.
cognitive behavioral therapy
dialectical behavioral therapy
Depression, Anxiety and Stress Scale
mobile health
National Health Service
randomized controlled trial
World Health Organization
RG codesigned the methodology, conducted the literature searches and data analysis, and drafted the manuscript. PS was responsible for review conception and methodology, data interpretation, and read and contributed to the manuscript. JP read and contributed to the manuscript. All authors read, contributed to, and approved the final manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
None declared.