Electronic Communication with Patients: Advantages and Risks

So Many Mental Health Apps, So Little Research

Mental health smartphone apps can make life easier for people living with depression, substance use, anxiety, schizophrenia, and other disorders. But these mobile tools, often available free or at low cost, are showing up in the Apple App Store and Google Play store faster than research can keep up with them.

The global mental health apps market was valued at approximately $587.9 million in 2018 and is expected to grow to over $3.9 billion by 2027, according to a new report from Absolute Market Insights.

“The vast majority of these apps do not have accompanying scientific evidence for their efficacy and effectiveness,” said Jamie Marshall, a clinical psychologist in private practice in Inverell, New South Wales, Australia, who studies the effectiveness of mental health apps. He anticipates completing a Ph.D. at the University of New England by the end of this year.

Marshall was the lead author of a study that looked at 293 apps claiming to offer therapeutic treatment for depression and/or anxiety. The study published in November 2019 in Frontiers in Psychiatry found that only about 3.4 percent had published research on their effectiveness.

Recovery Record, a free app developed for eating disorders management has been the focus of seven independent research partnerships that have produced almost 20 publications, said Jenna Tregarthen, CEO of Bright Solutions, Recovery Record’s developer.

“Science can be scary because you’re standing the ultimate test of independent research and possibly you’ll get bad results,” Tregarthen said. “But I believe that any health technology company has a duty of care to the users of their products as well as their stakeholders to have rigorous scientific evaluation. And that has to be the new norm.”

A clinical psychologist from Australia, Tregarthen was lecturing in health care innovation and patient-centered design while working on a Ph.D. at Stanford University when she founded Recovery Record in 2012. Since then the app has been used by nearly 900,000 people living with eating disorders.

A California-based HMO study in 2018 found that 289 eating disorder patients using Recovery Record in their outpatient care had a 3.8 times fewer emergency department admissions than a control group over a six-month period.

The same study found low weight patients experienced greater weight gain than the control group.

Patients can use Recovery Record for self-monitoring and share data with providers, including meal logs, outcomes questionnaire responses, and data on compliance with treatment goals and coping skills.

The app has undergone numerous updates since its introduction in 2012 to incorporate feedback from clinicians. A new feature recently added at the request of registered dieticians allows users to track stool, Tregarthen said.

“I really think the success of our platform is because it’s been constantly evolving based on what providers are saying they need so we’re building what’s actually practical and useful for them,” Tregarthen said.

Happify is an app that uses scientific research from positive psychology, cognitive behavioral therapy and mindfulness to offer games, tasks and quizzes and blog posts. Five open access published research studies about Happify include a randomized controlled trial that found about a 25 percent reduction in symptoms of anxiety and more than a 25 percent reduction in symptoms of depression for users who completed at least 16 activities over eight weeks.

Happify has an activity called Breather that provides biofeedback on heart rate variability. A randomized experimental trial showed users of Breather recovered 10 percent more effectively from stress than those who did not use the app.

“That’s a study we’re very proud of,” said Chief Scientist Acacia Parks, Ph.D. of the Breather study, which was published in November 2019 in JMIR Serious Gaming. “It’s one of the first times we’ve been able to bring in a biomarker and actually see that when we put people in a stressful situation in a lab and they used Breather, their bodies recovered from that stressful experience more quickly.”

Parks had been an associate professor of psychology at Hiram College before joining Happify full time in 2015 when the app hit one million users. The number of users has now reached four million consumers. Parks said a study looking at the impact of using Happify on self-reported loneliness is in progress.

The American Psychiatric Association’s App Evaluation Model uses a hierarchical rating system and rubric to assess what a mental health app claims to do versus what it actually does and what published scientific evidence is available. The model also considers when the app was last updated, what data is collected, who it is shared with and if users can opt out.

Clinicians who want to see what other experts think of a particular app can also check out online reviews in PsyberGuide, a project of the nonprofit organization One Mind. Nearly 200 apps have been rated based on credibility, user experience and transparency with an average credibility score of 2.44 and an average user experience score of 3.62, according to Project Manager Martha Neary, M.Sc.

Recovery Record scores a 4.29 out of 5 for credibility and a 2.9 out of 5 for user experience on PsyberGuide. But it was rated unacceptable for transparency because the reviewer could not find evidence that the app encrypts or de-identifies data or states that user information is stored locally.

In response, Tregarthen confirmed data is stored both locally and is encrypted on the device used and server, adding that the app is compliant with the HIPAA Privacy Rule. She said she planned to seek advice about the need to be more explicit about the level of encryption in the company’s privacy policy.

Neary said Recovery Record’s recent update in December 2019 would likely raise Recovery Record’s credibility rating which would show up when PsyberGuide completes an extensive re-review process.

Happify earned a 3.93 out of 5 for credibility and a 3.34 for user experience on PsyberGuide. It also received a questionable rating for transparency because of the lack of clarity on whether users can use the app without entering identifiable information. The app is HIPAA compliant and its privacy policy states that app users need to provide a valid email address.






So Many Mental Health Apps, So Little Research

Janine Weisman

Janine Weisman is a journalist based in Newport, Rhode Island who frequently writes about mental health. Find her on twitter @J9Weisman.


APA Reference
Weisman, J. (2020). So Many Mental Health Apps, So Little Research. Psych Central. Retrieved on September 19, 2020, from


Scientifically Reviewed
Last updated: 9 Mar 2020
Last reviewed: By John M. Grohol, Psy.D. on 9 Mar 2020
Published on All rights reserved.