The latest report of the PAHO (Pan American Health Organization) estimated the prevalence of depression in Spain to be 5.2%, and there is every indication that mental health disorders will increase significantly in the wake of the COVID-19 pandemic.
In this scenario, the use of mobile apps could help both in the prevention and treatment of these disorders, working in tandem with other treatments. But how do we really know which applications work and are scientifically validated? A team led by Carme Carrion, member of the eHealth Center, leader of the eHealth Lab research group at the UOC, has launched a project to develop a tool and methodology to help both patients and professionals identify the best apps for managing depression. The aim of the EvalDepApps project is to design an instrument to evaluate the apps that are being used in this field, in order to differentiate those that can be useful and add value.
We want to help professionals and users to separate the wheat from the chaff and identify the apps that can help to better manage the health problem on a daily basis, while also providing more data in real time and conditions that enable professionals to monitor more closely the evolution and process of each person affected by depression."
Carme Carrion, research director, UOC's Faculty of Health Sciences
The project team consists of 16 researchers from 8 different institutions. In addition to Carme Carrion (project coordinator), other participants from the UOC are Antoni Pérez-Navarro (member of the Faculty of Computer Science, Multimedia and Telecommunications and researcher with the ICSO group) and eHealth Center researchers Noemí Robles and Francesc Saigí (member of the UOC's Faculty of Health Sciences and director of the World Health Organization Collaborating Centre for Digital Health). The project will also include participation from patients and professionals from other research and healthcare institutions in Catalonia, the Valencian Community, Andalusia and the Canary Islands.
The risks of mental health apps
It is currently estimated that there are around 10,000 mental health applications of which, according to preliminary data from researchers, 250 are dedicated to treating, monitoring and supporting people with depression. "Apps considered to be medical devices currently need to follow a specific European regulation, but most of them are not classified as such, and are often accessible in the IOS and Android repositories and can be downloaded by everyone," explained Carme Carrion.
Any application can have security and data protection risks, but apps in the field of mental health may carry an added risk if the information they provide is inadequate. "These apps are often not addressed to specific individuals and are too general to be useful to most of the people who use them. There are only a few based on solid scientific evidence, so there is a danger that they will suggest actions or therapies without any validity, or even ones causing effects that run contrary to what is required," the researcher pointed out.
In this context, the healthcare system needs reliable, safe and effective tools to assess these applications. "This way, professionals will have more information to prescribe apps without risk for the patient and with maximum guarantees about their potential effectiveness; and patients will also be able to identify which apps have the best rating and can be found in the usual repositories," said Carme Carrion.
Application analysis and assessment criteria
The project will carry out a review of current apps for treating, monitoring and supporting people with depression. It will also look at what strategies are currently being used to evaluate such apps, as there is no official regulation, nor is there a consensus on what criteria should be assessed to consider a health app as sufficiently safe and effective. "There are different initiatives to assess mobile health solutions, however this assessment is often only partial. Thus, the validation and evaluation of health apps does not yet have an agreed, thorough and complete methodology for their risks, benefits, costs, social impact and organizational impact, or ethical and legal aspects," explained the researcher.
In order to carry out this task, the researchers based their work on the experience gained during a previous project carried out by the same EvalApps team, which created an app assessment system that helps to manage overweightedness and obesity. In that project,common criteria were identified to assess all types of apps, regardless of their purpose: data security and privacy, usability, reliability, level of development, and functionality.
EvalDepApps will take these parameters and - with participation from patients, app experts and mental health and primary care professionals- it will define the appropriate criteria in terms of effectiveness and safety of the actions to manage depression. "There are valid tools in general terms to assess any type of health app, but we need to find the criteria to validate their effectiveness and safety in the different types of health problems they address. In the field of mental health there are also some recommendations, for example from the American Psychiatric Association, but they have to be adapted to our context," she explained.
Co-creation workshops to design the app
After that, different co-creation workshops will be organized, inspired by the design thinking methodology, to design the app evaluation tool; this will involve defining the most appropriate instrument (app, website, multi-platform system, etc.) as well as the requirements or characteristics it should have to be useful and easy to use. For this process, the participation of both patients and experts from different disciplines is very important. "For some time now, developers and health professionals have been working closely together. However, to ensure that people make ongoing use of an app, we need to add the vision of the end user. This is key," the researcher pointed out.
Once developed, the tool will be tested with a group of volunteers, including users and health professionals. The final tool will be handed over to the different health departments of the autonomous communities concerned and made available to the general public free of charge in an open access format.