EvalDepApps, a tool that evaluates health apps for depression management
According to the World Health Organization (WHO, 2023), 5% of the world's population has depression , a health problem with high prevalence and that has a strong impact on people's quality of life and social life. In 2012, the WHO warned about the serious burden that depression represents, since it is considered the main cause of disability globally, in terms of the total number of years of healthy life lost due to this affectation (World Federation for Mental Health, 2012). In this context, health applications (apps) become useful tools that can contribute both to the prevention and early detection as well as to the treatment of these disorders. However, currently, most mental health apps designed to treat depression are not based on solid scientific validation, which may result in a lack of effectiveness for the people who use them.
Thus, it is of utmost importance that users have reliable, real-time data in order to make informed decisions about the most appropriate applications when it comes to taking care of their mental health.
Faced with this need, the eHealth Lab research group at the Open University of Catalonia has launched the EvalDepApps project, which aims to create an evaluation tool that allows us to identify health apps that help to better manage depression.
Apps for depression: what really works?
Mobile applications are revolutionizing the health sector, and mental health is no exception. Today, it is estimated that there are approximately 10,000 apps related to mental health, of which, according to some studies, 250 are focused on the treatment or monitoring of depression, and their use is constantly growing. These tools are fast, versatile and generally easy to use, which means that they can contribute to the empowerment of people treated and professionals in health management, making possible more accurate and immediate health mapping and monitoring, more precise diagnoses, and more personalized treatments, among others.
In addition to encouraging users to self-care, health apps also provide 24/7 support, which can make people more likely to share their concerns openly through an app rather than in person or face-to-face. In this sense, and after the COVID-19 pandemic, characterized by people's isolation and an indisputable impact on their mental health, apps have been seen as a resource capable of alleviating symptoms and contributing to a better quality of life for these people.
Mental health on your phone
However, and despite the fact that current European regulations require that applications be considered health products, most of them do not meet this requirement and can be easily downloaded through the usual repositories of our mobile phones. This poses a significant challenge, since, in addition to the risks in terms of data protection and security, in the specific field of mental health, unvalidated health apps can involve additional harm if the intervention or care they provide is not appropriate. All this leads us to ask how we can know which applications are really effective, work well and whether or not they have been scientifically validated.
It should also be noted that these apps are generally targeted at the general population, meaning they do not take into account the particularities of specific groups, and are often not based on solid scientific foundations. As a result, we find that they are unreliable apps when it comes to prescribing a personalized intervention aimed at treating depression.
Thus, it becomes key to have an evaluation instrument that allows us to discern and determine which applications are the best for managing depression, both for the professional who prescribes the app and for the person who uses it.
The EvalDepApps project seeks to develop and pilot an evaluation tool that allows examining health apps dedicated to the treatment, monitoring and social support of people with depression, identifying those that are truly useful and provide value based on the objectives pursued in each case.
Health apps on the market: a detailed analysis of the evaluation criteria
Today, there are several global initiatives that have emerged in recent years and whose objective is to advance the design of an appropriate health app evaluation methodology. Some of these initiatives are the Mobile Health evidence reporting and assessment (mERA) (Agarwal et al., 2016), the AQuAS-UOC framework (Bradway et al., 2017), the Mobile App Rating Scale (MARS) tools (Stoyanov et al., 2015) and Quality of Experience in mHealth Applications (QoE) (Martínez-Pérez et al., 2013) .
Likewise, other more limited models have gradually appeared, aimed at evaluating applications that have a specific objective. In the closest context, institutional initiatives in the regulation of health apps come from Catalonia and Andalusia. In Catalonia, the Office of Standards and Interoperability of Tic Salut Social, which depends on the Department of Health, makes a health app certification service available to users (Seguí et al., 2018). In Andalusia, with the aim of guaranteeing security and reliability, the Andalusian Health Quality Agency designed the AppSaludable label a few years ago for those tools that meet usability, quality, security and privacy criteria (Ferrero, 2013).
Despite the emergence of some initiatives, today there is no official regulation or consensus on the dimensions and items that must be evaluated to consider a health app to be sufficiently safe and effective. On the contrary, as previously mentioned, and as the theoretical frameworks highlight, it is more necessary than ever to have standardized tools and methodologies that allow evaluating the different aspects of the apps, without limiting themselves to only partial aspects, as most current initiatives do today.
In this sense, EvalDepApps aims to fill this gap, addressing all the criteria and dimensions that must be taken into account in order to identify the optimal health apps for the management of depression. The initiative has been funded by the Carlos III Health Institute through the Ministry of Science and Innovation within the framework of the call for applications from the Health Research Fund (FIS). It is also made up of experts from different universities and research centers of international reference: the Autonomous University of Barcelona, the Canary Islands Health Service, ALTHAIA, IDIAP Jordi Gol, the Costa del Sol Hospital, the Denia Hospital, the Germans Trias i Pujol Hospital and the Health Care Institute.
The project is currently in its development phase: an exhaustive review of health applications available on the market supported by scientific evidence has been carried out, and a thorough evaluation of their effectiveness has been made through a meta-analysis taking into account data from waiting lists, minimal interventions and usual clinical practice. The results obtained show that those interventions that use a hybrid format, that is, that combine the use of health apps with face-to-face care, are the ones that are positioned as the most effective compared to conventional clinical care.
Subsequently, the Delphi methodology was applied with the aim of reaching a consensus on the essential criteria that should be incorporated into the evaluation tool. This process involved technology developers, clinical professionals and users diagnosed with depression. However, this method did not contemplate the interaction between the participants. For this reason, the next step of the project includes the holding of co-design workshops with these groups to create a first version of the tool and advance towards its validation. The ultimate goal of the tool is for professionals to have better data to correctly prescribe health applications to people with depression, as well as for users to be able to find the best applications in the usual repositories.
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