Using Apps for Clinical Care? 5 Steps to Legal, Ethical, Evidence-Based Mental Health Apps

Privacy Failures – Research into Mental Health Apps, Part II


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App privacy is a crucial aspect to consider when utilizing mental health apps. However, a recent study by researchers Camacho, Cohen and Torous and published in JAMA Network Open showed no correlation between app privacy scores and consumer ratings. The study reviewed 578 mental health apps, examining various features including privacy. These findings highlight the importance for professionals to carefully evaluate and consider the privacy and accessibility of mental health apps before suggesting them for mental health support. The article below is a continuation of Therapy Apps – research into Mental Health Apps, Part I.

Insights Into Mental Health App Privacy Policies 

The study has revealed some key findings concerning the privacy and features of these apps:

Of the 578 apps reviewed, only 77% had a privacy policy. Nearly a quarter of the apps needed clear guidelines for handling user data.

The study found that, on average, the privacy policies that were present were written in at a 12th-grade reading comprehension level. This is concerning to supporters of the plain language community because the average reading level in the United States is 7-8-th grade. The finding suggests then, that many people will not understand the privacy implications of the apps used to track their behavioral health information.

The study also looked at the sharing of personal information with third parties. It was found that 44% of the apps shared personal health information (PHI), demographic data, and medical histories with third parties. This means that a significant portion of the apps shared sensitive information without their users’ explicit consent.

The study scraped and collected data from app vendors, analyzing the privacy scores of apps on the App Store and Google Play Store. The findings showed no significant correlation between privacy scores and the number of downloads on the Apple App Store. However, the number of downloads on Google’s store was weakly correlated with privacy.

However, Google Play Store app downloads could have been better connected with privacy ratings, demonstrating that app popularity indicators do not help identify applications with higher privacy.

There was no statistically significant correlation between privacy scores and star ratings. The researchers concluded that star ratings or the number of downloads for mental health apps currently available in the marketplace may not provide adequate information about the privacy or efficacy of mental health apps. In other words, app privacy metrics are not helpful for identifying apps with increased privacy.

Accessibility of Mental Health Apps

Another issue examined by the researchers involved accessibility features, which may include adjustable text size, and text-to-speech or speech-to-text abilities. Another accessibility feature is a colorblind color scheme adjuster. Only half of the apps reviewed included a single accessibility feature.

  • The researcher’s findings also mirror results in the literature indicating the limited availability of mental health apps offered in Spanish, with only 18% of the apps studied including with Spanish language functionality. Only 2% of the mental health apps were designed to support individuals experiencing schizophrenia.
  • Three hundred seventy-eight apps could function without an Internet connection, making them accessible to a broader range of individuals.
  • Almost 88% of all apps were available for free download, with 39% completely free and 44% available as in-app purchases. 34% of apps required a subscription to unlock all functionality.
  • These findings suggest that while the app marketplace offers a plethora of apps, marketplace forces alone are not creating an ecosystem of apps that are accessible to all or increasing access in patient groups that may need the most support.

“These findings suggest that apps on the marketplace offer overlapping features, and metrics such as star ratings or the number of downloads may not provide adequate information about the privacy or efficacy of mental health apps,” the journal article authors wrote.

Limitations of this Mental Health App Study

The study has its own set of limitations that must be taken into consideration when interpreting the results.

The focus of the study was primarily on evaluating the content type rather than the quality of the content.

Some of the apps included in the study cost $10 or less, which may not accurately represent the entire app landscape as more costly apps may offer different features.

The study’s findings may indicate the regulatory landscape for the most popular or widely used mental health apps from both app stores but cannot be generalized to all mental health apps.

“The findings of this cross-sectional study suggest that the current app marketplace lacks diversity in offerings and fails to implement potentially high-impact features,” the study’s authors wrote. “Another challenge to the app space is that easily accessible metrics like star ratings fail to consider privacy capabilities. Thus, clinicians and patients must discern apps beyond such measures to ensure the discovery of apps that both fit their unique needs and protect their privacy.”

Part I of this 2-part review of the important contribution made by researchers Camacho, Cohen, and Torous and published in JAMA Network Open can be found below, along with other blog posts published by in recent years.

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