Use of mobile apps and technologies in child and adolescent mental health: a systematic review

TLDR: Mental health apps directed at young people have the potential to be important assessment, management and treatment tools, therefore creating easier access to health services, helping in the prevention of mental health issues and capacitating to self-help in case of need.

Abstract: Question This review will aim to critically evaluate the currently available literature concerning the use of online mobile-based applications and interventions in the detection, management and maintenance of children and young people’s mental health and well-being. Study selection and analysis A systematic literature search of six electronic databases was conducted for relevant publications until May 2019, with keywords pertaining to mental health, well-being and problems, mobile or internet apps or interventions and age of the study population. The resulting titles were screened and the remaining 92 articles were assessed against the inclusion and exclusion criteria with a total of 4 studies included in the final review. Findings In general, young people seem to engage very well with this type of tools, and they demonstrate some positive effects in emotional self-awareness. There have been some studies about this issue and many of the outcomes were notstatistically significant. However, it is still a sparsely documented area, and more research is needed in order to prove these effects. Conclusions Mental health apps directed at young people have the potential to be important assessment, management and treatment tools, therefore creating easier access to health services, helping in the prevention of mental health issues and capacitating to self-help in case of need. However, a limited number of studies are currently available, and further assessments should be made in order to determine the outcomes of this type of interventions.

Figures

Table 1: Study Characteristics and Findings

Figure 1: Referral to Community CAMH Services per 100,000 population. Source: Earle, J. Children and Young

Table 2: Risk of Bias in Selected Studies. Adapted from Moher et al. (2009)[37].

Full text

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Punukollu, M. and Marques, M. (2019) The use of mobile apps and
technologies in child and adolescent mental health. Evidence-Based Mental
Health, 22(4), pp. 161-166. (doi: 10.1136/ebmental-2019-300093)
The material cannot be used for any other purpose without further
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http://eprints.gla.ac.uk/188842/
Deposited on 21 June 2019
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The Use of Mobile Apps and Technologies in Child and
Adolescent Mental Health: a Systematic Review
Corresponding author names and contact details:
Full name: Mallika Punukollu
Postal address: 213 Main Street, East Renfrewshire CAMHS, Barrhead Health and Social
Care Service, 1st floor, Barrhead G78 1SW
Telephone number: 01418007886
e-mail: mpunukollu@nhs.net
ORCID ID: 0000-0001-8407-2543
Author names and affiliations:
• Mallika Punukollu, Glasgow Royal Infirmary Library and eLearning Centre Glasgow,
UK; NHS Greater Glasgow and Clyde, CAMHS Glasgow, Glasgow, UK
• Mafalda Marques, Child and Adolescent Psychiatry Service, Pediatric Hospital of
Coimbra, Hospital and University Centre of Coimbra, Portugal
Word count: 3644

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Abstract
Question: This review will aim to critically evaluate the currently available
literature concerning the use of online mobile-based applications and
interventions in the detection, management and maintenance of children and
young people’s mental health and wellbeing.
Study Selection and Analysis: A systematic literature search of 6 electronic
databases was conducted for relevant publications until May 2019, with
keywords pertaining to mental health, wellbeing and problems, mobile or
Internet apps or interventions and age of the study population. The resulting
titles were screened and the remaining 92 articles were assessed against the
inclusion and exclusion criteria with a total of 4 studies included in the final
review.
Findings: In general, young people seem to engage very well with this type of
tools and they demonstrate some positive effects in emotional self-awareness.
There have been some studies about this matter and many of the outcomes were
not significantly significative. However, it is still a sparsely documented area and
more research is needed in order to prove these effects.
Conclusions: Mental health apps directed at young people have the potential to
be important assessment, management and treatment tools, therefore creating
easier access to health services, helping in the prevention of mental health issues
and capacitating to self-help in case of need. However, a limited number of
studies are currently available, and further assessments should be made in order
to determine the outcomes of this type of interventions.
Keywords: child and adolescent mental health, mobile health apps,
electronic health.

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List of Abbreviations
MH: Mental Health
CYP: Children and Young People
NHS: National Health Service
Apps: Mobile or Internet Applications
CAMH: Child and Adolescent Mental Health
CAMHS: Child and Adolescent Mental Health Service
CBT: Cognitive Behaviour Therapy
h.apps: health apps
m.tech: mobile technologies
RCT: Randomised Controlled Trial
ESA: Emotional Self-Awareness
IVR: Interactive Voice Response

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Summary Box:
What is already known about this subject?
• At present, child and adolescent mental health has constantly increasing needs
in terms of resources and investigation.
• In the past few years, technology has become more and more present in our
everyday routine and Internet and smartphones are now an ordinary tool on our
daily basis. Consequently, health apps are also increasing every day.
• Incorporating health apps in screening, assessment and management of mental
health issues in young people is now a promising field of study.
What are the new findings?
• There have been some studies about this matter and many of the outcomes
were not significantly significative.
• However, it is still a sparsely documented area and more research is needed in
order to prove this effects.
• In general, young people seem to engage very well with this type of tools and
they seem to demonstrate some positive effects in emotional self awareness.
How might it impact on clinical practice in the foreseeable future?
Mental health apps directed at children and adolescents have the potential to be
important assessment, management and treatment tools in this age group,
therefore creating a more easy access to mental health services, helping in the
prevention of more serious mental health issues and capacitating young people to
help themselves in case of need.

Frequently asked questions

Q1. Why were the results of the RCT and cross sectional studies included?

Owing to time constraints onlythe results of “full” studies such as RCT and cross sectional studies were included; ideally results of all available literature would have been included. 

Q2. What is the significant and impactful change to society in the last 50 years?

Mental Health6Arguably the most significant and impactful change to society in the last 50years has been the digital revolution, the introduction of digital technology and the Internet to all aspects of life; this includes interest in using them in the service of health; widely accepted applications already in use (Supplementary File 1: Digital Health Tool. 

Q3. What is the main reason for the lack of a regulatory framework for h.apps?

Another important consideration is the language: 56% of the apps are only available in English[17], making use in an increasing multicultural society more difficult. 

Q4. What is the surprising thing about the rise of digital health?

With the advent of smartphones, mobile telephones capable of computerfunctionality, digital health related content is in everyone’s pocket: 64.3% of the UK population owns a smartphone, with an even larger proportion regularly going online[12], so it is not surprising that the market of downloadable applications or “apps” has also embraced digital health content. 

Q5. How old were the participants in the Jang et al. (2017) study?

81.4% of participants in the Jang et al. (2017) study were aged 10 to 29 years but no further breakdown of the groups composition in terms of ages was provided[34]. 

Q6. What does the author think of h.apps?

This suggests that h.apps are an acceptable resource and can be a useful vehicle for enhancing access to evidence-based monitoring and self-help. 

Q7. What is the reason for the positive effects observed by Whittaker and Reid?

It may be that the effects observed by Whittaker[39] and Reid[37] are due to the usage of an app that makes adolescents think about their MH; this alone may have a positive effect as explained by Whittaker who notes that “the attention control was equally efficacious”[39]. 

Q8. What are the limitations of the review?

16In addition, confining the search to articles available in the English languagemay have limited the power of the review, particularly in the area of developing countries, applicability to low income countries being low. 

Q9. What is the reason why the MEMO-CBT program was not included in the review?

For this review, a total of 6 articles met the inclusion criteria which arereflective of the fact that the study of mobile technologies in child and adolescent mental health is still in its relative infancy. 

Q10. What is the way to provide a MH monitoring program?

The very act of engaging with MH monitoring may be beneficial for CYP and relatively inexpensive and user friendly apps may be the ideal mode to deliver that benefit in a cost-effective and efficient manner.