Larsen M, Huckvale K, Nicholas J, et al. (2019). Using science to sell apps: Evaluation of mental health app store quality claims. npj Digital Medicine. 2:18. doi: 10.1038/s41746-019-0093-1
Researchers evaluated 73 top-rated mental health applications (apps) in 5 categories (depression, self-harm, substance use disorders, anxiety disorders, schizophrenia) from the Google Play and iTunes app store to evaluate the nature of app efficacy claims and the strategies used to support these claims. Analysis revealed that a majority (53%) of the 73 apps claimed validity in diagnosis of a mental health condition, improvement of symptoms/mood, or self-management. Use of scientific language was the most common strategy to support efficacy claims (44%). However, of the apps that referenced scientific techniques, only about half (53%) included techniques with evidence of efficacy in scientific literature (systematic reviews or randomized controlled trials in MEDLINE, Embase, and PsycINFO databases), while a third of the apps (33%) listed scientific techniques with no evidence of efficacy in scientific literature. The remaining apps (14%) used techniques with mixed or unclear evidence. Only 2 apps (2.7%) cited direct evidence of real-world effectiveness (results from a pilot study and user-reported changes in mood after app use), and none of the apps (0%) had received certification or accreditation. Findings suggest app developers often use unsubstantiated scientific language to attract consumers. The United States Food and Drug Administration (FDA) has begun to explore regulation of health apps through a software precertification pilot program that may offer an opportunity for developers and researchers to collaborate on the collection of higher quality evidence of app efficacy and real-world performance data. To inform consumer choice, researchers suggest app stores implement standardized data fields in which developers could provide evidence-based details about mental health apps.