Conference Coverage

Vet accuracy, privacy policies of mental health apps


 

EXPERT ANALYSIS FROM APA 2019

– Smartphones are nearly ubiquitous, and the apps available on them run the gamut from entertainment to social media, organization tools, and references. It should be no surprise that mental health applications are also gaining traction, as people experiencing depression, anxiety, and other conditions turn to these programs for assistance.

Psychiatrists should be aware of any mental health apps that their patients are using, and they should do a little research to determine their safety and efficacy, according to Hephsibah M. Loeb, MD, a psychiatry resident at Jefferson Medical College, Philadelphia.

“It’s our responsibility to understand the medications we’re prescribing, so I don’t think this is any different,” said Dr. Loeb, who presented a poster outlining advice for clinicians at the annual meeting of the American Psychiatric Association.

One such app, called reSET, gained approval from Food and Drug Administration for the treatment of alcohol, cocaine, marijuana, and stimulant use disorders. Another app, called PRIME-D, designed for self-management of depression, showed some benefit in an open-label study. But there are many more apps out there, and how is a clinician to know of the potential benefits and hazards?

In her poster, Dr. Loeb outlined the APA’s App Evaluation tool, which is designed to help clinicians systematically investigate an app. The APA has no standing list of reviewed apps because they are changing all the time, and new apps are introduced and removed all the time.

“The evaluation model is a set of questions that the APA developed [representing] certain issues that if a patient reports using an app, a clinician should look into in order to determine if it’s an appropriate and safe tool. For example: Who developed the app? What is its privacy policy? Is the information correct?” Dr. Loeb asked.

Privacy is of particular concern, since the patient has no way of knowing how his or her data are being handled. “If you’re putting really personal stuff in there and you don’t know where it’s going, that’s a huge risk. We have HIPAA protection in the office, but needless to say, if someone downloads something from the app store, their information is not going to be protected by HIPAA,” Dr. Loeb said.

Despite these concerns, Dr. Loeb is not a naysayer. “I think that self-help is really interesting. Presumably, there are patients we’re not even seeing in the office,” she said. In some cases, people are not patients but have a complaint and need help. “If there weren’t an app or online therapy, they might not otherwise get help.”

But whether the help they’re getting is reliable is another question. “There’s the chance that the information is perfectly accurate; there’s the chance that there’s misinformation. There’s also the chance of mis–self-diagnosis,” Dr. Loeb said.

She specifically advises that clinicians recommend apps to their patients that permit data sharing with the clinician, since better clinical outcomes with apps are associated with receiving support from a trained mental health coach.

Finally, there’s one sure way to determine the quality of an app: Dr. Loeb said that a coauthor on the poster, Ann Chandy, MD, a clinical professor of psychiatry at Jefferson Medical College, uses an app herself when a patient brings it to her attention.

Dr. Loeb reported no relevant financial disclosures.

Next Article: