Apps May Promote Overdiagnosis of Mental Health Conditions

Norra MacReady

July 16, 2018

Mobile apps that offer advice on managing mental health may "medicalize" normal ups and downs and encourage the overdiagnosis of certain conditions, the results of a new study suggest.

Many of the apps urge people to assume personal responsibility for their improvement, without taking into consideration external and social factors related to mental health, senior author Quinn Grundy, PhD, RN, from the Charles Perkins Centre, Sydney School of Pharmacy, Faculty of Medicine and Health at the University of Sydney in Australia, says in a related press release.

In addition, the implication that mental health problems are widespread "promotes the medicalization of normal states," lead author Lisa Parker, PhD, MBBS, a postdoctoral research associate at the Charles Perkins Centre, warns in the release.

"Physicians should counterbalance these messages where necessary to ensure that self-help is just one aspect of a supportive climate for mental health care," the authors write in their article, published in the July/August issue of the Annals of Family Medicine.

Impetus for the study came from the authors' observation that, despite the growing popularity of these apps, evidence for their efficacy is limited, other than a recent meta-analysis showing some benefit in the management of depression. Therefore, Parker and colleagues conducted a qualitative content analysis of advertising materials for 61 popular mental health apps to determine how the apps frame the issues of mental health and illness, and how that in turn shapes perceptions of the pattern, causation, and management of mental health problems.

Of the apps included in the analysis, 36 (59%) were free. "Thirty-five apps (56%) claimed to reduce anxiety, panic, and stress, and 16 (26%) claimed to benefit those with mood disorders. The remaining 11 (18%) focused on well-being or other mental health issues (eg, anger management, eating disorders)," the authors write.

The therapeutic modalities most commonly offered fell into 3 categories: calming, such as mindfulness; cognitive restructuring, such as cognitive behavioral therapy; and tools for tracking, sharing, and comparing of mental states, such as self-monitoring instruments.

One prominent message to emerge was that "mental health problems existed for everybody," although the materials mostly portrayed people who were "employed, white, and in a family," the authors point out. Another message was that many mental health issues were the result of "unhelpful psychological habits" or "abnormal neurophysiology that could produce problems after a minor trigger."

"Only a few apps implied mental health symptoms might be a normal reaction to external stress," the authors say.

In addition, the materials often used moralistic language to promote use of the app, such as, "[t]ake action to improve your life," or, "if you are serious about managing your anxiety then you can do it yourself using the techniques in this app."

Many of the apps touted their ease of use, the authors add, yet often they "required frequent user action to deliver results."

Overall, the authors concluded that the apps conveyed 2 dominant messages: "(1) poor or fragile mental health is ubiquitous, and (2) individuals can easily manage their own mental health problems with apps." However, the scientific evidence offered to support these claims was limited.

The idea that mental health problems are common might help to reduce stigma, but may also promote "overdiagnosis and overtreatment," leading to "unnecessary treatment and divert resources from those who really need help," the authors write.

In addition, the focus on personal responsibility for managing one's mental health, without acknowledging the role of external factors, "constitutes a denial of the social determinants of health."

The authors recommend that clinicians ask patients about their use of these apps and try to counteract some of these messages. For example, "patients may benefit from discussion about the limitations of app use and be encouraged to seek clinical attention for important or enduring psychological distress." Clinicians also might help by presenting "alternative views about what constitutes normal psychological experiences, with specific attention toward counteracting medicalization."

"At the same time, people who have severe mental health issues may be helped by [general practitioners] or mental healthcare workers' discussions around the limitations of app use and the importance of seeking additional forms of supportive health care where needed," Parker said in the release.

Study limitations include restriction of the analysis to app advertising materials, use of a sample of mental health apps that may not be representative, the fact that many app developers frequently update or revise their material, and the possibility that consumers may not use the apps as directed or may be unaffected by their messages.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2018;16:338-342. Full text

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