title: Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress.
abstract: BACKGROUND
  The benefits of self-monitoring on symptom severity, coping, and quality of life have been amply demonstrated. However, paper and pencil self-monitoring can be cumbersome and subject to biases associated with retrospective recall, while computer-based monitoring can be inconvenient in that it relies on users being at their computer at scheduled monitoring times. As a result, nonadherence in self-monitoring is common. Mobile phones offer an alternative. Their take-up has reached saturation point in most developed countries and is increasing in developing countries; they are carried on the person, they are usually turned on, and functionality is continually improving. Currently, however, public conceptions of mobile phones focus on their use as tools for communication and social identity. Community attitudes toward using mobile phones for mental health monitoring and self-management are not known.
  
  
  OBJECTIVE
  The objective was to explore community attitudes toward the appropriation of mobile phones for mental health monitoring and management.
  
  
  METHODS
  We held community consultations in Australia consisting of an online survey (n = 525), focus group discussions (n = 47), and interviews (n = 20).
  
  
  RESULTS
  Respondents used their mobile phones daily and predominantly for communication purposes. Of those who completed the online survey, the majority (399/525 or 76%) reported that they would be interested in using their mobile phone for mental health monitoring and self-management if the service were free. Of the 455 participants who owned a mobile phone or PDA, there were no significant differences between those who expressed interest in the use of mobile phones for this purpose and those who did not by gender (χ2(1), = 0.98, P = .32, phi = .05), age group (χ2(4), = 1.95, P = .75, phi = .06), employment status (χ2(2), = 2.74, P = .25, phi = .08) or marital status (χ2(4), = 4.62, P = .33, phi = .10). However, the presence of current symptoms of depression, anxiety, or stress affected interest in such a program in that those with symptoms were more interested (χ(2) (1), = 16.67, P < .001, phi = .19). Reasons given for interest in using a mobile phone program were that it would be convenient, counteract isolation, and help identify triggers to mood states. Reasons given for lack of interest included not liking to use a mobile phone or technology, concerns that it would be too intrusive or that privacy would be lacking, and not seeing the need. Design features considered to be key by participants were enhanced privacy and security functions including user name and password, ease of use, the provision of reminders, and the availability of clear feedback.
  
  
  CONCLUSIONS
  Community attitudes toward the appropriation of mobile phones for the monitoring and self-management of depression, anxiety, and stress appear to be positive as long as privacy and security provisions are assured, the program is intuitive and easy to use, and the feedback is clear.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia. j.proudfoot@unsw.edu.au
authors.forename: Judith
authors.initials: J
authors.lastname: Proudfoot
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
authors.forename: Dusan
authors.initials: D
authors.lastname: Hadzi Pavlovic
authors.forename: Vijaya
authors.initials: V
authors.lastname: Manicavasagar
authors.forename: Einat
authors.initials: E
authors.lastname: Adler
authors.forename: Alexis
authors.initials: A
authors.lastname: Whitton
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control*; D001294:Attitude to Health; D001315:Australia / Q000453:epidemiology; D040421:Cell Phone / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000706:statistics & numerical data*; D018907:Privacy; D012649:Self Concept; D013315:Stress, Psychological / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D055815:Young Adult