Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality.
BACKGROUND
With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality.


OBJECTIVE
Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content.


METHODS
A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed.


RESULTS
Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%).


CONCLUSIONS
In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public.
Black Dog Institute, University of New South Wales, Sydney, Australia. j.nicholas@blackdog.org.au.
Jennifer
http://orcid.org/0000-0003-1889-1107
J
Nicholas
Mark Erik
http://orcid.org/0000-0002-0272-2053
ME
Larsen
Judith
http://orcid.org/0000-0002-3872-9871
J
Proudfoot
Helen
http://orcid.org/0000-0003-0435-2065
H
Christensen
D001315:Australia; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D006801:Humans; D063731:Mobile Applications / Q000592:standards; D010353:Patient Education as Topic / Q000379:methods*; D018907:Privacy; D012648:Self Care; D000068997:Smartphone; D017216:Telemedicine / Q000295:instrumentation
bipolar disorder; mobile applications; review; telemedicine