Effectiveness of evidence based mental health apps on user health outcome: A systematic literature review

Yeganeh Shahsavar; Avishek Choudhury

doi:10.1371/journal.pone.0319983

Peer Review History

Original SubmissionJuly 25, 2024
25 Jul 2024 Author Response https://doi.org/10.1371/journal.pone.0319983.r001
31 Oct 2024 Decision Letter - Ethan Moitra, Editor Dear Dr. Choudhury, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. As you will notice, I was only able to secure one reviewer for this manuscript. I conducted a review as well and agree with their helpful and clear comments. If you choose to revise and resubmit this manuscript, please address all of their concerns. If you resubmit, I might secure an additional reviewer. Please submit your revised manuscript by Dec 15 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . 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Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: This paper provides information about the effectiveness of evidence-based health apps on user mental health outcomes. The article provides information with high clinical relevance in the field of mental health interventions. However, some aspects must be improved to facilitate understanding. In this sense, I would like to add some comments/suggestions to this paper: • It is recommended to include the protocol registration number (line 103). • Why have authors limited the objective of the study only to these mental health problems (depression, anxiety, bipolar disorder, psychosis, and suicidal behaviors)? • Some search terms (depression, anxiety, suicide, mobile, app, and smartphone) do not match the aim of the study (depression, anxiety, bipolar disorder, psychosis, and suicidal behaviors). Bipolar disorder and psychosis are not included as search terms. • It is recommended to provide more information about the methodology for selecting articles (e.g., if it was done by title and abstract; if, in the event of not reaching an agreement, they included third parties in the decisión; what specific software was used to remove duplicates and for screening abstract). • Were all the apps based on the cognitive behavioral approach? Did any applications include functions from other approaches? In order to better understand the results, it is recommended to include a table specifying the components of the different apps (e.g., mindfulness, physical activity tracking) for each CBT-function. • It is recommended to specify the number of articles deleted by title and the number of articles deleted by abstract separately. • Was any quality assessment carried out on the articles used? For example, through the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) • In Table 1 it is recommended to indicate the standard deviation of the age of the participants. • It is recommended to review and unify the uppercase and lowercase letters used in the instruments column of table 1 • On lines 176-177 it is recommended to indicate the number of studies. • The improvement in mental health outcomes is mentioned in the discussion section. However, few applications address suicidal behaviors. It is recommended that this section be redone, specifying mental health information obtained in more detail. • Table 3 does not indicate whether the results obtained were short or long term. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? 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Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: report form plos one.docx https://doi.org/10.1371/journal.pone.0319983.r002
Revision 1
22 Jan 2025 Author Response Response to Editor Dear editor. Thank you for giving us the chance to improve the manuscript. Given the delay, we decided to redo the entire review and update our results. We have addressed all the comments and more. We were asked to include a list of all papers screened, with their DOI/Link and reason for exclusion (which I have never seen in my life before). All this information has been provided in S4 – however, I am unsure what value it will add to our work. Response to Reviewers Reviewers Reviewer #1: This paper provides information about the effectiveness of evidence-based health apps on user mental health outcomes. The article provides information with high clinical relevance in the field of mental health interventions. However, some aspects must be improved to facilitate understanding. In this sense, I would like to add some comments/suggestions to this paper: • It is recommended to include the protocol registration number (line 103). Response: We added the OSF protocol citation. “The detailed protocol (osf.io/x6m7u) is registered at the Open Science Framework [39].” • Why have authors limit the objective of the study only to these mental health problems (depression, anxiety, bipolar disorder, psychosis, and suicidal behaviors)? Response: We agree. However, reviews on other mental health disorder already exist and for some disorders, there are no apps for us to evaluated. We have clarified this in the manuscript. “Few existing review in this field have focused on feasibility of various apps designed for agoraphobia, eating disorders, post-traumatic stress disorders (PTSD), substance use disorders, sleep disorders [34, 35]. However, there is lack of evidence reviewing effectiveness of mobile apps in improving mental health outcomes [36, 37].” • Some search terms (depression, anxiety, suicide, mobile, app, and smartphone) do not match the aim of the study (depression, anxiety, bipolar disorder, psychosis, and suicidal behaviors). Bipolar disorder and psychosis are not included as search terms. Response: Thank you for pointing this out. We started with those keywords, but there are studies involving an app that matches our inclusion criteria. We then revised our search term in the manuscript to avoid further discrepancies. “Search query consisted of the following ((Depression OR anxiety OR suicid) AND (Mobile OR app OR smartphone)) NOT (sleep OR alcohol OR drugs OR addiction OR tobacco) (see S2)”. • It is recommended to provide more information about the methodology for selecting articles (e.g., if it was done by title and abstract; if, in the event of not reaching an agreement, they included third parties in the decision; what specific software was used to remove duplicates and for screening abstracts). Response: We have now updated this section to specify that Excel sheets were used for duplicate removal, decisions on conflicts were resolved through discussion between the two authors without the involvement of third parties and how titles and abstracts were screened. “The methodology for selecting studies involved a multi-step process. Two authors independently selected the studies using the inclusion and exclusion criteria. Conflicts were then resolved with discussion, without the involvement of third parties. First, duplicates were identified and removed using Excel sheets created from the database exports. Titles of potentially relevant studies were then screened manually to eliminate irrelevant articles. This was followed by a review of abstracts to exclude studies that did not use mobile phone technology, did not focus on mental health apps, lacked emphasis on treatment or mental health impact, or addressed unrelated topics like mobile or technology addiction. Finally, full-text studies were evaluated against the inclusion and exclusion criteria”. • Were all the apps based on the cognitive behavioral approach? Did any applications include functions from other approaches? To better understand the results, it is recommended to include a table specifying the components of the different apps (e.g., mindfulness, physical activity tracking) for each CBT function. Response: All the apps included in this study were based on the cognitive behavioral approach, as their core components (e.g., cognitive change, attention change, and context engagement) align with CBT principles. While some functions, such as distress tolerance (BlueIce app) and self-soothing (iBobbly app), share similarities with techniques used in Dialectical Behavior Therapy (DBT), these were integrated within a CBT framework. Additionally, general wellness strategies, such as physical activity tracking and gamified challenges, complement CBT techniques by enhancing behavioral engagement. To address this comment, we have added an extra column to Table III that specifies the components of each app (e.g., mindfulness, physical activity tracking) and their alignment with CBT functions, ensuring comprehensive understanding. • It is recommended to specify the number of articles deleted by title and the number of articles deleted by abstract separately. Response: Thank you for your suggestion. We have included the specific numbers of articles deleted at each stage (by title and by abstract) in the manuscript. Also see S4. • Was any quality assessment carried out on the articles used? For example, through the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) Response: Yes, we conducted a quality assessment of the included articles using the Mixed Methods Appraisal Tool (MMAT) instead of EPHPP. Quality Assessment and Risk of Bias: “We conducted a quality assessment of the papers following the Mixed Methods Appraisal Tool (MMAT) (see S3) [42]. The MMAT assesses the quality of qualitative, quantitative, and mixed methods studies. It focuses on methodological criteria and includes the nature of the study (randomized or nonrandomized clinical trial) across the performance bias, detection bias, attrition bias, and selection bias. No articles were excluded”. • In Table 1 it is recommended to indicate the standard deviation of the age of the participants. Response: We reviewed and updated Table 1 to include the mean and standard deviation (SD) of participant ages for studies where these values were explicitly reported in the original articles. For other studies that only provided age ranges, we were unable to calculate or include the SD due to the lack of detailed data. • It is recommended to review and unify the uppercase and lowercase letters used in the instrument’s column of table 1 Response: Thank you for the suggestion. We have reviewed and updated the "Survey Instrument" column in Table 1 to ensure consistency in the use of uppercase and lowercase letters. All survey names now follow a standardized Title Case format with properly formatted acronyms in parentheses. • On lines 176-177 it is recommended to indicate the number of studies. Response: We have addressed this by including the number of studies corresponding to each approach in the manuscript. • The improvement in mental health outcomes is mentioned in the discussion section. However, few applications address suicidal behaviors. It is recommended that this section be redone, specifying mental health information obtained in more detail. Response: Thank you for your valuable feedback. We have revised the discussion section and provided more detailed information, particularly regarding suicidal behaviors. Discussion: “Our review also highlights a gap in the efficacy of mHealth apps for managing more complex mental health conditions such as suicidal behaviors, where evidence remains scant and less definitive. Only a few apps specifically target suicidal ideation or behaviors. For example, among the apps reviewed, BlueIce and TEC app include features designed to help users manage self-harming and suicidal thoughts. These apps employ distress tolerance techniques, mood tracking, and crisis management features to address suicidal behaviors, but the evidence supporting their efficacy remains preliminary. This mirror concerns in the broader literature about the challenges of addressing high-risk mental health conditions through app-based interventions alone. • Table 3 does not indicate whether the results obtained were short or long term. Response: We have added a new column, "Study duration," to Table 3 to specify the duration of each study (e.g., 3 weeks, 6 weeks). Attachments Attachment Submitted filename: Response to Reviewers.docx* https://doi.org/10.1371/journal.pone.0319983.r003
12 Feb 2025 Decision Letter - Ethan Moitra, Editor Effectiveness of Evidence Based Mental Health Apps on User Health Outcome: A Systematic Literature Review PONE-D-24-30773R1 Dear Dr. Choudhury, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ethan Moitra Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: Thanks to the authors for carrying out a thorough review based on the indicated suggestions/comments. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0319983.r004
Formally Accepted
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