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<div>Digital technology provides a way of increasing access to evidence-based interventions [6]. Computerized cognitive behavioral therapy (CBT), for example, offers a promising and acceptable way of delivering interventions for anxiety and depression for children and young people [6,7]. However, technology is constantly evolving and mobile technologies in particular are being adopted at an increasing rate; by 2020, it is estimated there will be 6.1 billion mobile phone users globally [8]. The majority of children and adolescents in 2017 have use of a mobile phone (72% of children aged 0-11 years and 96% of those aged 12-17 years) [9]. Mobile tablet use is also increasing with seven in 10 (71%) children aged 5 to 15 years having access to a tablet at home [10]. Therefore, mobile health (mHealth) offers a particularly powerful and ubiquitous platform for delivering mental health interventions to adolescents. mHealth uses the functions of a mobile device, but most commonly relies on the download of mobile apps to help support health care delivery [11]. More than 15,000 mobile apps for health care were identified in a recent survey with at least 29% designed for mental health [12]. These apps vary in function and may focus on symptom assessment, psychoeducation, promoting engagement with therapy homework (eg, a thought diary or activity schedule), practicing skills learned in therapy, or monitoring symptoms or mood [11].</div><div></div><div></div><div>Despite the large number of apps available, the evidence base is scarce, particularly for adolescents. A 2013 review of mobile mental health apps for all ages identified eight papers describing only five apps [18]. Four of the five apps demonstrated significant reductions in depression, stress, and substance use, although a number of issues with the quality of these studies suggest these conclusions needed to be interpreted cautiously. The review also highlighted how research has lagged behind app development. A review of mHealth apps for the most prevalent conditions identified by the WHO identified more than 1536 apps for depression, but only 32 associated published articles [19]. Content analysis of commercially available apps for depression [20] and bipolar disorder [21] demonstrate a concerning trend that downloadable apps may not necessarily reflect evidence-based treatment guidelines. The majority rarely cite source information and often lack privacy policies. This was also evidenced in the now offline NHS App Library, in which only four of the 27 apps included any evidence of patient-reported outcomes to corroborate their effectiveness [22]. As such, the majority of mental health apps available for download are not supported by evidence-based research and may not follow evidence-based treatment guidelines.</div><div></div><div></div><div></div><div></div><div></div><div>Quick Heal Mobile Security Product Key For Android Crack Free 124l</div><div></div><div>Download: https://t.co/FxdMZSPGGs </div><div></div><div></div><div>Few apps have been specifically developed for children and adolescents, and the benefit of mental health mobile apps for this population is unclear. Two systematic reviews exploring the evidence for digital health interventions (including computerized CBT, mobile phone apps, and wearable technologies) for children and young people with mental health problems in 2014 and 2016 [6,23,24] identified randomized controlled trials (RCTs) for only two apps (Mobiletype and FindMe). Results showed no significant benefits of these apps on depression or autism spectrum disorder symptoms. A scoping review of mHealth interventions for children and young people yielded similar results [25]. Only one app (Mayo Clinic Anxiety Coach) included outcomes using a standardized rating scale, whereas the other two apps identified (SmartCAT and Mobile Mood Diary) had feasibility outcomes, but no efficacy outcomes reported [25].</div><div></div><div></div><div>We included abstracts describing mental health apps for mobile devices (mobile phone or tablet) for use by children and adolescents younger than 18 years. Studies with participants older than 18 years were included if the sample included children younger than 18 years. Mental health problems included depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia. To ensure we were capturing current and emerging evidence, we included conference proceedings, theses, case studies, RCTs, uncontrolled feasibility studies, qualitative studies, articles analyzing apps for adolescents available in app stores, and articles detailing app design and development.</div><div></div><div></div><div>Although the evidence base is currently lacking, this does not rule out the fact that well-designed, adequately tested, evidenced-based mobile apps could be effective. The evidence base for the clinical effectiveness of mobile apps in adult mental health is slowly emerging [18,50-52]. Our review suggests that the comparative literature for children and adolescents is significantly lagging, a trend also noted within the literature on other forms of eHealth, such as computerized CBT [6,7].</div><div></div><div></div><div>Therapist perspectives on mobile apps were mixed, with concerns relating to patient security, increased responsibility and workloads, and the need to set clear boundaries between sessions [28]. These are different concerns to those surrounding the use of other forms of eHealth, such as computerized CBT, in which clinicians were concerned about the effectiveness of computerized CBT with more severe mental health problems and the lack of a therapeutic relationship [55]. This may reflect differences in the purpose of these interventions (ie, computerized CBT being a therapeutic intervention compared to apps that are an adjunct to therapy). Interestingly, therapists who used the app Mobile Mood Diary in clinical practice reported benefits such as facilitation of client engagement [28]. Lack of technical confidence was the most common barrier to implementation. This lack of technical confidence may be addressed by improving the user-friendliness of the app, either by codesigning apps with therapists or providing training for therapists.</div><div></div><div></div><div></div><div></div><div></div><div></div><div>This review highlights several methodological concerns about the quality of the research evidence for mental health mobile apps, especially those for adolescents. Sample sizes tend to be small and reporting of demographic data such as gender and age inadequate, particularly in pilot feasibility studies. Few participants have an identified mental health problem and, as such, little is known about the acceptability and use of apps with clinical groups. As far as can be determined, the youngest participant in these studies was 9-years-old, meaning there is no research evidence for the use of mobile apps in children younger than this age. Where reported, symptoms tended to be mild to moderate in severity and, as such, the appropriateness of mobile apps for complex or more severe problems is unknown. Studies tend to be short in duration and there is sparse information on whether positive gains from using mobile apps are maintained. Finally, none of the apps in this review have been evaluated using a suitable RCT comparing a mobile app to an adequate control group. Future research should address these methodological concerns. Given the beneficial role that parent participation and engagement can have in adolescent mental health treatment [61], future research may also want to consider the role of parents/guardians in supporting adolescents using apps for mental health.</div><div></div><div> dd2b598166</div>
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