@Article{info:doi/10.2196/14567,
author="Baumel, Amit
and Muench, Frederick
and Edan, Stav
and Kane, John M",
title="Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="25",
volume="21",
number="9",
pages="e14567",
keywords="user engagement; usage; adherence; retention; mental health; depression; anxiety; mHealth",
abstract="Background: Understanding patterns of real-world usage of mental health apps is key to maximizing their potential to increase public self-management of care. Although developer-led studies have published results on the use of mental health apps in real-world settings, no study yet has systematically examined usage patterns of a large sample of mental health apps relying on independently collected data. Objective: Our aim is to present real-world objective data on user engagement with popular mental health apps. Methods: A systematic engine search was conducted using Google Play to identify Android apps with 10,000 installs or more targeting anxiety, depression, or emotional well-being. Coding of apps included primary incorporated techniques and mental health focus. Behavioral data on real-world usage were obtained from a panel that provides aggregated nonpersonal information on user engagement with mobile apps. Results: In total, 93 apps met the inclusion criteria (installs: median 100,000, IQR 90,000). The median percentage of daily active users (open rate) was 4.0{\%} (IQR 4.7{\%}) with a difference between trackers (median 6.3{\%}, IQR 10.2{\%}) and peer-support apps (median 17.0{\%}) versus breathing exercise apps (median 1.6{\%}, IQR 1.6{\%}; all z≥3.42, all P<.001). Among active users, daily minutes of use were significantly higher for mindfulness/meditation (median 21.47, IQR 15.00) and peer support (median 35.08, n=2) apps than for apps incorporating other techniques (tracker, breathing exercise, psychoeducation: medians range 3.53-8.32; all z≥2.11, all P<.05). The medians of app 15-day and 30-day retention rates were 3.9{\%} (IQR 10.3{\%}) and 3.3{\%} (IQR 6.2{\%}), respectively. On day 30, peer support (median 8.9{\%}, n=2), mindfulness/meditation (median 4.7{\%}, IQR 6.2{\%}), and tracker apps (median 6.1{\%}, IQR 20.4{\%}) had significantly higher retention rates than breathing exercise apps (median 0.0{\%}, IQR 0.0{\%}; all z≥2.18, all P≤.04). The pattern of daily use presented a descriptive peak toward the evening for apps incorporating most techniques (tracker, psychoeducation, and peer support) except mindfulness/meditation, which exhibited two peaks (morning and night). Conclusions: Although the number of app installs and daily active minutes of use may seem high, only a small portion of users actually used the apps for a long period of time. More studies using different datasets are needed to understand this phenomenon and the ways in which users self-manage their condition in real-world settings. ",
issn="1438-8871",
doi="10.2196/14567",
url="http://www.jmir.org/2019/9/e14567/",
url="https://doi.org/10.2196/14567",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573916"
}