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Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements
  1. John Torous1,
  2. Jennifer Nicholas2,
  3. Mark E Larsen2,
  4. Joseph Firth3,
  5. Helen Christensen2
  1. 1 Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 NICM Health Research Institute , School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
  1. Correspondence to Dr John Torous, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; jtorous{at}


The potential of smartphone apps to improve quality and increase access to mental health care is increasingly clear. Yet even in the current global mental health crisis, real-world uptake of smartphone apps by clinics or consumers remains low. To understand this dichotomy, this paper reviews current challenges surrounding user engagement with mental health smartphone apps. While smartphone engagement metrics and reporting remains heterogeneous in the literature, focusing on themes offers a framework to identify underlying trends. These themes suggest that apps are not designed with service users in mind, do not solve problems users care most about, do not respect privacy, are not seen as trustworthy and are unhelpful in emergencies. Respecting these current issues surrounding mental health app engagement, we propose several solutions and highlight successful examples of mental health apps with high engagement. Further research is necessary to better characterise engagement with mental health apps and identify best practices for design, testing and implementation.

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  • Funding JT is supported by a carreer development award from the NIMH: 1K23MH116130-01 and a NARSAD Young Investigator Award from the Brain and Behavior Foundation.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.