@article{ref1,
title="The association between app administered depression assessments and suicidal ideation in the user comments: an observational study",
journal="JMIR mHealth and uHealth",
year="2020",
author="DeForte, Shelly and Huang, Yungui and Bourgeois, Tran and Hussain, Amad and Lin, Simon",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Many people use apps to help understand and manage their depression symptoms. App-administered questionnaires for the symptoms of depression, such as the Patient Health Questionnaire 9, are easy to score and implement in an app, but may not be accompanied by essential resources and access needed to properly support and to avoid potential harm.   OBJECTIVE: Our main goal was to evaluate the differences in risks and helpfulness associated with using an app to self-diagnose depression, comparing assessment-only apps with multi-featured apps. Secondly, we also investigated whether, what, and how additional app features may mitigate potential risks.   METHODS: In this retrospective observational study, we identified apps in the Google Play app store that provided a depression assessment as a feature and had at least five user comments. We separated apps into two categories based on those having only a depression assessment vs. those that offered additional supportive features. We conducted theoretical thematic analyses over the user reviews, with thematic coding indicating the helpfulness of the app, the presence of suicidal ideation, and how and why the apps were used. We compared the results across the two categories of apps and analyzed the differences using chi-square statistical tests.   RESULTS: A total of six apps were used of which 3 (50%) provided only a depression assessment (assessment only) and 3 (50%) provided features in addition to self assessment (multi-featured). User comments for assessment only apps (n = 31, 9.4%) indicated significantly more suicidal ideation or self harm compared to comments for multi-featured apps (n = 48, 2.3%, χ2=43.88, P<.001). Compared to users of assessment only apps, users of multi-featured apps were over 3 times more likely to comment in favor of the apps' helpfulness, mood tracking, journaling, and informational resources (n = 56, 17% vs. n = 1223, 59% respectively, χ2=200.36, P<.001). Number of users under age 18 years was significantly higher among assessment only app users (n = 40, 12%) compared to multi-featured app users (n = 9, 0.04%, χ2=189.09, P<.001).   CONCLUSIONS: Apps that diagnose depression by self-assessment without context or other supportive features are more likely to be used by those under the age of 18 and more likely to be associated with increased user distress and potential harm. Depression self-assessments in apps should be implemented with caution and should be accompanied by evidence-based capabilities that establish proper context, increase self-empowerment, and encourage users to seek clinical diagnostics and outside help.  CLINICALTRIAL:<p /> <p>Language: en</p>",
language="en",
issn="2291-5222",
doi="10.2196/18392",
url="http://dx.doi.org/10.2196/18392"
}