The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials
Open accessAbstract
Although impressive progress has been made toward developing empirically-supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app-supported smartphone interventions are touted as a possible solution, access to up-to-date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta-analysis of 66 randomized controlled trials of app-supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post-traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment. © 2019 World Psychiatric Association
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Claims the paper makes
12 of 23 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured
- Findingcitation
Most effects were robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating).
“Crucially, these effects were robust even after performing various sensitivity analyses that adjusted for common biasing factors in RCTs, including the type of control condition, trial risk of bias rating, and publication bias 57,58 .”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [57] 57. Cristea IA. The waiting list is an inadequate benchmark for estimating the effectiveness of psychotherapy for depression. Epidemiol Psychiatr Sci 2019;28:278-9. source
The opening discussion reports that a meta-analysis found psychotherapy for depression remained effective after sensitivity analyses addressing waiting-list controls, trial risk of bias, and publication bias. It reports one overall effect estimate, reduced by half to Hedges’ g = 0.31; it does not establish that most individual effects were robust. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [58] 58. Cuijpers P, Cristea I. How to prove that your therapy is effective, even when it is not: a guideline. Epidemiol Psychiatr Sci 2016;25:428-35. source
The section “Use the ‘weak spots’ of randomised trials” discusses how control groups and risk of bias can influence apparent treatment effects. Our copy does not report the cited effects or sensitivity analyses adjusting for control condition, risk-of-bias rating, or publication bias; searches for robustness and those adjustments found no such result. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Premisecitation
The efficacy of smartphone interventions for common and costly mental health problems, such as depressive and anxiety symptoms, was preliminarily documented in two recent metaanalyses.
“The efficacy of smartphone interventions for common and costly mental health problems, such as depressive and anxiety symptoms, was preliminarily documented in two recent metaanalyses.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [7] 7. Firth J, Torous J, Nicholas J et al. The efficacy of smartphone-based men- tal health interventions for depressive symptoms: a meta-analysis of ran- domized controlled trials. World Psychiatry 2017;16:287-98. source
- cites [8] 8. Firth J, Torous J, Nicholas J et al. Can smartphone mental health interven- tions reduce symptoms of anxiety? A meta-analysis of randomized con- trolled trials. J Affect Disord 2017;218:15-22. source
- Premisecitation
Preliminary findings from these meta-analyses suggest that app-supported smartphone interventions have potential in treating and preventing certain common and debilitating mental health problems.
“Preliminary findings from these meta-analyses suggest that app-supported smartphone interventions have potential in treating and preventing certain common and debilitating mental health problems.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [7] 7. Firth J, Torous J, Nicholas J et al. The efficacy of smartphone-based men- tal health interventions for depressive symptoms: a meta-analysis of ran- domized controlled trials. World Psychiatry 2017;16:287-98. source
- cites [8] 8. Firth J, Torous J, Nicholas J et al. Can smartphone mental health interven- tions reduce symptoms of anxiety? A meta-analysis of randomized con- trolled trials. J Affect Disord 2017;218:15-22. source
The Discussion reports preliminary evidence that smartphone-delivered psychological interventions reduce anxiety symptoms, supporting their potential for treating a common mental health problem. This meta-analysis does not establish that the interventions prevent mental health problems; its measured outcome was symptom reduction. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Findingcitation
These effects were robust even after performing various sensitivity analyses that adjusted for common biasing factors in RCTs, including the type of control condition, trial risk of bias rating, and publication bias.
“Crucially, these effects were robust even after performing various sensitivity analyses that adjusted for common biasing factors in RCTs, including the type of control condition, trial risk of bias rating, and publication bias 57,58 .”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [57] 57. Cristea IA. The waiting list is an inadequate benchmark for estimating the effectiveness of psychotherapy for depression. Epidemiol Psychiatr Sci 2019;28:278-9. source
- cites [58] 58. Cuijpers P, Cristea I. How to prove that your therapy is effective, even when it is not: a guideline. Epidemiol Psychiatr Sci 2016;25:428-35. source
The sections “Use the ‘weak spots’ of randomised trials,” “Design your trial in the right way,” and “Use the right publication strategy” discuss risk of bias, control-group choice, and nonpublication of negative trials as factors that can distort observed effects (page numbers unavailable). The paper does not report the cited sensitivity analyses or establish that the effects remained robust after them. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Premisecitation
Automated (and personalized) support has been shown to produce equivalent clinical outcomes to human support in RCTs of computerized treatments.
“Automated (and personalized) support has been shown to produce equivalent clinical outcomes to human support in RCTs of computerized treatments 67”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [67] 67. Kelders SM, Bohlmeijer ET, Pots WTM et al. Comparing human and auto- mated support for depression: fractional factorial randomized controlled trial. Behav Res Ther 2015;72:72-80. source
The Clinical outcomes section reports no significant difference between support conditions at follow-up, and the Implications section suggests automated support can be as effective at six months in this web-based depression intervention. But the Limitations section explicitly says this was not an equivalence trial and that equivalence cannot be stated with certainty; the claim also generalizes from this study to RCTs of computerized treatments. (LLM, conf=0.90)
Experimental — accuracy not yet measured
- Interpretationcitation
These findings, although preliminary, are in line with reports regarding Internet-based treatments.
“These findings, although preliminary, are in line with reports regarding Internet-based treatments 71”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [71] 71. Carlbring P, Andersson G, Cuijpers P et al. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an up- dated systematic review and meta-analysis. Cogn Behav Ther 2018;47:1-18. source
- Findingown data
Smartphone interventions significantly outperformed control conditions in improving depressive symptoms (g=0.28, n=54).
“The pooled effect size for the 54 comparisons between smartphone interventions and control conditions on depressive symptoms was g=0.28 (95% CI: 0.21-0.36),with moderate heterogeneity”
Quote in the paperSubstantial claim - Findingown data
Larger effect sizes were found by studies that used a CBT-based app.
“Larger effect sizes were found by studies that used elevated stress levels as an entry criterion for trial inclusion, that used a CBT-based app, that offered professional guidance, and that had a longer post-assessment duration (≥ 7 weeks) compared to those with a shorter duration.”
Quote in the paperNot a substantial claim - Findingown data
Studies that delivered a CBT-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes.
“Studies that delivered a cognitive behavior therapy (CBT)-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes.”
Quote in the paperSubstantial claim - Findingown data
Smartphone interventions significantly outperformed control conditions in improving quality of life (g=0.35, n=43).
“The pooled effect size for the 43 comparisons was g=0.35 (95% CI: 0.29-0.42),with low heterogeneity”
Quote in the paperSubstantial claim - Findingown data
The pooled effect size remained statistically significant across all sensitivity analyses.
“The pooled effect size remained statistically significant across all sensitivity analyses.”
Quote in the paperNot a substantial claim - Findingown data
Smartphone interventions significantly outperformed control conditions in improving generalized anxiety symptoms (g=0.30, n=39).
“The pooled effect size for the 39 comparisons was g=0.30 (95% CI: 0.20-0.40),with high heterogeneity”
Quote in the paperSubstantial claim - Findingown data
37 studies (56.1%) reported data needed to calculate an effect size based on the intention-to-treat principle.
“37 studies (56.1%) reported data needed to calculate an effect size based on the intention-to-treat principle.”
Quote in the paperNot a substantial claim - Findingown data
The pooled effect size for the four comparisons was g=0.09 (95% CI: -0.21 to 0.39), with moderate heterogeneity.
“The pooled effect size for the four comparisons was g=0.09 (95% CI: -0.21 to 0.39), with moderate heterogeneity.”
Quote in the paperSubstantial claim - Findingown data
Larger effect sizes were found by studies that used elevated stress levels as an entry criterion for trial inclusion.
“Larger effect sizes were found by studies that used elevated stress levels as an entry criterion for trial inclusion, that used a CBT-based app, that offered professional guidance, and that had a longer post-assessment duration (≥ 7 weeks) compared to those with a shorter duration.”
Quote in the paperNot a substantial claim - Findingown data
24 trials (36.4%) used adequate allocation concealment.
“24 (36.4%)used adequate allocation concealment”
Quote in the paperNot a substantial claim - Findingown data
Smartphone interventions were significantly more effective than control conditions in improving general psychological distress (g=0.40).
“Smartphone interventions were significantly more effective than control conditions in improving general psychological distress (g=0.40)”
Quote in the paperSubstantial claim - Findingown data
A negative, non-significant effect size was observed when restricting these analyses to low risk of bias trials.
“A negative, non-significant effect size was observed when restricting these analyses to low risk of bias trials.”
Quote in the paperNot a substantial claim - Findingown data
The pooled effect size for the 54 comparisons between smartphone interventions and control conditions on depressive symptoms was g=0.28 (95% CI: 0.21-0.36), with moderate heterogeneity.
“The pooled effect size for the 54 comparisons between smartphone interventions and control conditions on depressive symptoms was g=0.28 (95% CI: 0.21-0.36),with moderate heterogeneity”
Quote in the paperSubstantial claim - Findingown data
The pooled effect size for the six comparisons of smartphone vs. active interventions was g=0.02 (95% CI: -0.14 to 0.17).
“The pooled effect size for the six comparisons of smartphone vs. active interventions was g=0.02 (95% CI: -0.14 to 0.17).”
Quote in the paperSubstantial claim - Findingown data
Larger effect sizes were found by studies that reminded participants to engage.
“Two significant moderators were observed in subgroup analyses.Larger effect sizes were found by studies that reminded participants to engage, and by those that offered professional guidance.”
Quote in the paperNot a substantial claim - Findingown data
Non-significant effect sizes were observed for low risk of bias trials.
“Non-significant effect sizes were observed for low risk of bias trials.”
Quote in the paperSubstantial claim - Findingown data
Larger effect sizes were found by studies that offered professional guidance.
“Larger effect sizes were found by studies that used elevated stress levels as an entry criterion for trial inclusion, that used a CBT-based app, that offered professional guidance, and that had a longer post-assessment duration (≥ 7 weeks) compared to those with a shorter duration.”
- Also stated in: § Efficacy of smartphone interventions on well-being/ quality of life · plain
“Two significant moderators were observed in subgroup analyses.Larger effect sizes were found by studies that reminded participants to engage, and by those that offered professional guidance.”
Quote in the paperNot a substantial claim - Also stated in: § Efficacy of smartphone interventions on well-being/ quality of life · plain
- Findingown data
Studies that offered professional guidance and engagement reminders were consistently associated with larger effect sizes on several mental health outcomes.
“Studies that offered professional guidance (e.g., supportive text messages, personalized feedback, telephone calls) and engagement reminders were consistently associated with larger effect sizes on several mental health outcomes”
- Also stated in: § DISCUSSION · boosted
“Studies that offered professional guidance and engagement reminders were shown to produce the largest effects”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · boosted
- Findingown data
Sensitivity analyses yielded a pooled effect size highly similar to the overall effect.
“These sensitivity analyses yielded a pooled effect size highly similar to the overall effect”
Quote in the paperNot a substantial claim - Findingown data
Larger effect sizes were found by studies that had a longer post-assessment duration (≥ 7 weeks) compared to those with a shorter duration.
“Larger effect sizes were found by studies that used elevated stress levels as an entry criterion for trial inclusion, that used a CBT-based app, that offered professional guidance, and that had a longer post-assessment duration (≥ 7 weeks) compared to those with a shorter duration.”
Quote in the paperNot a substantial claim - Findingown data
It remained statistically significant across all sensitivity analyses.
“It remained statistically significant across all sensitivity analyses.”
Quote in the paperNot a substantial claim - Findingown data
The pooled effect size for the two comparisons of smartphone vs. active interventions was g=0.21 (95% CI: -0.46 to 0.88), with high heterogeneity.
“The pooled effect size for the two comparisons of smartphone vs. active interventions was g=0.21 (95% CI: -0.46 to 0.88), with high heterogeneity.”
Quote in the paperNot a substantial claim - Findingown data
Studies with a follow-up length between 7 and 11 weeks produced larger effect sizes than studies with a follow-up length of 2-6 or ≥12 weeks.
“Studies with a follow-up length between 7 and 11 weeks produced larger effect sizes than studies with a follow-up length of 2-6 or ≥12 weeks.”
Quote in the paperNot a substantial claim - Findingown data
In the meta-analysis, statistically significant effect sizes were observed in both symptomatic and non-symptomatic samples.
“The statistically significant effect sizes were observed in both symptomatic (e.g., people meeting diagnostic criteria or reporting elevated mental health symptoms) and non-symptomatic (e.g., university students, general population) samples”
Quote in the paperSubstantial claim - Findingown data
Several trials (n=28) did not use any indication of mental health problems as an inclusion criterion, but rather targeted general well-being in these samples.
“Several trials (n=28) did not use any indication of mental health problems as an inclusion criterion (e.g., general community sample, student samples), but rather targeted general well-being in these samples.”
Quote in the paperNot a substantial claim - Findingown data
No significant group differences were observed for panic symptoms (g=-0.05).
“No significant group differences were observed for panic symptoms (g=-0.05)”
Quote in the paperNot a substantial claim - Findingnone given
The pooled effect size was somewhat larger when adjusting for potential publication bias.
“The pooled effect size was somewhat larger when adjusting for potential publication bias”
Quote in the paperNot a substantial claim - Findingown data
Studies that offered professional guidance produced larger effect sizes than studies that did not offer guidance.
“Studies that offered professional guidance (e.g., regular supportive text messages, phone calls, or personalized feedback from therapists or research staff ) produced larger effect sizes than studies that did not offer guidance.”
Quote in the paperSubstantial claim - Findingown data
Smartphone interventions still significantly outperformed control conditions even in the subset of studies that did not offer guidance or reminders.
“although smart-phone interventions still significantly outperformed control conditions even in the subset of studies that did not offer guidance or reminders.”
Quote in the paperSubstantial claim - Findingown data
No other study characteristics were significantly associated with effect sizes.
“No other study characteristics were significantly associated with effect sizes.”
Quote in the paperNot a substantial claim - Findingown data
The pooled effect size for the four comparisons between smartphone intervention + standard intervention vs. the standard intervention-only arm was g=0.26 (95% CI: -0.09 to 0.61).
“The pooled effect size for the four comparisons between smartphone intervention + standard intervention vs. the standard intervention-only arm was g=0.26 (95% CI: -0.09 to 0.61).”
Quote in the paperSubstantial claim - Findingown data
The pooled effect size remained statistically significant across the sensitivity analyses.
“The pooled effect size remained statistically significant across the sensitivity analyses.”
Quote in the paperNot a substantial claim - Findingown data
Smartphone interventions significantly outperformed control conditions in improving stress levels (g=0.35, n=27).
“The pooled effect size for the 27 comparisons was g=0.35 (95% CI: 0.21-0.48),with high heterogeneity”
Quote in the paperSubstantial claim - Findingown data
The number of studies contributing to the analyses of panic, post-traumatic stress, and negative affect was low.
“No significant group differences were observed for panic symptoms (g=-0.05),post-traumatic stress symptoms (g=0.18), and negative affect (g=-0.08),although the number of studies contributing to these analyses was low.”
Quote in the paperNot a substantial claim - Findingown data
Effects remained robust even after adjusting for various biasing factors in RCTs.
“with effects remaining robust even after adjusting for various biasing factors in RCTs.”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.44 (95% CI 0.15-0.73) on positive affect.
“Overall effect | 6 | 0.44 (0.15-0.73)** | 67% (24-85)”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had no significant overall effect on post-traumatic stress symptoms (g=0.18, 95% CI -0.04 to 0.41).
“Overall effect | 4 | 0.18 (-0.04 to 0.41) | 0% (0-86)”
Quote in the paperNot a substantial claim - Findingown data
Smartphone apps vs control conditions had no significant overall effect on panic symptoms (g=-0.05, 95% CI -0.41 to 0.31).
“Overall effect | 3 | -0.05 (-0.41 to 0.31) | 0% (0-92)”
Quote in the paperNot a substantial claim - Findingown data
Interventions containing mindfulness- or acceptance-based components were not associated with effect sizes.
“While interventions containing mindfulness-or acceptancebased components were not associated with effect sizes”
Quote in the paperNot a substantial claim - Findingown data
In low risk of bias trials, smartphone apps vs control conditions had an overall effect size of g=0.43 (95% CI 0.31-0.55) on depressive symptoms.
“Low risk of bias only (all criteria met) | 13 | 0.43 (0.31-0.55)*** | 41% (0-68)”
Quote in the paperSubstantial claim - Findingown data
The meta-analysis found evidence for the efficacy of app-supported smartphone interventions.
“In summary, we found evidence for the efficacy of app-supported smartphone interventions.”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.58 (95% CI 0.25-0.90) on social anxiety symptoms.
“Overall effect | 6 | 0.58 (0.25-0.90)*** | 78% (53-89)”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.40 (95% CI 0.24-0.56) on general distress.
“Overall effect | 12 | 0.40 (0.24-0.56)*** | 60% (24-77)”
Quote in the paperSubstantial claim - Findingown data
After adjusting for publication bias, smartphone apps vs control conditions had an overall effect size of g=0.41 (95% CI 0.32-0.49) on depressive symptoms.
“Adjusted for publication bias | 37 | 0.41 (0.32-0.49)”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.35 (95% CI 0.29-0.42) on quality of life.
“43 | 0.35 (0.29-0.42)*** | 24% (0-47)”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had no significant overall effect on negative affect (g=-0.08, 95% CI -0.48 to 0.32).
“Overall effect | 5 | -0.08 (-0.48 to 0.32) | 76% (45-89)”
Quote in the paperSubstantial claim - Findingown data
CBT-based interventions produced larger effects for anxiety and stress.
“CBTbased interventions produced larger effects for anxiety and stress.”
Quote in the paperNot a substantial claim - Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.28 (95% CI 0.21-0.36) on depressive symptoms.
“Overall effect | 54 | 0.28 (0.21-0.36)*** | 54% (38-66)”
Quote in the paperSubstantial claim - Findingown data
Smartphone interventions did not significantly differ from active interventions on any outcome.
“Smartphone interventions did not significantly differ from active interventions on any outcome.”
- Also stated in: § DISCUSSION · plain
“smartphone interventions did not differ significantly from active intervention comparisons on any outcome.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.35 (95% CI 0.21-0.48) on stress levels.
“Overall effect | 27 | 0.35 (0.21-0.48)*** | 69% (55-79)”
Quote in the paperSubstantial claim - Findingown data
Smartphone apps vs control conditions had an overall effect size of g=0.30 (95% CI 0.20-0.40) on generalized anxiety symptoms.
“39 0.30 (0.20-0.40)*** | 63% (48-73)”
Quote in the paperSubstantial claim - Interpretationreasoning
The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed.
“The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed.”
Quote in the paperSubstantial claim - Interpretationown data
We found evidence that app-supported smartphone interventions are efficacious for several common mental health problems.
“We found evidence that app-supported smartphone interventions are efficacious for several common mental health problems.”
Quote in the paperSubstantial claim - Interpretationown data
These findings point further toward the clinical utility of mental health apps.
“and point further toward the clinical utility of mental health apps.”
Quote in the paperSubstantial claim - Study design and conductreasoning
Conclusions concerning the relative efficacy of different theoretical orientations would be premature at this stage, as too few head-to-head comparisons of different smartphone interventions have been performed.
“However, conclusions concerning the relative efficacy of different theoretical orientations would be premature at this stage, as too few head-to-head comparisons of different smartphone interventions have been performed”
Quote in the paperSubstantial claim - Study design and conductown data
Nearly all included studies assessed outcomes via self-report questionnaires.
“Third, nearly all included studies assessed outcomes via selfreport questionnaires.”
Quote in the paperSubstantial claim - Premisecitation
Head-to-head comparisons of CBT vs. non-CBT-based smartphone interventions reported no differences in level of symptom improvement.
“those that compared CBT vs. non-CBT-based smartphone interventions reported no differences in level of symptom improvement [68][69][70]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [68][69][70]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
It is unclear whether improvements in mental health are sustained after the period of the study.
“Thus, it is unclear whether improvements in mental health are sustained after the period of the study.”
Quote in the paperSubstantial claim - Interpretationreasoning
It is possible that the meta-analysis's effect size estimates were slightly underestimated.
“So, it is possible that our effect size estimates were slightly underestimated.”
Quote in the paperNot a substantial claim - Study design and conductown data
Possible negative effects of smartphone interventions (e.g., deterioration rates) were not assessed, since they were not reported in the included studies.
“First, possible negative effects of smartphone interventions (e.g., deterioration rates) 73 were not assessed, since they were not reported in the included studies.”
Quote in the paperNot a substantial claim
- Classified as probably not a substantial claim. 24
- May combine two claims. 23
- The quote only partly states this claim. 2
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationThe treatment of mental health problems is expected to change considerably over the next few decades as a result of the widespread availability of Internet and mobile-device applications, and their use to deliver psychological interventions.
“The treatment of mental health problems is expected to change considerably over the next few decades as a result of the widespread availability of Internet and mobile-device applications, and their use to deliver psychological interventions 1,2 .”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [1] 1. Fairburn CG, Patel V. The impact of digital technology on psychological treatments and their dissemination. Behav Res Ther 2017;88:19-25. source
- cites [2] 2. Patel V, Prince M. Global mental health: a new global health field comes of age. JAMA 2010;303:1976-7. source
The section “Global Mental Health: a new global health field comes of age” discusses psychological treatments and ways to expand care, but does not address Internet or mobile-device applications as a means of delivering them. Searches for Internet, mobile technology, and digital treatment found no passage supporting the predicted change over the next few decades. No page number is available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Classified as probably not a substantial claim.
PremisecitationFirth et al identified a small number of randomized controlled trials (RCTs) that examined the efficacy of app-based smartphone interventions on symptoms of anxiety (n=9) and depression (n=18) in both clinical and non-clinical samples.
“Firth et al 7,8 identified a small number of randomized controlled trials (RCTs) that examined the efficacy of app-based smartphone interventions on symptoms of anxiety (n=9) and depression (n=18) in both clinical and non-clinical samples.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [7] 7. Firth J, Torous J, Nicholas J et al. The efficacy of smartphone-based men- tal health interventions for depressive symptoms: a meta-analysis of ran- domized controlled trials. World Psychiatry 2017;16:287-98. source
- cites [8] 8. Firth J, Torous J, Nicholas J et al. Can smartphone mental health interven- tions reduce symptoms of anxiety? A meta-analysis of randomized con- trolled trials. J Affect Disord 2017;218:15-22. source
May combine two claims.
PremisecitationSmartphone interventions were found to be significantly more efficacious in reducing symptoms of anxiety and depression than both waitlist (g=0.45 and g=0.56) and active control (mainly attention/placebo-based) groups (g=0.19 and g=0.21).
“Smartphone interventions were found to be significantly more efficacious in reducing symptoms of anxiety and depression than both waitlist (g=0.45 and g=0.56) and active control (mainly attention/placebo-based) groups (g=0.19 and g=0.21).”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [7] 7. Firth J, Torous J, Nicholas J et al. The efficacy of smartphone-based men- tal health interventions for depressive symptoms: a meta-analysis of ran- domized controlled trials. World Psychiatry 2017;16:287-98. source
- cites [8] 8. Firth J, Torous J, Nicholas J et al. Can smartphone mental health interven- tions reduce symptoms of anxiety? A meta-analysis of randomized con- trolled trials. J Affect Disord 2017;218:15-22. source
Section 3.3 reports significant reductions in anxiety symptoms versus waitlist controls (g=0.452) and active controls (g=0.189), matching the claim’s rounded anxiety figures. The paper’s meta-analysis concerns anxiety; our copy does not support the depression figures of g=0.56 and g=0.21. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S4 (based).
Findingnone givenSince the publication of those two meta-analyses, which included data from RCTs published until May 2017, nearly 50 RCTs evaluating the efficacy of smartphone apps on various mental health outcomes have been conducted.
“Since the publication of those two meta-analyses, which included data from RCTs published until May 2017, nearly 50 RCTs evaluating the efficacy of smartphone apps on various mental health outcomes have been conducted.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataMeasures of well-being/quality of life were assessed in 36 studies (54.5%).
“Measures of well-being/quality of life were assessed in 36 studies (54.5%).”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataSmartphone interventions significantly outperformed control conditions in improving general psychiatric distress (g=0.40, n=12).
“Smartphone interventions were significantly more effective than control conditions in improving general psychological distress (g=0.40)”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe pooled effect size for the 39 comparisons was g=0.30 (95% CI: 0.20-0.40), with high heterogeneity.
“The pooled effect size for the 39 comparisons was g=0.30 (95% CI: 0.20-0.40),with high heterogeneity”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe pooled effect size for the 27 comparisons was g=0.35 (95% CI: 0.21-0.48), with high heterogeneity.
“The pooled effect size for the 27 comparisons was g=0.35 (95% CI: 0.21-0.48),with high heterogeneity”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe pooled effect size for the 43 comparisons was g=0.35 (95% CI: 0.29-0.42), with low heterogeneity.
“The pooled effect size for the 43 comparisons was g=0.35 (95% CI: 0.29-0.42),with low heterogeneity”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe pooled effect size for the 12 comparisons between smartphone interventions and active comparisons was g=0.13 (95% CI: -0.07 to 0.34), with moderate heterogeneity.
“The pooled effect size for the 12 comparisons between smartphone interventions and active comparisons was g=0.13 (95% CI: -0.07 to 0.34), with moderate heterogeneity.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDepressive symptoms were assessed as an outcome in 47 trials (71.2%), and 11 trials (16 comparisons) delivered an app that was specifically designed to target depressive symptoms.
“Depressive symptoms were assessed as an outcome in 47 trials (71.2%), and 11 trials (16 comparisons) delivered an app that was specifically designed to target depressive symptoms.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Findingnone givenMost RCTs of smartphone apps have been published within the last couple of years.
“Since most RCTs of smartphone apps have been published within the last couple of years, and interventions delivered through smartphone devices are attracting enormous public, scientific and media attention 9 , we expect that a significant number of additional RCTs will be conducted and published in the near future.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataBegg and Mazumdar test was non-significant (p=0.217).
“Begg and Mazumdar test was non-significant (p=0.217).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataSmartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13).
“Smartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataStress levels were assessed in 22 trials (33.3%).
“Stress levels were assessed in 22 trials (33.3%).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataFifty trials (75.7%) reported an adequate sequence generation.
“Fifty trials (75.7%) reported an adequate sequence generation”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataBegg and Mazumdar test was non-significant (p=0.392).
“Begg and Mazumdar test was non-significant (p=0.392).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataOut of a total of 3,136 screened abstracts, 66 RCTs with 77 smartphone intervention conditions were included.
“Out of a total of 3,136 screened abstracts, 66 RCTs with 77 smartphone intervention conditions were included.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataGeneralized anxiety symptoms were assessed as an outcome in 29 studies (43.9%), and eight studies (12 comparisons) delivered an app that was specifically designed to target generalized anxiety symptoms.
“Generalized anxiety symptoms were assessed as an outcome in 29 studies (43.9%), and eight studies (12 comparisons) delivered an app that was specifically designed to target generalized anxiety symptoms.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFour trials (6.1%) reported blinding of outcome assessors and 62 (93.9%) used self-report questionnaires.
“four (6.1%) reported blinding of outcome assessors and 62 (93.9%) used self-report questionnaires”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataA variety of smartphone apps were tested, most of which were based on cognitive and/or behavioral principles (n=35) and/or acceptance-or mindfulness-based principles (n=38).
“A variety of smart-phone apps were tested, most of which were based on cognitive and/or behavioral principles (n=35) and/or acceptance-or mindfulness-based principles (n=38).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataSeventeen trials (25.7%) met all four criteria, 16 (24.2%) met three criteria, 27 (40.9%) met two criteria, and six trials (9.1%) met one of the criteria.
“Seventeen trials (25.7%) met all four criteria, 16 (24.2%)met three criteria, 27 (40.9%)met two criteria, and six trials (9.1%) met one of the criteria.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataSmartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=-0.05, n=3).
“No significant group differences were observed for panic symptoms (g=-0.05)”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe majority of RCTs were published in the last two years.
“Importantly, the majority of RCTs were published in the last two years, highlighting that this area of research is gaining significant momentum and is growing exponentially.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataBegg and Mazumdar test was non-significant (p=0.622).
“Begg and Mazumdar test was non-significant (p=0.622).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe pooled effect size was small but still statistically significant when attention/placebo control conditions were used (g=0.12), and larger when waitlist (g=0.32) or informational resources (g=0.39) were used as control conditions.
“The pooled effect size was small but still statistically significant when attention/placebo control conditions were used (g=0.12),and larger when waitlist (g=0.32) or informational resources (g=0.39) were used as control conditions.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataSmartphone interventions significantly outperformed control conditions in improving a range of mental health outcomes, with small to moderate effect sizes.
“They significantly outperformed (with small to moderate effect sizes) control conditions in improving a range of mental health outcomes”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationThis change is predicted to alleviate many barriers that stand in the way of people seeking or receiving treatment under the current model of health care delivery (e.g., insufficient number of trained professionals, geographical constraints, lack of anonymity), thereby vastly increasing the availability of psychological therapies.
“This change is predicted to alleviate many barriers that stand in the way of people seeking or receiving treatment under the current model of health care delivery (e.g., insufficient number of trained professionals, geographical constraints, lack of anonymity), thereby vastly increasing the availability of psychological therapies 3,4 .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [3] 3. Kazdin AE. Addressing the treatment gap: a key challenge for extending evidence-based psychosocial interventions. Behav Res Ther 2017;88:7-18. source
- cites [4] 4. Kazdin AE. Expanding mental health services through novel models of intervention delivery. J Child Psychol Psychiatry 2019;60:455-72. source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA protocol for this review was registered via PROSPERO (CRD42019122136).
“A protocol for this review was registered via PROSPERO (CRD42019122136).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThere were three small deviations to the original protocol.
“There were three small deviations to the original protocol.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenIf data from both intention-to-treat and completer analyses were presented, the former were extracted and analyzed.
“If data from both intention-to-treat and completer analyses were presented, the former were extracted and analyzed.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe authors found no evidence that various intervention features (e.g., in-app feedback, mood monitoring features, theoretical orientation) were significantly associated with effect sizes, although larger effects were observed when in-person feedback was not provided.
“The authors found no evidence that various intervention features (e.g., in-app feedback, mood monitoring features, theoretical orientation) were significantly associated with effect sizes, although larger effects were observed when in-person feedback was not provided 7 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] 7. Firth J, Torous J, Nicholas J et al. The efficacy of smartphone-based men- tal health interventions for depressive symptoms: a meta-analysis of ran- domized controlled trials. World Psychiatry 2017;16:287-98. source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenTwo independent assessors (JL and MM) examined the full texts and selected eligible RCTs.
“Two independent assessors (JL and MM) examined the full texts and selected eligible RCTs.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationPublication bias was examined through the trim-and-fill procedure, as well as Begg and Mazumdar rank correlation test.
“Publication bias was examined through the trim-and-fill procedure 15 , as well as Begg and Mazumdar rank correlation test.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] 15. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56:455-63. source
May combine two claims.
InterpretationreasoningThe present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
“Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.”
Quote in the paperSubstantial claim- Rests on an assumption: A significant proportion of people with mental health problems do not receive empirically-supported psychological treatments.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSmartphone interventions offer many advantages over other digital interventions (e.g., computer-based), including their ability to allow users to engage in exercises and monitor symptoms in situ, in real time, and immediately before and after pivotal events, as well as their capacity to be accessed in private and at a time and location of choice.
“Smartphone interventions, in particular, offer many advantages over other digital interventions (e.g., computer-based), including their ability to allow users to engage in exercises and monitor symptoms in situ, in real time, and immediately before and after pivotal events, as well as their capacity to be accessed in private and at a time and location of choice 5 .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] 5. Stolz T, Schulz A, Krieger T et al. A mobile app for social anxiety disorder: a three-arm randomized controlled trial comparing mobile and PC-based guided self-help interventions. J Consult Clin Psychol 2018;86:493-504. source
May combine two claims.
InterpretationcitationTherapist guidance and engagement reminders bolster the effectiveness of smartphone interventions, consistent with prior meta-analyses of Internet-based and computerized psychological treatments.
“That therapist guidance and engagement reminders bolster the effectiveness of smartphone interventions is consistent with what has been observed in a series of metaanalyses of Internet-based and computerized psychological treatments [61][62][63][64] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [61][62][63][64]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataJL conducted the quality assessments and MM coded a random 40% of studies, with good agreement observed between raters (kappa = 0.77, 0.69, 1.00 and 0.91, respectively).
“JL conducted the quality assessments and MM coded a random 40% of studies, with good agreement observed between raters (kappa = 0.77, 0.69, 1.00 and 0.91, respectively).”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningSince we expected considerable heterogeneity among the studies, random effects models were employed.
“Since we expected considerable heterogeneity among the studies, random effects models were employed.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataFew studies contributed to the head-to-head comparisons, so these analyses may have been underpowered.
“However, we note that few studies contributed to these head-to-head comparisons, so these analyses may have been underpowered.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningPower may have also been an issue for the other outcomes in which smartphone interventions conferred no benefit over control conditions (panic, post-traumatic stress, and negative affect).
“Power may have also been an issue for the other outcomes in which smartphone interventions conferred no benefit over control conditions (panic, post-traumatic stress, and negative affect).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningThe present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for the millions of people worldwide who cannot receive standard psychological treatment.
“the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for the millions of people worldwide who cannot receive standard psychological treatment.”
Quote in the paperNot a substantial claim- Rests on an assumption: There are millions of people worldwide who need mental health treatment but cannot access standard psychological treatment.
May combine two claims.
Study design and conductreasoningThe meta-analysis did not analyze the long-term effects of smartphone interventions, due to large differences in follow-up times and inconsistent handling of drop-outs across studies.
“Second, we did not analyze the long-term effects of smartphone interventions, due to large differences in follow-up times and since drop-outs were dealt with inconsistently across studies.”
Quote in the paperSubstantial claim
The paper relies on this without support.
A significant proportion of people with mental health problems do not receive empirically-supported psychological treatments.
“the reality remains that a significant proportion of people with mental health problems do not receive these treatments.”
The paper relies on this without support.
There are millions of people worldwide who need mental health treatment but cannot access standard psychological treatment.
“the millions of people worldwide who cannot receive standard psychological treatment.”
“the millions of people around the world in need of (and who cannot gain access to) treatment.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Mindfulness-based interventions have gained research interest, showing enhanced well-being in various settings, particularly for coping with chronic conditions such as chronic pain.
“mindfulness-based interventions have gained research interest, showing enhanced well-being in various settings [32-34], particularly for coping with chronic conditions, such as chronic pain [35-37].”
From Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial (2024) · cites this paper as [33]
The Discussion reports growing research on app-supported smartphone interventions, and the subgroup table shows improved well-being or quality of life for interventions containing mindfulness components. The paper does not establish that mindfulness-based interventions help people cope with chronic pain; its findings concern smartphone interventions for mental health problems. (LLM, conf=0.82)
Experimental — accuracy not yet measuredTechnologically enhanced interventions generally result in equivalent outcomes to in-person treatment across disorders.
“technologically enhanced interventions generally result in equivalent outcomes to in-person treatment across disorders”
From Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder (2024) · cites this paper as Linardon et al., 2019
The Abstract and Discussion report that app-supported smartphone interventions did not differ significantly from active interventions, which included face-to-face and computerized treatment. The Discussion calls these findings preliminary because few studies made head-to-head comparisons and the analyses may have been underpowered. The paper therefore does not establish equivalent outcomes specifically versus in-person treatment, or for technologically enhanced interventions generally across disorders. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDMHIs are efficacious, with effect sizes comparable to face-to-face therapy in clinical trials.
“DMHIs are also efficacious, with effect sizes comparable to face-to-face therapy in clinical trials (Linardon et al., 2019).”
From A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype (2023) · cites this paper as Linardon et al., 2019
The Abstract reports that app-supported smartphone interventions were efficacious and did not differ significantly from active interventions, including face-to-face therapy. But the comparison pooled different active treatments and involved few studies (n≤13); it does not establish that effect sizes were specifically comparable to face-to-face therapy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThere is convincing evidence for the effectiveness of digital interventions when delivered in health and community settings.
“There is now convincing evidence for the effectiveness of digital interventions when delivered in health and community settings [10]”
From Feasibility and Preliminary Efficacy of Web-Based and Mobile Interventions for Common Mental Health Problems in Working Adults: Multi-Arm Randomized Pilot Trial (2022) · cites this paper as [10]
The Discussion reports that app-supported smartphone interventions improved several mental-health outcomes across clinical and non-clinical populations, including general-population samples. It does not establish effectiveness for digital interventions broadly or specifically assess delivery in both health and community settings. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEMA/EMI have shown good results in other psychological disorders, such as substance use, anxiety, and major depressive disorders.
“EMA/EMI have shown good results in other psychological disorders, such as substance use disorders (e.g., smoking cessation), anxiety disorders (e.g., social anxiety disorder, generalized anxiety disorder), and major depressive disorders (LaFreniere and Newman, 2016; Colombo et al., 2019; Linardon et al., 2019; Miralles et al., 2020).”
From Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial (2021) · cites this paper as Linardon et al., 2019
The Discussion reports that app-supported smartphone interventions improved depressive symptoms and generalized and social anxiety symptoms compared with controls. It does not establish efficacy for EMA/EMI specifically or report a result for substance use disorders or smoking cessation. Its findings concern symptoms across clinical and non-clinical populations, not necessarily diagnosed major depressive disorder. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Available evidence suggests that smartphone-based interventions that include training in meditation and mindfulness may provide psychological benefits similar to in-person MBIs, albeit smaller in magnitude.
“Although preliminary, available evidence suggests that smartphone-based interventions that include training in meditation and mindfulness may provide psychological benefits that are similar to in-person MBIs (eg, decreased psychological symptoms, increased positive functioning), albeit smaller in magnitude [30,39-42].”
From Testing the efficacy of a multicomponent, self-guided, smartphone-based meditation app: Three-armed randomized controlled trial (2020) · cites this paper as [41]
The Abstract reports improvements in psychological symptoms and positive affect from smartphone interventions, and the Discussion says the analysis included apps with mindfulness or acceptance-based components. It also reports no significant difference from active interventions, but those comparisons were not specific to in-person mindfulness-based interventions. The paper does not establish that mindfulness apps have smaller benefits than in-person MBIs. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDigital health technologies, particularly smartphone applications, offer a promising solution to barriers in delivering mind-body therapies and psychotherapy.
“Digital health technologies, particularly smartphone applications, offer accessible, personalized, and sustainable therapeutic solutions to address these challenges.”
From User Experience and Clinical Utility of a Smartphone-Based Application for Hwa-Byung Treatment: a protocol for a single-arm prospective pilot study. (2026) · cites this paper as [8]
The Abstract says smartphone interventions may reduce barriers to psychological treatment and offer private, flexible access. The Discussion describes them as potentially low-cost and accessible, but presents personalized automated support as a future research direction. The paper does not establish that these interventions are sustainable or specifically address barriers to delivering mind-body therapies; no page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNotifications can be set to remind users to engage, a function that has been shown to improve the efficacy of mental health apps.
“Notifications can also be set to remind users to engage, a function that has been shown to improve the efficacy of mental health apps [24].”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [24]
Higher levels of professional input may confer greater efficacy.
“In general, higher levels of professional input may confer greater efficacy [24].”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [24]
There is a growing body of evidence supporting the efficacy of app-based mental health interventions.
“In addition to their feasibility, there is a growing body of evidence supporting the efficacy of app-based mental health interventions [44,45].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [45]
Mobile health apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format.
“Mobile health (mHealth) apps leverage the ubiquity of mobile devices and the mobile-cellular telecommunication infrastructure and offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format [4].”
The inconsistency may also be because previous studies included both native smartphone and web-based apps.
“The inconsistency may also be because previous studies included both native smartphone and web-based apps [4,10].”
The finding that participants receiving interventions for depression experienced little symptom reduction that was not statistically significant is inconsistent with other systematic reviews reporting small-to-moderate effect sizes on depression symptom reduction.
“The finding is inconsistent with other systematic reviews reporting that smartphone apps have small-to-moderate effect sizes on depression symptom reduction [4,10,12].”
Several meta-analyses of randomised controlled trials involving smartphone-based mental health interventions have shown significant small-to-medium effects on anxiety and depression symptoms compared to controls, across both clinical and non-clinical populations.
“Several meta-analyses of randomised controlled trials (RCTs) involving smartphone-based mental health interventions have shown significant small-to-medium effects on anxiety and depression symptoms compared to controls, across both clinical and non-clinical populations [8,9,10].”
From A pilot evaluation of a smartphone application for workplace depression (2020) · cites this paper as [10]
Psychological interventions for common mental disorders, such as anxiety and depression, can be delivered remotely via smartphone apps.
“psychological interventions for common mental disorders, such as anxiety and depression, can be delivered remotely via smartphone apps 125”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [125]
There is strong evidence that psychological interventions can be effectively delivered through mHealth.
“There is strong evidence that psychological interventions can be effectively delivered through mHealth115–117.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [115]
eHealth and mHealth interventions are extensively researched and show promise to extend mental healthcare given their flexibility and anonymity in conduct, possible cost-effectiveness, and outreach on a population scale.
“eHealth and mHealth interventions (i.e., psychotherapeutic treatment programs that are either delivered via personal computers and web-browsers, or smartphones and mobile applications, respectively) are extensively researched in recent years and show promise to extend mental healthcare”
From More Light? Opportunities and Pitfalls in Digitalized Psychotherapy Process Research (2021) · cites this paper as Linardon et al., 2019
Some meta-analyses of mobile health apps concluded that self-help apps cannot be recommended, while others concluded they may serve as cost-effective, easily accessible, low intensity interventions.
“some meta-analysis of mobile health apps to conclude that self-help apps “cannot be recommended” [20] while others that these apps may “serve as a cost-effective, easily accessible, and low intensity interventions” [21].”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Smartphone interventions showed weak evidence of very small effects compared to active controls on anxiety in the general population (d = 0.18 [21]).
“Smartphone interventions showed weak evidence of very small effects compared to active controls in the general population and among those with elevated symptoms (ds = 0.18 and 0.19, respectively [21, 38]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Compared to non-specific controls, smartphone interventions showed suggestive evidence of small magnitude effects on depression (d = 0.39 [21]).
“Compared to non-specific controls, smartphone interventions showed suggestive evidence of small magnitude effects (d = 0.39 [21]) as did app interventions among those with elevated symptoms (d = 0.34 [20]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on depression (d = 0.32 [21]).
“Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on depression (d = 0.32 [21]) and meditation apps showed weak evidence of small magnitude effects (d = 0.35 [39]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Compared to specific active controls, smartphone interventions were not significantly superior in their effects on anxiety (d = 0.09 [21]).
“Compared to specific active controls, meditation apps and smartphone interventions were not significantly superior in their effects on anxiety (ds = 0.26 and 0.09, respectively [21, 39]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on quality of life (d = 0.35 [21]).
“Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on quality of life (d = 0.35 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Smartphone interventions did not differ from specific active controls on quality of life (d = 0.02 [21]).
“Smartphone interventions did not differ from specific active controls on quality of life (d = 0.02 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Smartphone interventions did not differ from active controls on stress (d = 0.09 [21]).
“Smartphone interventions did not differ from active controls (d = 0.09 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Compared to non-specific controls, smartphone interventions showed weak evidence of small magnitude effects on quality of life (d = 0.41 [21]).
“Compared to non-specific controls, smartphone interventions showed weak evidence of small magnitude effects on quality of life (d = 0.41 [21]) and meditation apps showed weak evidence of small magnitude effects on wellbeing (d = 0.31 [39]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on stress (d = 0.47 [21]).
“Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on stress (d = 0.47 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Smartphone interventions did not differ significantly from specific active controls on depression (d = 0.13 [21]).
“Smartphone interventions did not differ significantly from specific active controls (d = 0.13 [21]) or when tested as an adjunct to treatment (d = 0.26 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Smartphone interventions did not differ significantly when tested as an adjunct to treatment on depression (d = 0.26 [21]).
“Smartphone interventions did not differ significantly from specific active controls (d = 0.13 [21]) or when tested as an adjunct to treatment (d = 0.26 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
Smartphone interventions did not yield benefits on depression when added as adjunctive to other treatments, although the effect was of small magnitude (d = 0.26 [21]).
“Similarly, smartphone interventions did not yield benefits on depression when added as adjunctive to other treatments, although the effect was of small magnitude (d = 0.26 [21]).”
From Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials (2022) · cites this paper as [21]
In Linardon et al., the effect size for anxiety decreased as the control condition became more stringent, and was no longer significant when an active treatment control was used.
“A closer examination revealed that the effect size decreased as the control condition became more stringent, with the effect no longer being significant when an active treatment control was used.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al., 15 studies with follow-ups at 7 to 11 weeks found a medium effect size (g=0.52; 95% CI 0.41 to 0.63).
“However, those (15 studies) that included follow-ups at 7 to 11 weeks found a medium effect size (g=0.52; 95% CI 0.41 to 0.63).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Linardon et al. was rated high quality overall and moderate quality when compared with active controls.
“Overall, we rated this meta-analysis as being of high quality (overall) and moderate quality when compared with active controls because of the strengths mentioned and the fact that the results were either imprecise or inconsistent (or small N for active controls).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
The evidence for social anxiety apps was rated as poor to moderate quality.
“Only apps focusing on social anxiety (6 studies) reported a significant medium effect size, with quality evidence of poor to moderate quality (see Tables 1 and 2).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al., the effect size for anxiety remained small for follow-ups of 2 to 6 weeks.
“They also looked at some follow-up data and found that the effect size remained small for follow-ups of 2 to 6 weeks.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Panic and posttraumatic stress symptoms did not improve in the studies reviewed (3 and 4 studies, respectively).
“Panic and posttraumatic stress symptoms did not improve in the studies reviewed (3 and 4 studies, respectively), with the evidence rated as poor to moderate quality.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
The evidence for panic and posttraumatic stress symptoms was rated as poor to moderate quality.
“Panic and posttraumatic stress symptoms did not improve in the studies reviewed (3 and 4 studies, respectively), with the evidence rated as poor to moderate quality.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Only apps focusing on social anxiety (6 studies) reported a significant medium effect size.
“Only apps focusing on social anxiety (6 studies) reported a significant medium effect size, with quality evidence of poor to moderate quality (see Tables 1 and 2).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, all included studies were randomized controlled trials.
“all studies included were RCTs”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Linardon et al found a small to medium effect size for depressive symptoms.
“As for Linardon et al [47], the effect size was small to medium”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, the effect was precise.
“the effect precise”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, the sample was large.
“a large sample”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, there was no negative effect of publication bias; an increase was noted.
“with no negative effect of publication bias (in fact an increase was noted)”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, the quality of evidence was rated as high overall, given that heterogeneity was found.
“The quality of the evidence was also rated as high (overall), given that heterogeneity was found.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Linardon et al's meta-analysis is the most recent but does not include all studies reviewed in Versluis et al's or Firth et al's meta-analyses.
“Linardon et al’s [47] meta-analysis is the most recent but does not include all the studies reviewed in either Versluis et al’s [45] or Firth et al’s [40] meta-analyses, justifying the need to keep all 3 in this meta-review.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, follow-ups were reported for some studies, with a small effect size at posttreatment and at 2 to 6 weeks, but a medium effect at 7 to 11 weeks follow-up (g=0.46, 95% CI 0.36-0.55).
“Furthermore, follow-ups were reported for some studies, indicating that the effect size was small at posttreatment and at 2 to 6 weeks, but medium at 7 to 11 weeks follow-up (g=0.46, 95% CI 0.36-0.55).”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for stress, the effect size was small to medium and quality of evidence was moderate to high.
“For stress, the effect size was small to medium but with moderate to high–quality evidence”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for quality of life, the effect size was small to medium and quality of evidence was high.
“As for the quality of life, the effect was also small to medium, but the quality of the evidence was high”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Linardon et al included indirect measures: distress, stress, and quality of life.
“Linardon et al [47] also included indirect measures, namely, distress, stress, and quality of life.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for distress, the effect size was small to medium and overall quality of evidence was moderate.
“They reported a small-medium effect size, but overall, moderate-quality evidence for distress.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
For indirect mental health outcomes such as distress, stress, or quality of life, effects are consistently small to medium, with greater quality evidence for the most recent meta-analysis.
“As for indirect mental health outcomes, namely, outcomes that were considered but were not the main focus of the app intervention (such as distress, stress, or quality of life), the effects are consistently small to medium, with greater quality evidence for the most recent meta-analysis [47].”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for depression, quality of evidence was moderate to high for stand-alone apps and moderate for guidance.
“with the quality of the evidence being moderate to high for stand-alone apps and moderate for guidance.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
There are discrepancies in results, with Firth et al seeing a small effect size when apps were compared with active controls, but Linardon et al not observing a significant effect when active controls were used.
“There are some discrepancies in the results reported, with Firth et al [39] seeing a small effect size when apps were compared with active controls, but in a study by Linardon et al [47], a significant effect was not observed when active controls were used for comparison.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for depression, the effect size was medium for apps with guidance versus small for stand-alone apps.
“For depression, the effect size was medium for apps with guidance versus small for stand-alone apps”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for anxiety, quality of evidence was moderate to high for stand-alone apps and moderate for apps with guidance.
“with the quality of the evidence being moderate to high for stand-alone and moderate for apps with guidance.”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
In Linardon et al, for anxiety, the effect size was medium for guidance compared with small for stand-alone apps.
“For anxiety, the effect size is medium for guidance, compared with small for stand-alone apps”
From Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses (2020) · cites this paper as [47]
Preliminary evidence from this analysis did not show any difference in clinical outcomes with mHealth interventions in head to head trials with face-to-face delivery of therapies.
“Preliminary evidence from this analysis did not show any difference in clinical outcomes with mHealth interventions in head to head trials with face-to-face delivery of therapies.”
From What is the clinical value of mHealth for patients? (2020) · cites this paper as [19]
An updated meta-analysis from October 2019 identified 66 randomized controlled trials and demonstrated significantly improved clinical outcomes for management of depression, anxiety, and stress with mHealth apps vs control groups, with associated improvements in quality of life.
“An updated meta-analysis from October 2019 identified 66 randomized controlled trials and demonstrated significantly improved clinical outcomes for management of depression, anxiety, and stress with mHealth apps vs control groups, with associated improvements in quality of life.”
From What is the clinical value of mHealth for patients? (2020) · cites this paper as [19]
Emerging literature suggests DMHIs could be an effective stand-alone or supplemental treatment option.
“emerging literature on DMHIs suggests that these too could be an effective stand-alone or supplemental treatment option [2,3].”
From Digital Mental Health Interventions for Depression: Scoping Review of User Engagement (2022) · cites this paper as [3]
Guided digital mental health treatments produce much larger benefits than fully automated digital mental health treatments.
“Guided DMHTs, which include low-intensity support from a clinician or coach via messaging or telephone, produce much larger benefits than fully automated DMHTs (22).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [22]
Guided digital mental health treatments have treatment effectiveness for depression and anxiety comparable to standard face-to-face therapies.
“Results from meta-analyses of at least 66 well-designed RCTs have indicated that guided DMHT has treatment efficiency for common mental health conditions such as depression and anxiety disorders that is comparable to the efficiencies of standard face-to-face therapies (13, 22, 23).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [22]
One meta-analysis of randomised controlled trials found a significant difference between app interventions and control conditions (but not face-to-face or computer interventions) on certain outcomes.
“However, one meta-analysis of randomised controlled trials found a significant difference between app interventions and control conditions (but not face-to-face or computer interventions) on certain outcomes [12].”
From Artificial intelligence and machine learning in mobile apps for mental health: A scoping review (2022) · cites this paper as [12]
Several systematic reviews have recently been published focusing on various aspects and outcomes of mental health apps.
“Several systematic reviews have recently been published focusing on various aspects and outcomes of mental health apps [8–13].”
From Artificial intelligence and machine learning in mobile apps for mental health: A scoping review (2022) · cites this paper as [12]
Digital health interventions with some guidance tend to produce greater improvements than stand-alone interventions.
“Digital health interventions that include some guidance tend to result in greater improvements than stand-alone interventions.161, 162”
From Digital health and telehealth in cancer care: A scoping review of reviews (2023) · cites this paper as [161]
No significant differences were found in the adherence rate with antipsychotic medication for the MyCHOIS-CommonGround intervention.
“although no significant differences were found in the adherence rate with antipsychotic medication”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [48]
Engagement through the MyCHOIS-CommonGround website was associated with a higher level of ongoing engagement in out-patient mental health service compared to the control group.
“engagement through the MyCHOIS–CommonGround website was associated with a higher level of ongoing engagement in out-patient mental health service compared to that of the control group”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [48]
The MyCHOIS-CommonGround intervention was cost-effective, making it particularly suitable for attaining long-term outcomes in patients with severe mental disorders.
“Another noticeable advantage was the cost-effectiveness of the intervention which makes it particularly suitable for attaining long-term outcomes in patients with severe mental disorders [46–50]”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [48]
A growing body of evidence supports the effectiveness of digital mental health interventions in improving depression and anxiety symptoms, sometimes to a degree equivalent to that obtained from in-person treatment.
“Furthermore, a growing body of evidence supports the effectiveness of digital mental health interventions in improving depression and anxiety symptoms, sometimes to a degree equivalent to that obtained from in-person treatment [17-19].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [19]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Stress-effect confidence interval excludes its own estimate
MinorThe reported low-risk-of-bias stress effect is 0.78, but its stated 95% confidence interval runs from 0.63 to 0.04. The estimate cannot lie outside its own confidence interval; the midpoint of the printed bounds is 0.335.
Reported 0.78 · recomputed 0.335
“| Low risk of bias only | 4 | 0.78 (0.63-0.04)*** | 0% (0-22) |”
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RetractedUnderstanding users’ perspectives on mobile apps for anxiety management
Balaskas, A., Schueller, S. M., Cox, A. L., & Doherty, G. J. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.854263 · Cited by 49 · see citing works
Ha, S., Ho, S. H., Bae, Y.-H., Lee, M., Kim, J. H., Kim, J. H., & Lee, J. (2023) · Journal of Medical Internet Research · doi:10.2196/50029 · Cited by 57 · see citing works
Ahorsu, D. K., Lin, C., Imani, V., Carlbring, P., Nygårdh, A., Broström, A., Hamilton, K., & Pakpour, A. H. (2020) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2020.107371 · Cited by 49 · see citing works
Self-citationApp-Based Interventions for Moderate to Severe Depression
Bae, H., Shin, H., Ji, H.-G., Kwon, J. S., Kim, H., & Hur, J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.44120 · Cited by 47 · see citing works
- Authors
- Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., & Fuller‐Tyszkiewicz, M.
- Affiliations
- Deakin University (AU)
- Amsterdam Public Health (NL)
- Stockholm University (SE)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2019-09-09
- Volume
- 18
- Issue
- 3
- Pages
- 325-336
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6732686
- OpenAlex
- W2972598474
- Cited by
- 886
- References
- 81
- Citations by year
- 2026: 127 · 2025: 135 · 2024: 110 · 2023: 123 · 2022: 114 · 2021: 115 · 2020: 75 · 2019: 4 · 2018: 1
- FWCI
- 53.36
- Type
- journal article
- Language
- en
- Open access
- green
- research.vu.nl
- Licence
- Locations
- World Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- PubMed Central (submittedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- smartphone-based intervention, mental health apps, digital mental health, depression, generalized anxiety disorder, stress, quality of life, social anxiety
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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