Systematic review and meta-analysis of adverse events in clinical trials of mental health apps
Open accessAbstract
Mental health apps are efficacious, yet they may pose risks in some. This review (CRD42024506486) examined adverse events (AEs) from mental health apps. We searched (May 2024) the Medline, PsycINFO, Web of Science, and ProQuest databases to identify clinical trials of mental health apps. The risk of bias was assessed using the Cochrane Risk of Bias tool. Only 55 of 171 identified clinical trials reported AEs. AEs were more likely to be reported in trials sampling schizophrenia and delivering apps with symptom monitoring technology. The meta-analytic deterioration rate from 13 app conditions was 6.7% (95% CI = 4.3, 10.1, I 2 = 75%). Deterioration rates did not differ between app and control groups (OR = 0.79, 95% CI = 0.62–1.01, I 2 = 0%). Reporting of AEs was heterogeneous, in terms of assessments used, events recorded, and detail provided. Overall, few clinical trials of mental health apps report AEs. Those that do often provide insufficient information to properly judge risks related to app use.
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Torous, J., Bucci, S., Bell, I. H., Kessing, L. V., Faurholt‐Jepsen, M., Whelan, P., Carvalho, A. F., Keshavan, M., Linardon, J., & Firth, J. (2021) · World Psychiatry · doi:10.1002/wps.20883 · Cited by 1,199 · see citing works
Self-citationLaestadius, L., Bishop, A., Gonzalez, M., Illenčík, D., & Campos-Castillo, C. (2024) · New Media & Society · doi:10.1177/14614448221142007 · Cited by 420 · see citing works
Kauer, S. D., Reid, S. C., Crooke, A. H. D., Khor, A., Hearps, S. J. C., Jorm, A. F., Sanci, L., & Patton, G. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.1858 · Cited by 404 · see citing works
The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial
Arean, P. A., Hallgren, K. A., Jordan, J. T., Gazzaley, A., Atkins, D. C., Heagerty, P. J., & Anguera, J. A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.6482 · Cited by 376 · see citing works
Consensus statement on defining and measuring negative effects of internet interventions
Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., Ljótsson, B., Kaldo, V., Titov, N., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.001 · Cited by 371 · see citing works
CBT for depression: a pilot RCT comparing mobile phone vs. computer
Watts, S., Mackenzie, A., Thomas, C., Griskaitis, A., Mewton, L., Williams, A., & Andrews, G. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-49 · Cited by 329 · see citing works
Huckvale, K., Torous, J., & Larsen, M. E. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.2542 · Cited by 312 · see citing works
Self-citationLiu, H., Peng, H., Song, X., Xu, C., & Zhang, M. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100495 · Cited by 296 · see citing works
A systematic assessment of smartphone tools for suicide prevention
Larsen, M. E., Nicholas, J., & Christensen, H. (2016) · PLoS ONE · doi:10.1371/journal.pone.0152285 · Cited by 289 · see citing works
Ly, K. H., Trüschel, A., Jarl, L., Magnusson, S., Windahl, T., Johansson, R., Carlbring, P., & Andersson, G. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-003440 · Cited by 269 · see citing works
Roepke, A. M., Jaffee, S. R., Riffle, O. M., McGonigal, J., Broome, R., & Maxwell, B. (2015) · Games for Health Journal · doi:10.1089/g4h.2014.0046 · Cited by 265 · see citing works
Rozental, A., Kottorp, A., Forsström, D., Månsson, K., Boettcher, J., Andersson, G., Furmark, T., & Carlbring, P. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000018 · Cited by 230 · see citing works
Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De La Mata, N., & Christensen, H. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013518 · Cited by 227 · see citing works
A randomized controlled trial of a smartphone app for posttraumatic stress disorder symptoms.
Kuhn, E., Kanuri, N., Hoffman, J. E., Garvert, D. W., Ruzek, J. I., & Taylor, C. B. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000163 · Cited by 225 · see citing works
Definition, assessment and rate of psychotherapy side effects
Linden, M., & Schermuly-Haupt, M.-L. (2014) · World Psychiatry · doi:10.1002/wps.20153 · Cited by 220 · see citing works
Franklin, J. C., Fox, K. R., Franklin, C. R., Kleiman, E. M., Ribeiro, J. D., Jaroszewski, A. C., Hooley, J. M., & Nock, M. K. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000093 · Cited by 217 · see citing works
Faurholt-Jepsen, M., Frost, M., Ritz, C., Christensen, E. M., Jacoby, A. S., Mikkelsen, R. L., Knorr, U., Bardram, J. E., Vinberg, M., & Kessing, L. V. (2015) · Psychological Medicine · doi:10.1017/s0033291715000410 · Cited by 213 · see citing works
Schlosser, D. A., Campellone, T. R., Truong, B., Etter, K., Vergani, S., Komaiko, K., & Vinogradov, S. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby078 · Cited by 206 · see citing works
Mantani, A., Kato, T., Furukawa, T. A., Horikoshi, M., Imai, H., Hiroe, T., Chino, B., Funayama, T., Yonemoto, N., Zhou, Q., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8602 · Cited by 192 · see citing works
Reid, S. C., Kauer, S. D., Hearps, S. J., Crooke, A. H., Khor, A. S., Sanci, L. A., & Patton, G. C. (2011) · BMC Family Practice · doi:10.1186/1471-2296-12-131 · Cited by 192 · see citing works
Donker, T., Cornelisz, I., van Klaveren, C., van Straten, A., Carlbring, P., Cuijpers, P., & van Gelder, J.-L. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.0219 · Cited by 187 · see citing works
He, Y., Yang, L., Zhu, X., Wu, B., Zhang, S., Qian, C., & Tian, T. (2022) · Journal of Medical Internet Research · doi:10.2196/40719 · Cited by 178 · see citing works
Ben-Zeev, D., Brian, R. M., Jonathan, G., Razzano, L., Pashka, N., Carpenter-Song, E., Drake, R. E., & Scherer, E. A. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201800063 · Cited by 173 · see citing works
Ly, K. H., Topooco, N., Cederlund, H., Wallin, A., Bergström, J., Molander, O., Carlbring, P., & Andersson, G. (2015) · PLOS ONE · doi:10.1371/journal.pone.0126559 · Cited by 171 · see citing works
Karyotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718000648 · Cited by 167 · see citing works
Possemato, K., Kuhn, E., Johnson, E., Hoffman, J. E., Owen, J. E., Kanuri, N., De Stefano, L., & Brooks, E. (2016) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.09.005 · Cited by 167 · see citing works
Sun, Y., Li, Y., Wang, J., Chen, Q., Bazzano, A. N., & Cao, F. (2021) · Journal of Medical Internet Research · doi:10.2196/23410 · Cited by 165 · see citing works
Graham, A. K., Greene, C. J., Kwasny, M. J., Kaiser, S. M., Lieponis, P., Powell, T., & Mohr, D. C. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1011 · Cited by 162 · see citing works
Birney, A. J., Gunn, R., Russell, J. K., & Ary, D. V. (2016) · JMIR mHealth and uHealth · doi:10.2196/mhealth.4231 · Cited by 159 · see citing works
Moberg, C., Niles, A., & Beermann, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12556 · Cited by 157 · see citing works
Sun, S., Lin, D., Goldberg, S., Shen, Z., Chen, P., Qiao, S., Brewer, J., Loucks, E., & Operario, D. (2022) · Journal of Counseling Psychology · doi:10.1037/cou0000568 · Cited by 138 · see citing works
Self-citationApps and eating disorders: A systematic clinical appraisal
Fairburn, C. G., & Rothwell, E. R. (2015) · International Journal of Eating Disorders · doi:10.1002/eat.22398 · Cited by 121 · see citing works
Mohr, D. C., Schueller, S. M., Tomasino, K. N., Kaiser, S. M., Alam, N., Karr, C., Vergara, J. L., Gray, E. L., Kwasny, M. J., & Lattie, E. G. (2019) · Journal of Medical Internet Research · doi:10.2196/13609 · Cited by 116 · see citing works
Greer, J. A., Jacobs, J., Pensak, N., MacDonald, J. J., Fuh, C.-X., Perez, G. K., Ward, A., Tallen, C., Muzikansky, A., Traeger, L., et al. (2019) · The Oncologist · doi:10.1634/theoncologist.2018-0536 · Cited by 112 · see citing works
Ghanbari, E., Yektatalab, S., & Mehrabi, M. (2021) · JMIR mHealth and uHealth · doi:10.2196/19262 · Cited by 104 · see citing works
Pham, Q., Khatib, Y., Stansfeld, S., Fox, S., & Green, T. (2016) · Games for Health Journal · doi:10.1089/g4h.2015.0033 · Cited by 104 · see citing works
Stolz, T., Schulz, A., Krieger, T., Vincent, A., Urech, A., Moser, C., Westermann, S., & Berger, T. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000301 · Cited by 102 · see citing works
Ponzo, S., Morelli, D., Kawadler, J. M., Hemmings, N. R., Bird, G., & Plans, D. (2020) · JMIR mHealth and uHealth · doi:10.2196/17767 · Cited by 100 · see citing works
A Self-Help App for Syrian Refugees With Posttraumatic Stress (Sanadak): Randomized Controlled Trial
Röhr, S., Jung, F. U., Pabst, A., Grochtdreis, T., Dams, J., Nagl, M., Renner, A., Hoffmann, R., König, H.-H., Kersting, A., et al. (2021) · JMIR mhealth and uhealth · doi:10.2196/24807 · Cited by 92 · see citing works
Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A. J., Emsley, R., Gu, J., Shin, O., Otto, M. W., et al. (2020) · Depression and Anxiety · doi:10.1002/da.23079 · Cited by 86 · see citing works
Hur, J.-W., Kim, B., Park, D., & Choi, S.-W. (2018) · Telemedicine and e-Health · doi:10.1089/tmj.2017.0214 · Cited by 82 · see citing works
Dahne, J., Lejuez, C. W., Diaz, V. A., Player, M. S., Kustanowitz, J., Felton, J. W., & Carpenter, M. J. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.12.003 · Cited by 78 · see citing works
Torok, M., Han, J., McGillivray, L., Wong, Q., Werner-Seidler, A., O’Dea, B., Calear, A., & Christensen, H. (2022) · PLoS Medicine · doi:10.1371/journal.pmed.1003978 · Cited by 71 · see citing works
O'Toole, M. S., Arendt, M. B., & Pedersen, C. M. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.07.007 · Cited by 71 · see citing works
Vaughan, B., Goldstein, M. H., Alikakos, M., Cohen, L. J., & Serby, M. J. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.01.001 · Cited by 63 · see citing works
Dahne, J., Collado, A., Lejuez, C. W., Risco, C. M., Diaz, V. A., Coles, L., Kustanowitz, J., Zvolensky, M. J., & Carpenter, M. J. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.009 · Cited by 62 · see citing works
Heim, E., Ramia, J. A., Hana, R. A., Burchert, S., Carswell, K., Cornelisz, I., Cuijpers, P., El Chammay, R., Noun, P., van Klaveren, C., et al. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100380 · Cited by 61 · see citing works
van Aubel, E., Bakker, J. M., Batink, T., Michielse, S., Goossens, L., Lange, I., Schruers, K., Lieverse, R., Marcelis, M., van Amelsvoort, T., et al. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103592 · Cited by 57 · see citing works
A therapist-guided smartphone app for major depression in young adults: A randomized clinical trial
Raevuori, A., Vahlberg, T., Korhonen, T., Hilgert, O., Aittakumpu-Hyden, R., & Forman-Hoffman, V. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.02.007 · Cited by 52 · see citing works
A Gamified Smartphone-Based Intervention for Depression: Randomized Controlled Pilot Trial
Lukas, C. A., Eskofier, B., & Berking, M. (2021) · JMIR Mental Health · doi:10.2196/16643 · Cited by 49 · see citing works
Christoforou, M., Sáez Fonseca, J. A., & Tsakanikos, E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7747 · Cited by 48 · see citing works
LaFreniere, L. S., & Newman, M. G. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000794 · Cited by 48 · see citing works
Roy, M. J., Costanzo, M. E., Highland, K. B., Olsen, C., Clayborne, D., & Law, W. (2017) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2017.0221 · Cited by 43 · see citing works
Roy, A., Hoge, E. A., Abrante, P., Druker, S., Liu, T., & Brewer, J. A. (2021) · Journal of Medical Internet Research · doi:10.2196/26987 · Cited by 41 · see citing works
Shin, B., Oh, J., Kim, B.-H., Kim, H. E., Kim, H., Kim, S., & Kim, J.-J. (2021) · JMIR Mental Health · doi:10.2196/30590 · Cited by 38 · see citing works
A randomized controlled trial of a smartphone-based application for the treatment of anxiety
Newman, M. G., Jacobson, N. C., Rackoff, G. N., Bell, M. J., & Taylor, C. B. (2021) · Psychotherapy Research · doi:10.1080/10503307.2020.1790688 · Cited by 37 · see citing works
Bentz, D., Wang, N., Ibach, M. K., Schicktanz, N. S., Zimmer, A., Papassotiropoulos, A., & de Quervain, D. J. F. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00387-7 · Cited by 34 · see citing works
Gao, M., Roy, A., Deluty, A., Sharkey, K. M., Hoge, E. A., Liu, T., & Brewer, J. A. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001083 · Cited by 24 · see citing works
Zhao, C., Zhao, Z., Levin, M. E., Lai, L., Shi, C., Hu, J., Chen, W., & Ren, Z. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104440 · Cited by 22 · see citing works
Taylor, R. W., Male, R., Economides, M., Bolton, H., & Cavanagh, K. (2023) · JMIR Formative Research · doi:10.2196/41590 · Cited by 15 · see citing works
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Self-citation
- Authors
- Linardon, J., Fuller-Tyszkiewicz, M., Firth, J., Goldberg, S. B., Anderson, C., McClure, Z., & Torous, J.
- Affiliations
- Deakin University (AU)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- University of Wisconsin–Madison (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Linardon, Jake
- Venue
- npj Digital Medicine
- Published
- 2024-12-18
- Volume
- 7
- Issue
- 1
- Pages
- 363-363
- ISSN
- 2398-6352 (ISSN-L)
- PMC
- PMC11655657
- OpenAlex
- W4405516678
- Cited by
- 44
- References
- 60
- Citations by year
- 2026: 18 · 2025: 26
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- npj Digital Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- Funders
- Argosy Foundation
- UK Research and Innovation (MR/T021780/1)
- National Institutes of Health
- Medical Research Council (MR/T021780/1)
- National Health and Medical Research Council (1196948, K23AT010879)
- National Center for Complementary and Integrative Health (K23AT010879, R24AT012845)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- mental health apps, adverse events, digital mental health interventions, clinical trials, schizophrenia, symptom monitoring, degradation rate, risk of bias, adverse event reporting, mobile application security
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