From the Editor

Sigmund Freud, Aaron Beck, Steve Jobs?

Do apps have the potential to reshape mental health?

It’s a hot topic and Nature – the prestigious British journal – explores the potential and pitfalls of mental health apps.

In this week’s Reading, we consider “Pocket Psychiatry.”

Also: journalist John Stossel discusses his lung cancer – and health-care delivery.


e-Therapy and Its Critics

“Pocket Psychiatry”

Emily Anthes, Nature, 6 April 2016!/menu/main/topColumns/topLeftColumn/pdf/532020a.pdf


Type ‘depression’ into the Apple App Store and a list of at least a hundred programs will pop up on the screen. There are apps that diagnose depression (Depression Test), track moods (Optimism) and help people to “think more positive” (Affirmations!). There’s Depression Cure Hypnosis (“The #1 Depression Cure Hypnosis App in the App Store”), Gratitude Journal (“the easiest and most effective way to rewire your brain in just five minutes a day”), and dozens more. And that’s just for depression. There are apps pitched at people struggling with anxiety, schizophrenia, post-traumatic stress disorder (PTSD), eating disorders and addiction.

This burgeoning industry may meet an important need. Estimates suggest that about 29% of people will experience a mental disorder in their lifetime. Data from the World Health Organization (WHO) show that many of those people — up to 55% in developed countries and 85% in developing ones — are not getting the treatment they need. Mobile health apps could help to fill the gap. Given the ubiquity of smartphones, apps might serve as a digital lifeline — particularly in rural and low-income regions — putting a portable therapist in every pocket. “We can now reach people that up until recently were completely unreachable to us,” says Dror Ben-Zeev, who directs the mHealth for Mental Health Program at the Dartmouth Psychiatric Research Center in Lebanon, New Hampshire.

Emily Anthes

So opens an essay by Emily Anthes published in Nature.

Anthes notes the popularity of apps, and the potential. Indeed, she offers a broad view, even touching on global psychiatry. She describes the relative dearth of psychiatrists in the developing world – but the widespread availability of smart phones; they have been adapted by 63% of the population in the developing world. “Smart phones have the potential to reach people without access to care,” she notes.

“But the technology is moving a lot faster than the science.” She observes the uneven quality of apps.


· A 2013 review identified more than 1,500 depression-related apps but just 32 published research papers.

· Australian researchers did a similar review with higher critiera, finding just eight papers on five apps.

· The U.K.’s National Health Service launched a library of health apps, including 14 for depression and anxiety. When reviewed, only four had any evidence.

That said, some apps have been carefully developed. In 2010, Veterans Affairs in the United States teamed up with Department of Defense to create PTSD Coach – an app that can help a vet at the moment of distress. The free app had 150,000 downloads in three years, in 86 countries. In a 2014 study, 80% of vets found the app helpful in tracking and managing symptoms.

Other apps that are mentioned in the article:

· FOCUS is designed for people with schizophrenia, helping them follow mood and sleep patterns.

· Sleepio, an app designed by a sleep scientist, uses evidence-based interventions for insomnia.

· ClinTouch, a psychiatric-symptom-assessment app designed by researchers at the University of Manchester, looks for emerging symptoms of relapse.

A few thoughts:

1. This essay is balanced and well written.

2. Past Readings have also looked at apps. Shen et al. wrote a great paper on the uneven quality of depression apps. You can find that Reading here:

3. At The Scarborough Hospital where I work, we are experimenting with apps and, using a modified scale, have developed a mental health app library. The project is led by Shawnna Balasingham, the ever-capable manager of outpatient mental health services. We recognize that our patients increasingly use apps, and we want to help steer their choices. As the research in this area evolves, we hope to expand our library. You can find it here: (Note that the TSH website works best when viewed with browsers other than Internet Explorer.)

Health Care Delivery

“I have lung cancer. My medical care is excellent but the customer service stinks”

John Stossel,

20 April 2016

I write this from the hospital. Seems I have lung cancer.

My doctors tell me my growth was caught early and I’ll be fine. Soon I will barely notice that a fifth of my lung is gone. I believe them. After all, I’m at New York-Presbyterian Hospital. U.S. News & World Report ranked it No. 1 in New York. I get excellent medical care here.

But as a consumer reporter, I have to say, the hospital’s customer service stinks.

John Stossel

So opens an opinion piece by journalist John Stossel published by Drawing on his experience being treated for lung cancer and his stay in the ICU, the long-time consumer reporter suggests problems with customer service.

Over the years, Readings have been drawn from many sources. For the record, this is the first time I’ve chosen a essay – not exactly a paper from a psychiatry journal. But health care delivery is an important topic, and Stossel writes about the problems he experiences at New York-Presbyterian. I work at a Canadian hospital, but the problems are too familiar – the noise, the waiting, the difficulty reaching providers.

“I shouldn’t be surprised that hospitals are lousy at customer service. The Detroit Medical Center once bragged that it was one of America’s first hospitals to track medication with barcodes. Good! But wait – ordinary supermarkets did that decades before.”

Stossel, who is a libertarian, ties this back to the way health care is funded, arguing that insurance and government payments divorce consumers from the system. That’s a defensible argument, though certainly a controversial one. Others would argue that health care is simply different from other service industries; that argument was first forwarded by Nobel laureate Kenneth Arrow in his work on information asymmetry.

But whether you agree with Stossel’s diagnosis of the system’s ills, it’s difficult not to appreciate his description of his experiences.

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.