“This app said I had severe depression, and now I don’t know what to do”: the unintentional harms of mental health applications

Title of the Paper

“This app said I had severe depression, and now I don’t know what to do”: the unintentional harms of mental health applications

Bibliographic Information

• Subject Area: Human-Computer Interaction (HCI), Digital Health, Ethics and Design of Mental Health Applications
• Keywords: Depression apps, mental health apps, user reviews, thematic analysis, ethics of digital technology

Research Background and Questions

• Research Background:

  • In the United States, approximately 1 in 10 adults and 1 in 5 young people and adolescents reported experiencing depression in 2020, with depression rates nearly tripling during the COVID-19 pandemic.
  • Although mental health applications have shown preliminary efficacy, the lack of market regulation may lead to potential risks going unnoticed.
  • Mobile-based mental health solutions are increasingly popular, yet research on the negative impacts of such technologies on users remains limited.

• Core Research Questions:

  • What potential harms might interactions with depression self-management apps cause to users?
  • What issues increase the risk of harm caused by these applications?

• Research Motivation:

  • While existing studies report the effectiveness of mental health apps in alleviating symptoms, negative user experiences and related ethical issues may impact users' mental health.
  • This study aims to uncover potential harm areas caused by depression self-management apps through user review analysis and provide ethical design recommendations for developers.

Solutions

• Research Methods:

  • Data Collection: A systematic screening of 36 depression self-management apps from Google Play and Apple App Stores was conducted, collecting a total of 27,222 user reviews, with 6,253 reviews analyzed.
  • Analysis Method: Braun and Clarke's reflexive thematic analysis method was employed to identify negative outcomes and harms through user reviews.

• Results Framework:

  • The study identified four major themes causing harm to users and analyzed them based on APA (American Psychological Association) ethical principles.
  • Ethical design recommendations, user protection strategies, and guidelines for mental health practitioners were provided.

• Research Innovations:

  • Unlike previous high-level summaries, this study delves into specific harms triggered by negative user experiences.
  • It offers concrete improvement suggestions for mental health technologies using the APA ethical framework.

Research Findings

Four Major Themes (Risk Areas)

1. Theme 1: Feeling unsupported due to errors and design flaws

   • Errors caused users to lose data or prevented access to critical features, leading to anxiety and even emotional breakdowns.
   • Ambiguous features or recommendations left users confused or fearful.
   • Users expressed strong dissatisfaction with developers' failure to promptly fix issues.

2. Theme 2: Feeling unworthy of mental health care due to low accessibility

   • Paywalls prevented some users from continuing to access support.
   • Lack of adaptive design for visually impaired users exacerbated the exclusionary nature of the apps.

3. Theme 3: Feeling deceived or manipulated due to marketing strategies or updates

   • Some apps required payment after free trials to access users' historical data.
   • Issues with product pricing and transparency created financial stress for some users.

4. Theme 4: Feeling concerned or confused about mental health data privacy

   • Apps had unclear data-sharing policies and privacy protection measures.
   • Users worried that sensitive data might be sold or leaked to third parties, potentially leading to severe social exclusion or psychological harm.

Discussion Based on Ethical Principles

• APA Ethical Analysis:
  • Principle 1: Beneficence and Non-Maleficence:
    • Anxiety, fear, and harm caused by app design flaws and deficiencies violate this principle.
  • Principle 2: Integrity:
    • Misleading experiences due to false advertising indicate that developers failed to uphold the principle of integrity.
  • Principle 3: Justice:
    • Unequal paywalls and lack of accessible design hinder equal benefit for all users.
  • Principle 4: Respect for People’s Rights and Dignity:
    • Inadequate privacy protection may infringe on users' rights and expose them to risks.

Experimental and Evaluation Results

• Negative user reviews revealed widespread and profound potential harms.
• Improvement measures based on user suggestions were proposed, such as ensuring price transparency, enhancing data privacy policies, optimizing thematic design, and diversifying functionality.

Limitations and Future Directions

• Limitations:

  • The study only used apps from U.S. stores, potentially overlooking cultural differences in international applications.
  • Other types of mental health apps (e.g., anxiety management or AI therapy) were not covered.
  • Some negative impacts may stem from users' misunderstanding of privacy policies rather than actual risks.

• Future Research Directions:

  • Expand international research to collect user reviews in different cultural contexts.
  • Use quantitative thematic modeling analysis to broaden classification scope.
  • Strengthen guidance and education to address users' misinterpretations of privacy policies.

Through these recommendations, the study not only explores the ethical challenges of mental health apps but also calls upon developers, users, and practitioners to take action to collectively promote the healthy development of mental health technologies.