Better Protection Urgently Needed for Millions Using Depression Apps, Study Finds

No app is a cure-all for mental health, and data protection practices are near non-existent

Experts agree that depression apps should never share user data with third parties without explicit consent. Unfortunately, in the emerging digital mental health marketplace there’s little stopping these apps and their developers from collecting intimate details about suicidal thoughts, medication struggles and emotional breakdowns with almost no safeguards in place.

Now, a study published in BMJ Open shows unanimous concern about data privacy. To start, 43 experts created the first comprehensive checklist for evaluating mental health apps. The panel included psychiatrists, psychologists, digital health researchers and people living with depression. All seven proposed privacy and safety criteria, and that idea passed the first round of voting with overwhelming support (the strongest consensus in the entire evaluation process).

Depression currently affects around 5% of the world’s adult population, and the World Health Organization predicts it will become the largest global disease burden by 2030. People suffering from depression are 46-60% more likely to die prematurely than the general population due to suicide and untreated physical problems.

Many avoid seeking professional help due to stigma, turning instead to mental health apps downloaded privately to their phones. Previous research found only 26.7% of examined depression apps were supported by actual scientific evidence. Most lack any validation or systematic clinical testing, including basic safety standards for protecting user data.

Unanimous Verdict on Privacy

Researchers conducted a two-round consensus process where experts anonymously rated 51 potential evaluation criteria. Participants scored each criterion on a six-point scale, with 6 meaning maximum importance.

The criterion on data transfer to third parties achieved 100% consensus in the first round (the highest agreement level for any criterion in the entire study). Six other privacy and safety criteria also reached maximum consensus, requiring at least 80% of participants to rate them as 5 or 6 on the importance scale.

Together, safety and privacy criteria made up 25% of the final 28-item checklist, tied for the largest category alongside clinical effectiveness. The same team had also previously conducted similar research on weight management apps, in which privacy made up 24.5% of final criteria. The slightly higher emphasis comes from the sensitive nature of mental health data.

Why Depression Data Needs Extra Protection

Mental health information carries unique risks. Leaked depression data could affect employment, insurance coverage, child custody decisions or personal relationships. For individuals already battling stigma, a privacy breach adds another burden.

“People with mental diseases are often stigmatised, they may avoid visiting a healthcare professional and resort to digital resources without advice or supervision,” the researchers explain. “If we add to this the lack of mobile app standardisation, the need for more studies that test and validate apps with a clinical orientation is evident.”

Even worse, users struggle to assess whether apps protect their data or share details with advertisers, data brokers or other third parties. App store ratings provide no reliable information about privacy practices.

Clinical Effectiveness Ranks Equally High

While privacy concerns led the discussion, clinical effectiveness tied as the most important category, also contributing 25% of selected criteria. Participants wanted assurance that app recommendations are evidence-based (95.7% agreement). They emphasized apps should offer measurable objectives (87% consensus) and clearly explain how interventions work with expected timeframes (82.6%).

Usability and functionality made up 17.9% of final criteria. Experts valued apps that allow customization according to user preferences (87%) and have components that are easily interpretable (82.6%).

The study’s 26 participants in Round 1 and 23 in Round 2 included healthcare professionals, technology experts and people diagnosed with depression. Researchers gave equal weight to all perspectives.

Tracking Features Ranked Surprisingly Low

Health indicators (specific tracking features like monitoring sleep, exercise or mood patterns) received the lowest priority, making up only 7.1% of final criteria. Eight health indicator criteria presented in Round 2 failed to achieve high consensus.

This skepticism matches the team’s previous systematic review and meta-analysis on depression app efficacy. That research found none of the app-specific features (self-monitoring, goal setting, feedback, gamification or reminders) were significantly associated with better clinical outcomes.

“This may explain the low prioritisation of Health Indicators in this study and suggests a need for personalised approaches that accommodate individual differences, preferences and needs,” the researchers note.

Apps Work Best With Professional Support

Participant comments emphasized that apps should complement, not replace, professional care. “The app should be a screening tool and a useful tool to detect serious cases and to raise awareness among users that they should seek professional help,” one participant wrote.

This matches the team’s earlier meta-analysis showing depression apps achieve the greatest efficacy when combined with face-to-face therapy sessions. Apps alone produce moderate positive effects compared to minimal intervention, but hybrid approaches deliver superior results.

Several participants stressed adapting content to different populations. “Consider particularities both in terms of gender perspective and in terms of age and cultural range,” one commented.

A Framework for Protection

The 28 criteria now form the foundation for the EvalDepApps assessment tool. This framework will help healthcare professionals and patients identify which apps meet rigorous standards for safety, privacy and effectiveness.

Healthcare providers currently lack guidance on which apps to recommend. Patients downloading apps independently have even less information. Star ratings in app stores tell nothing about data practices, clinical evidence or safety protocols.

The evaluation tool fills this need by establishing clear quality benchmarks. Apps that meet all 28 criteria demonstrate they protect user privacy, base recommendations on scientific evidence and provide appropriate support for managing depression.

With depression rates rising globally (up 49.86% between 1990 and 2017) digital interventions will play an increasingly important role in mental healthcare. As care moves onto smartphones, the experts behind EvalDepApps argue that protecting patient data cannot be optional. For people living with depression, many of whom are already isolated or stigmatized, inadequate privacy protections add risk to populations already facing elevated mortality rates.

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