Supporting Mental Health with Apps: A Systematic Review of Potential and Quality of Implemented Behavior Change Techniques in Mobile Health Applications

The rapid digitalization of healthcare has led to the widespread availability of mobile health (mHealth) applications, including those aimed at mental health and well-being. The present study followed the PRISMA guidelines and systematically reviewed English and/or German mental health apps available in the Google Play Store to evaluate their functional quality and behavior-change potential. It utilized the Mobile App Rating Scale (MARS) to assess app quality, including engagement, functionality, esthetics, and information quality, and the App Behavior Change Scale (ABACUS) to evaluate the potential for behavior change by inclusion of behavior change techniques (BCTs). A total of 77 apps were reviewed, with findings indicating an average functional quality and moderate behavior-change potential, as the reviewed apps only utilized a limited amount of BCTs. Notably, only a small fraction of apps had been evaluated in randomized controlled trials (RCTs). Further analysis showed that MARS and ABACUS scores had limited predictive power regarding app popularity as measured by stars awarded by users and number of user ratings in the Google Play Store. The study highlights the need for more rigorous testing of mHealth apps and suggests that factors beyond those measured by MARS and ABACUS may influence app popularity. In addition to the scientific value, this review provides insights for both users interested in mental health support via apps and developers aiming to enhance the quality and impact of mental health applications.