Mobile Health Applications for Mental Illnesses: An Asian Context

Abstract

Advances in digital technologies have created unprecedented opportunities to assess and improve health behavior and health outcomes. Evidence indicates that a majority of the world’s population, including traditionally underserved populations and low- and middle-income countries, has access to mobile technologies (phones, tablets, mobile devices). Given the widespread access to mobile technology worldwide, health behavior-change tools delivered on mobile platforms enable broader reach and scalability of evidence-based assessment and interventions, especially for addressing the growing burden of mental health disorders globally. The purpose of this article was to present a qualitative review of mobile mental health applications in an Asian context. We searched on-line databases and included 19 articles in this review. We have identified mobile health applications that address eight categories of mental illnesses. These applications were developed in only six countries and regions in Asia. Future studies from more diverse countries for diverse cultures should be conducted to examine the advantages and disadvantages of mobile health technology.

1.1. Introduction

The use of technology in the medical field has exploded over the last decade, impacting health care in innovative ways. The use of mobile applications in mental health is a rapidly growing sector of healthcare and is impacting the quality of service and lifestyles of individuals over the globe (BinDhim et al., 2016; Naslund & Aschbrenner et al., 2019). In Asia, mobile applications are being used to assess psychopathology, improve quality of care, provide interventions, access and monitor patients, and break the stigma that often surrounds mental illness (e.g., Begume, 2019; Das et al., 2020; Gowda et al., 2019; Li et al., 2014; Muke et al., 2019; Patil et al., 2020). Advancements in mobile application innovation in the mental health field necessitate the development of a repository of standards and best practices for implementation. This literature review details how mobile applications are currently utilized in Asia. Studies that examine Asian populations are reviewed and interpreted to provide an in-depth understanding of how mobile applications have been utilized in an Asian context, as well as their future implications.

2.1. Methods

Articles, published between the years of 2008 and 2019, were selected from peer-reviewed journals and online databases including PubMed, Health Reference Center, and ProQuest: PsychInfo. Additional criteria for selection included that articles were full text, their PDFs were downloadable from the web or accessible through interlibrary loan, and they were originally published in English or that an English translation was available. Each search term was composed of two to three components: a) words referencing mental health or a specific mental illness diagnosis, b) words referencing internet or mobile applications, and c) words referencing location (See Table 1).

Table 1.

Search Terms and Phrases for the Literature Review

1. Mental health applications in Asia

2. Mental health mobile technology

3. Mobile applications for mental health in Asia

4. Cognitive training mobile applications in Asia

5. Mobile applications for psychosis in Asia

6. Mobile applications for anxiety in Asia

7. Mobile applications for depression in Asia

8. Cognitive training mobile applications

9. Mobile applications for psychosis

10. Mobile applications for anxiety

11. Mobile applications for depression

12. Electronic mental health services in Asia

13. Mental health app in Asia

14. Mental health mobile applications in Asia

15. Mobile applications for cognitive training

16. Mobile applications for psychosis in China

17. Mobile applications for anxiety in India

18. Mobile applications for depression in Korea

19. Electronic mental health services in Taiwan

20. Electronic mental health services in Japan

2.2. Selection Criteria

Inclusion criteria required that articles must reference (1) mental illness, (2) mobile or internet application, and (3) the continent of Asia or a specific country in Asia. Additional filters for location included the search terms: Asia, Japan, Taiwan, Korea, China, India, and other specific countries within Asia.

3.1. Results

The 20 search terms yielded 6,672 articles; 6,635 articles were excluded due to their being duplicates or not meeting the inclusion criteria. After review of the abstracts and full articles (N=37), an additional 15 articles were excluded. Twenty-two articles met the inclusion criteria and were reviewed. Table 2 lists articles included for review, categorized by mental illness and Table 3 contains articles categorized by mental illness and geographical region. In the following sections, we review the articles by the mental illness category.

Table 2.

Articles by Mental Illness Category

Category	Articles
Addiction	1. Schulte, M., Liang, D., Wu, F., Lan, Y.C., Tsay, W., Du, J., Zhao, M., Li, X. and Hser, Y.I., 2016. A smartphone application supporting recovery from heroin addiction: Perspectives of patients and providers in China, Taiwan, and the USA. Journal of Neuroimmune Pharmacology, 11(3), pp.511-522.  2. Takano, A., Miyamoto, Y., Kawakami, N., Matsumoto, T., Shinozaki, T. and Sugimoto, T., 2016. Web-based cognitive behavioral relapse prevention program with tailored feedback for people with methamphetamine and other drug use problems: Protocol for a multicenter randomized controlled trial in Japan. BMC psychiatry, 16(1), p.87.  3. Zhang, M., Heng, S., Song, G., Fung, D.S. and Smith, H.E., 2019. Co-designing a mobile gamified attention bias modification intervention for substance use disorders: Participatory research study. JMIR mHealth and uHealth, 7(10), p.e15871.
Anxiety	1. Wang, Z., Wang, J. and Maercker, A., 2013. Chinese My Trauma Recovery, a Web-based intervention for traumatized persons in two parallel samples: Randomized controlled trial. Journal of medical Internet research, 15(9), p.e213.
Depression	1. Guo, Y., Hong, Y.A., Cai, W., Hai, Y., Qiao, J., Xu, Z., Zhang, H., Zeng, C., Liu, C., Li, L., Li, Y., Zhu, M., Zeng, Y. and Penedo, F.J. 2020. Effect of a WeChat-Based intervention (Run4Love) on depressive symptoms among people living with HIV in China: A randomized controlled trial. J. Med. Internet Res., 22(2), e16715.  2. Jang, S.H., Woo, Y.S., Hong, J.W., Yoon, B.H., Hwang, T.Y., Kim, M.D., Lee, S.Y. and Bahk, W.M., 2017. Use of a smartphone application to screen for depression and suicide in South Korea. General hospital psychiatry, 46, pp.62-67.  3. Kim, J., Lim, S., Min, Y.H., Shin, Y.W., Lee, B., Sohn, G., Jung, K.H., Lee, J.H., Son, B.H., Ahn, S.H. and Shin, S.Y., 2016. Depression screening using daily mental-health ratings from a smartphone application for breast cancer patients. Journal of medical Internet research, 18(8), p.e216.  4. Muke, S.S., Shrivastava, R.D., Mitchell, L., Khan, A., Murhar, V., Tugnawat, D., Shidhaye, R., Patel, V. and Naslund, J.A., 2019. Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India. Asian journal of psychiatry, 45, pp.99-106.  5. Sun, M., Tang, S., Chen, J., Li, Y., Bai, W., Plummer, V., Lam, L., Qin, C. and Cross, W.M., 2019. A study protocol of mobile phone app-based cognitive behaviour training for the prevention of postpartum depression among high-risk mothers. BMC public health, 19(1), p.710.  6. Watanabe, N., Horikoshi, M., Yamada, M., Shimodera, S., Akechi, T., Miki, K., Inagaki, M., Yonemoto, N., Imai, H., Tajika, A. and Ogawa, Y., 2015. Adding smartphone-based cognitive-behavior therapy to pharmacotherapy for major depression (FLATT project): study protocol for a randomized controlled trial. Trials, 16(1), p.293.
Eating Disorder	1. Kim, Y.R., Cardi, V., Lee, G.Y., An, S., Kim, J., Kwon, G., Kim, J.W., Eom, J.S. and Treasure, J., 2019. Mobile self-help interventions as augmentation therapy for patients with anorexia nervosa. Telemedicine and e-Health, 25(8), pp.740-747.
General	1. Chib, A., Wilkin, H.A. and Hua, S.R.M., 2013. International migrant workers’ use of mobile phones to seek social support in Singapore. Information Technologies & International Development, 9(4), pp.pp-19.  2. Das, S., Manjunatha, N., Kumar, C.N., Math, S.B. and Thirthalli, J., 2020. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital. Asian Journal of Psychiatry, 48, p.101886.  3. Maulik, P.K., Kallakuri, S., Devarapalli, S., Vadlamani, V.K., Jha, V. and Patel, A., 2017. Increasing use of mental health services in remote areas using mobile technology: a pre–post evaluation of the SMART Mental Health project in rural India. Journal of global health, 7(1).  4. Maulik, P.K., Tewari, A., Devarapalli, S., Kallakuri, S. and Patel, A., 2016. The systematic medical appraisal, referral and treatment (SMART) mental health project: Development and testing of electronic decision support system and formative research to understand perceptions about mental health in rural India. PloS one, 11(10), p.e0164404.  5. Zhang, M., Ying, J., Song, G., Fung, D.S. and Smith, H., 2018. Attention and cognitive bias modification apps: Review of the literature and of commercially available apps. JMIR mHealth and uHealth, 6(5), p.e10034.
Memory	1. Cho, S., Lee, J.H., Kim, I.K., Kim, M.G., Sik, K.Y. and Lee, E., 2016. The educational and supportive mobile application for caregivers of dementia people. Studies in health technology and informatics, 225, pp.1045-1046.  2. Man, D.W.K., Tam, S.F. and Hui-Chan, C.W.Y., 2003. Learning to live independently with expert systems in memory rehabilitation. NeuroRehabilitation, 18(1), pp.21-29.
Mood	1. Woo, Y.S., Bahk, W.M., Hong, J., Yoon, B.H., Hwang, T.Y., Kim, M.D. and Jon, D.I., 2016. Use of a smartphone application to screen for bipolar spectrum disorder in a community sample. Health informatics journal, 22(3), pp.779-788.
Schizophrenia	1. Gowda, G.S., Reddy, P.B., Enara, A., Thamaraiselvan, S.K., Basavaraju, V. and Math, S.B., 2019. Video based intervention to improve compliance with prescribed drug regimen. Asian journal of psychiatry, 43, p.99.  2. Lee, K., Bejerano, I.L., Han, M. and Choi, H.S., 2019. Willingness to use smartphone apps for lifestyle management among patients with schizophrenia. Archives of Psychiatric Nursing.  3. Zhang, T., Xu, L., Li, H., Woodberry, K.A., Kline, E.R., Jiang, J., Cui, H., Tang, Y., Tang, X., Wei, Y. and Hui, L., 2019. Calculating individualized Risk components using a mobile app-based risk calculator for clinical high risk of psychosis: Findings from ShangHai At Risk for Psychosis (SHARP) program. Psychological Medicine, pp.1-8.

Table 3.

Articles Listed by Mental Illness Category and Country/Region

Category	Country and Region	Number of Articles
Addiction	P.R. China, Japan, Singapore	3
Anxiety	P.R. China	1
Depression	South Korea, P.R. China, Japan, India	6
Eating disorder	South Korea	1
General	India, Singapore	5
Memory	P.R. China, South Korea	2
Mood	South Korea	1
Schizophrenia	Republic of Korea, R.R. China	3
Total	6	22

3.1.1. Addiction-Related Articles

Addiction: Article 1.

S-Health is a smartphone application designed to assist with management, treatment, and medication compliance of patients suffering from heroin addiction (Schulte et al., 2016). This study assessed the acceptance of a mobile application among patients across different cultural demographics. This study included 22 providers and 72 patients from China (n=18), Taiwan (n=14), and the U.S. (n=40). Study results indicated that patients in Taiwan and China reported the application as less effective for physical cravings but as beneficial for psychological cravings. In addition, patients in the U.S. valued social support from group therapy more than patients in Taiwan and China; therefore, they were less likely to use the application as a singular means of treatment but rather, in tandem with other social treatment modalities.

Addiction: Article 2.

Takano and colleagues’ (2016) pilot study assessed the effectiveness of the E-SMARPP web application. This application was developed to address the risk of methamphetamine relapse for drug users in Japan. The experimental group received cognitive-behavioral relapse prevention sessions and web-based assessments. The control group was provided the informational content and the self-monitoring calendar only. While no significant differences were noted in risk for relapse between the treatment and control groups; recommendations for the use of the app in conjunction with other treatment modalities seem promising.

Addiction: Article 3.

Zhang and colleagues (2019) used participatory research design, in the form of future workshop, to explore the usefulness of co-designing mobile gamified attention bias modification intervention for patients with substance use disorders. The researchers conducted a three-stage workshop with 10 healthcare professionals and 10 inpatients and outpatients. Participants, in two separate groups, critiqued attention bias modification intervention, brainstormed intervention features and explored how gamifications could enhance existing intervention apps, and sketched a new prototype. Researchers reported meaningful feedback from participants with regard to visual presentation of the existing apps, gaming features, scoring feedback, safety of administration, and additional educational materials.

3.1.2. Anxiety-Related Article

A Chinese version of the My Trauma Recovery website (CMTR) was developed to treat post-traumatic stress disorder (PTSD) symptoms in Chinese patients (Wang et al., 2013). The sample of 139 rural and urban residential participants were randomly assigned to a treatment group and a one-month waiting-list group. Overall, both samples showed significant decrease in PTSD symptoms after the first 30 days; however, the rural sample showed less improvement than the urban sample. While the CMTR website did show improvement for both the rural and urban samples, more research is needed on the utilization of web-based mental health applications.

3.1.3. Depression-Related Articles

Depression: Article 1.

Due to the stigma associated with HIV, people living with HIV (PLWH) are at a higher risk for mental health disorders (Guo et al., 2020). A WeChat-based intervention, Run4Love was created to address the need for mental health (i.e., depressive symptoms) intervention for PLWH in China. Three hundred PLWH were recruited from an outpatient clinic and were randomly assigned to treatment and control groups. The treatment group received cognitive-behavioral stress management (CBSM) courses through the WeChat platform. The control group received literature on physical health and standard HIV treatment. The results revealed significant reductions in depressive symptoms in the treatment group. This study represents important outcomes in mental health interventions using mobile apps.

Depression: Article 2.

Jang and colleagues (2017) assessed depression and suicidal ideation in 208,683 participants using a smartphone application. The smartphone app administered the Center for Epidemiological Studies Depression Scale (CES-D) to assess depression. Participants with a history of schizophrenia had higher CES-D compared to those with other or no psychiatric history. Higher depression scores were also associated with increased risk for suicide. Additionally, consistent with previous studies, depression prevalence rate was 25.7%, which supports the validity of screening for depression using a mobile app. This study highlights several advantages of using a smartphone app in screening for psychiatric disorders. Most notable is the easy access and guaranteed anonymity of the participants. In addition, using an app allows for early detection of depression and is free from the stigma that individuals who seek psychiatric services in person often feel.

Depression: Article 3.

Kim et al. (2016) evaluated the potential of a mobile mental health tracker as an indicator for depression. The researchers collected 5,792 sets of daily mental health ratings from 78 breast cancer patients over a 48-week period. The results revealed that adherence to self-reporting was associated with an increase in the accuracy of depression screening. Also, as expected, screening accuracy was higher for patients with a higher level of adherence. This study demonstrates that the depression screening performance of mobile mental health trackers is comparable to the traditional method (i.e., Patient Health Questionnaire-9 [PHQ-9]) in a clinical setting.

Depression: Article 4

Muke et al (2019) selected three community health centers to explore the acceptability and feasibility of using digital technology to deliver a training program for identifying and treating depression to health workers (Accredited Social Health Activists,ASHAs). The study involved two sequential phases of prototype testing, delivered on tablets, mobile phones, and laptops. After testing each prototype, 8-12 participants attended a semi-structured focus group that provided feedback which was used to improve the quality (e.g., images, language, etc.) of the second prototype. The results revealed that the ASHAs had a positive experience using the digital technology, despite having limited familiarity with using digital devices prior to this study, and it acceptable for learning new content and feasible to use.

Depression: Article 5.

Recent studies in China show that the prevalence of Postpartum Depression is approximately 25%, concerningly higher than the global average of 13%. Although Computerized Cognitive Behavioral Therapy (CCBT) and app-based Cognitive Behavioral Therapy (CBT) have been used in many countries to treat depression, no current CCBT or app-based CBT is available for women with postpartum depression (PPD). Sun and colleagues’ (2019) use a double-blind, randomized controlled trial to examine the effect of an app-based CBT on psychosocial outcomes including postpartum depression, anxiety, pressure, and parenting sense of competence. The measures will consist of the Chinese versions of the Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety, and Stress Scale (DASS-21), and Parenting Sense of Competence Scale (C-PSOC). This mobile intervention will consist of six modules; participants will complete one module each week for six consecutive weeks. Results of this intervention program will add to the repertoire of evidence-based mobile health interventions.

Depression: Article 6.

The Kokoro mobile app was designed to deliver cognitive behavioral therapy (CBT) for individuals with DSM-5-diagnosed major depressive disorder (Watanabe et al., 2015). The researchers investigated whether switching medications while utilizing the Kokoro app was more effective for treating depression symptoms than solely switching medications. During the nine weeks of the study, the experimental group switched from their current antidepressants to either escitalopram or sertraline while also receiving CBT from the Kokoro app; the control group switched their medications but did not receive CBT. This study was registered as a clinical trial with no results available for review.

3.1.4. Eating Disorder-Related Article

Research has shown that patients with anorexia nervosa (AN) who are resistant to first-line treatment may benefit from an adaptive form of interventions. Kim et al. (2019) examined the feasibility and acceptability of adapting treatment to include recovery orientated self-management materials in the form of vodcasts for Korean patients with AN. The vodcasts consisted of 2-3-minute videos that described recovery tips from successful eating disorder patients. Twenty-two patients with AN or atypical AN were recruited from an outpatient clinic. Thirteen (72.2%) patients reported the vodcasts as satisfying and of interest. Positive themes identified include the vodcast providing emotional support (43%), treatment accessibility (11%), and appropriate information regarding eating disorders (10%). Overall, the intervention was associated with changes in eating disorder psychopathology and affective symptoms, but not BMI over the course of the study.

3.1.5. General Symptoms Related Articles

General: Article 1.

Chib et al. (2013) examined if the use of mobile phones facilitated migrant workers’ ability to seek social support in their host country--Singapore. The respondents completed a multidimensional acceleration stress measure and a measure of informational and emotional support. Females reported receiving more information, instrumental, and emotional support than males with the use of a mobile phone. Regarding migrant stress, mobile phones and emotional support helped to alleviate stress for female workers but increased the levels of stress for the male workers. More research is needed relative to the gender differences in efforts to establish the relationship between migration stress, social support, and mobile use.

General: Article 2.

Das et al. (2019) assessed the acceptability, feasibility, clinical effectiveness, and cost of a video-conference-based Telepsychiatric Aftercare Consultation (TAC). Using Zoom, Skype, Hangout, and WhatsApp, 50 psychiatric patients participated in a video-based teleconsultation, followed by a regular in-person follow up. Self-report measures of acceptability, satisfaction, respect for privacy, clinical effectiveness, and technical feasibility were administered and assessed. The majority (75%) of the participants were highly satisfied with the telepsychiatry service, with 98% feeling that TAC is as effective as their in-person consultation, and 96% wanting to be followed up by TAC again. This study suggests that TAC could be a patient-friendly option for low- and middle-income countries like India.

General Article 3.

The SMART web application was developed utilizing the electronic decision support system (EDSS) technology (Maulik et al., 2016). EDSS technology assists with identifying and providing treatment options for common mental disorders (CMD) such as anxiety, depression, and psychosomatic symptoms. A version of the EDSS for (Accredited Social Health Activists, ASHAs). ASHAs was created for initial screening. Based on screening, participants were referred to a primary health care (PHC) doctor, who utilized a second version of the EDSS. This version included diagnostic and management guidelines from the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) and assisted the PHC doctor with diagnoses. Overall, the EDSS-driven SMART application was able to complete the task of identifying participants with CMDs.

General: Article 4.

Maulik et al. (2017) evaluated the ability of a multifaceted intervention to increase mental health screening and referral. After completing a baseline survey, 5,167 participants completed a screening tool that consisted of the PHQ-9 and GAD. Mental health service utilization increased from 0.8% at baseline to 12.6% post-intervention. The results from the anti-stigma campaign also showed that the communities’ knowledge, attitude, and behavior related to mental health had improved. Overall, this project showed that the delivery of mobile-based mental health services was feasible in the community and consequently, increased mental health services utilization.

General: Article 5.

Zhang and colleagues (2018) investigated whether mobile applications designed to modify attention or cognitive bias are being scientifically tested and which of those tested are commercially available. PubMed and MEDLINE databases were systematically searched, identifying 40 articles. After consideration of exclusion criteria, only eight qualified for review. Identified apps were cross-searched in Apple’s iTunes store and the Google play store. Of the eight apps, seven supported cognitive bias modification mobile, and one of them was commercially available.

3.1.6. Memory-Related Articles

Memory: Article 1.

In facing the steady increase of dementia and belied ideas from the public, the focus has shifted to early diagnosis to reduce the progression of the disease. The targeted app was developed in South Korea to assist elderly individuals at high risk for dementia to monitor deteriorating cognition, educate them on their status, locate local healthcare facilities within the area, and inform caregiver(s) with useful information (Cho et al., 2016). The application utilizes GPS coordinates to find local healthcare facilities and it also administers the mini-mental state examination (MMSE). Seventeen users reported that the application was relatively comfortable to use and more convenient than pen-and-paper.

Memory: Article 2.

Expert Systems (ES) is an artificial intelligence mechanism with inference and knowledge base (Man et al., 2003). There are eight decision-making factors in ES memory rehabilitation (ES-MR) and three treatment strategy categories: memory retraining methods, methods of behavioral adaptation, and methods of environmental adaptation. In the 2-week trial, a small sample of five outpatients in Hong Kong with significant brain trauma was given the ES-MR to use. Sixty percent of patients found the system beneficial while 40% indicated having difficulty using the system and applying treatments. After alterations, the ES has the potential for CD-ROMS and PDAs for easy and on-the-go use.

3.1.7. Mood-Related Article

Woo et al. (2015) studied the feasibility of using a smartphone application to screen for bipolar spectrum disorders. This two-month study consisted of 27,159 participants, of whom 75% were between 10-29 years old. The participants downloaded the app and completed a Korean Mood Disorder Questionnaire (K- MDQ). Similar to results reported in France (8.3%), 8.2% scored positive for a bipolar mood disorder. To the contrary, lower incidences were reported for the general population in the United States (3.7%) and in Australia (2.5%). It was also found that the presence of a past psychiatric history was the only predictor of K-MDQ positive results. The results of this study suggest that bipolar mood disorder screenings in younger members of the community can be successful when delivered via smartphone applications.

3.1.8. Schizophrenia Related Articles

Schizophrenia Article 1.

Noncompliance with prescribed drug regimens is common with severe mental disorders such as psychosis. The researchers (Gowda et al., 2019) conducted a case study on a 36-year-old man diagnosed with psychosis to determine the effects of a video-based intervention on medication compliance. The video intervention consisted of the treating team’s narrative, explaining identification, dosage, and frequency of medication. The patient viewed these videos on a mobile phone when he took the prescribed medication. The results of the intervention show significant improvement in patients’ symptoms and biopsychosocial functioning. Additionally, the patient has continued to remain asymptomatic in the past 15 months. Asynchronous video-based interventions, such as this one, are feasible, acceptable, cost effective, and may help with drug adherence.

Schizophrenia Article 2.

Lee et al. (2019) examined patients’ opinions and willingness to use smartphone apps for lifestyle management, such as eating habits, physical activity, controlling smoking and alcohol intake, and overcoming stress. Results showed that schizophrenia patients with more positive perceptions of smartphone apps were more willing to use the device for lifestyle management, which was significantly associated with improved dietary and living habits. Additionally, middle-aged and younger adults were more likely to experience lifestyle habits benefits due to their willingness to use smartphone apps than were older adults. These findings suggest that improving willingness to use apps can help patients with schizophrenia improve their lifestyle, potentially preventing relapse.

Schizophrenia Article 3.

Zhang et al. (2019), and the Shanghai At Risk for Psychosis (SHARP) team, developed and validated the predictive accuracy and individualized risk component of a mobile app-based risk calculator (RC) of individuals at Clinical High Risk (CHR) for psychosis and schizophrenia. The results show that the app-based SHARP-RC has acceptable discriminative ability and comparable accuracy of psychosis prediction to findings reported in the North American Prodrome Longitudinal Study (NAPLS)-2. These findings suggest that the application may be useful in clinical application in China.

4. Discussion and Implications for Future Research

There are 2.71 billion smartphone users in the world, about half of them are from Asia (Leftronic, December, 2019; Statista, December, 2019). Asia-Pacific ranks number one with the heaviest mobile data traffic. The 2019 mobile social media growth ranking also exemplifies the fast increase of users in Asia: China, India, Brazil, Indonesia, Philippines, Vietnam, and Japan. The high ownership of mobile devices and internet access in Asia provides a valuable opportunity to expand mental health care to rural areas and other hard to reach areas in Asian countries. The mobile health applications (MHA) acts as a platform bridging the gap between mental health professionals and app users. But current app use is not directly engaged in interventions for patients in need of mental health care. Therefore, there exists a huge demand and market for MHA to evaluate and treat individuals with various mental illnesses in Asian countries. In order to develop these cost-effective MHAs, mental health professionals should work with app developers closely.

MHAs offer novel opportunities for assisting individuals experiencing different mental health challenges. The U.S. and western countries lead in MHA development, making up 50% of MHA worldwide, with Asia-Pacific regions accounting for only 4% (Li et al., 2014; Palmier-Claus et al., 2013). MHA approaches to mental illness assessment and intervention have shown success in Western countries (e.g., Payne et al., 2015; Schlosser et al., 2016), but are still undeveloped in Asian countries. There are only a few apps, specific to patients with depression, that are used purely for communication, and no apps were found specifically for common mental disorders, such as, substance abuse and anxiety (Shang et al., in press). Applications for more severe mental illnesses like schizophrenia (Patil et al., 2020) and for youth with mental health issues are more limited. There is a huge app market and such MHA will significantly help to enhance public health. Few research papers in the Asian context discuss patients’ perceptions, beliefs, concerns, and experiences of MHA in detail or surveys. Therefore, more studies in such areas are warranted.

As our review shows, MHA research has only been conducted in about six countries and regions of Asia. Future studies from more diverse countries for diverse cultures should be conducted to examine the differential reports of the advantages and disadvantages of mobile health technology. Advances in MHAs have created unprecedented opportunities to assess health behavior and outcomes and engage underserved populations (Berrouiguet et al., 2016; Li et al., 2014; Rathbone & Prescott, 2017). MHA may constitute a culturally appropriate approach to engage individuals in Asian countries to whom mental illness is highly stigmatizing (Li & Keshavan, 2012; Li & Seidman, 2010).

This study has some limitations that should be addressed. First, we conducted a qualitative analysis of the MHA studies in Asian context. When more studies are available, future studies should use quantitative techniques such as meta-analysis to examine the effectiveness of MHA-based interventions. Second, this qualitative review only included studies published in English, more studies may be available if we include studies in other languages (i.e., Hsu et al., 2018; Shang et al., in press), which may expand the knowledge of existing MHAs in Asian context. Thirdly, we attempted to exhaust all search terms (our search terms may also have limitations) and databases available in our libraries, however may have left out some studies not available in our databases. Despite these limitations, our study provides valuable insight regarding the use of MHA for mental illness in Asian countries and has implications worldwide.