心理健康应用程序带来挑战

纽约——加拿大麦克马斯特大学精神与行为科学系教授Michael Van Ameringen博士在美国精神病学会（APA）年会上指出，一套针对心理健康智能手机应用程序的评分系统即将问世。

“我们医务人员必须使与时俱进，从而能够满足患者的新需求。很多患者正在使用这类应用程序，以增强他们从我们这里得到的治疗，甚至以这类应用程序为主要治疗手段。不论是好事还是坏事，这类应用程序已经在人们手中了。”

据Van Ameringen博士介绍，这套评分系统是由美国焦虑与抑郁学会（ADAA）理事会制定的，他本人是该理事会的成员。“我们的目标是为医生和用户提供针对现有应用程序的公正、专业的评分。我们计划对每种应用程序进行评分，不过我们不会将它们分为不同等级，也不会声称某种应用程序优于其他。”

研究者通过搜索iTunes、Google Play和BlackBerry World等应用程序商店，列出了一份应用程序清单。Van Ameringen博士指出，有2种应用程序已经非常风靡。其中1种名为Prolonged Exposure Coach（长期暴露指导），旨在辅助创伤后应激障碍（PTSD）的长期暴露治疗。这种应用程序是由美国国防部远程医疗技术中心、部署心理学研究中心和退伍军人事务部PTSD中心共同开发的。

另1种流行的应用程序名为MindShift，其目标用户是“受到焦虑困扰的青少年或年轻成人”。该程序是由非营利性组织AnxietyBC与官方机构BC心理健康与成瘾服务部共同开发的。

Van Ameringen博士指出：“我们知道，这些应用程序中有不少都相当风靡，被很多人下载使用。但其实我们并不知道每天究竟有多少人在使用它们。”尽管这些应用程序得以风靡，但试图推广它们的提供者面对着诸多问题。“保密性是这些应用程序的最大挑战。而且一些用户可能认为这些应用程序是专业评估和治疗的良好替代品。”最令人担忧的问题可能是，多数应用程序并未经过科学、严谨的评价。

Van Ameringen博士认为，今后必须针对这些应用程序的有效性开展更多的临床试验，并且通过头对头试验来比较这些应用程序与当前治疗的优劣。“我们必须弄明白，如何将这些应用程序融入现行治疗模式，已经如何在患者中最有效地使用它们。”

Van Ameringen博士披露称与多家药企存在利益关系，包括Valiant、礼来、辉瑞和葛兰素史克。

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By: DENISE NAPOLI, Internal Medicine News Digital Network

NEW YORK – A forthcoming rating system for mental health smartphone applications acknowledges that – for better or worse – these tools are in patients’ hands, Dr. Michael Van Ameringen said in a presentation at the annual meeting of the American Psychiatric Association.

"Like any medical professional, it is our role to keep ourselves updated with our patients’ concerns," Dr. Van Ameringen noted in a follow-up interview. "Many patients are using these apps to enhance the treatment they are receiving from us, or it is their primary source of treatment."

According to Dr. Van Ameringen, professor in the department of psychiatry and behavioral sciences at McMaster University, Hamilton, Ont., the initiative for a rating system comes from the board of directors of the Anxiety and Depression Association of America (ADAA), of which Dr. Van Ameringen is a member.

"Our goal was to make it easier for professionals and consumers to get unbiased professional ratings of currently available apps," Dr. Van Ameringen said. "We plan to rate each one, though we are not going to rank them or endorse one app over the other."

The list of apps was developed by a search of the iTunes store, Google Play store and BlackBerry World; the final review will be available on the ADAA website.

Dr. Van Ameringen pointed to two apps that will be featured on the ADAA review that he said have gained distinct popularity.

The first, Prolonged Exposure (PE) Coach, is intended to be used as a "treatment companion" during prolonged exposure therapy for posttraumatic stress disorder, according to the U.S. Department of Veterans Affairs website.

It was created by the U.S. Department of Defense’s National Center for Telehealth and Technology and Center for Deployment Psychology and the VA’s National Center for PTSD.

Another, MindShift, is geared toward "teens and young adults coping with anxiety," according to the website for AnxietyBC, a nonprofit that developed the app in concert with the BC Mental Health & Addiction Services, an agency of the Provincial Health Services Authority.

"We know that many of these apps are very popular and are downloaded a significant number of times," Dr. Van Ameringen said. "We don’t really know how many people are using them on a day-to-day basis."

Despite their popularity, the proliferation of mental health apps poses several issues for providers seeking to recommend their use.

"Confidentiality is the biggest challenge with these apps," Dr. Van Ameringen said. "Consumers may also believe that the app alone is a good substitute for professional assessment and treatment."

Perhaps the most worrisome problem is the fact that most apps have not been evaluated with customary scientific rigor, said Dr. Ameringen.

Going forward, said Dr. Van Ameringen, more clinical trials must be conducted on these apps’ efficacy, and head-to-head trials should compare them to current treatments.

One thing is sure: The mental health app landscape continues to expand, and patients have taken notice. That means providers must take notice, too.

"We need to understand where these apps fit into our current treatment model and how they can be used most effectively in our patients," he said.

Dr. Van Ameringen disclosed financial relationships with several pharmaceutical companies, including Valiant, Eli Lilly, Pfizer, and GlaxoSmithKline.