Systematic assessment of the quality and integrity of popular mental health smartphone apps using the American Psychiatric Association's app evaluation model.

Mobile phones are playing an increasingly important role in supporting mental health, by providing confidential, accessible and scalable support for individuals who may not seek or have means of accessing professional help. There are concerns, however, that many apps claiming to support mental health do not meet professional, ethical or evidence-based standards. App store search algorithms favour popularity (reviews and downloads) and commercial factors (in-app purchases), with what appears to be low prioritisation of safety or effectiveness features. In this paper, the most visible 100 apps for "depression", "anxiety" and/or "mood" on the Google Play and Apple App stores were selected for assessment using the American Psychiatric Association App Evaluation model. This model systematically assesses apps across five broad steps: accessibility, integrity, clinical and research evidence base, user engagement and interoperability. Assessment is hierarchical, with the most fundamental requirements of apps assessed first, with apps excluded at each step if they do not meet the criteria. The relationship between app quality and app store visibility was first analysed. App quality was also compared across four different app function types: mental health promotion or psychoeducation; monitoring or tracking; assessment or prevention; and intervention or treatment. Of the 92 apps assessed (after eight failed to meet inclusion criteria), half failed to meet the first criterion step of accessibility, and a further 20% of the remaining apps failed to meet the second criterion step of security and privacy. Only three of the 10 apps most visible on app stores met the criteria for research/clinical base and engagement/ease of use, and only one app fulfilled all five criterion steps of the evaluation model. Quality did not differ significantly across app function type. There was no significant correlation between app quality and app store visibility, which presents a potential risk to vulnerable consumers. The findings of this review highlight the need for greater accountability of app developers to meet, and report, at least minimum quality and integrity standards for their apps. Recommendations are also provided to assist users and clinicians to make informed choices in their selection of reputable and effective mental health apps.

Examining the processes and effects of an exemplar school-based well-being approach on student competency, autonomy and relatedness.

As the application of positive education becomes more prevalent in schools, the importance of gathering information on optimal processes and outcomes associated with the programs, increases. The fulfillment of psychological needs such as competence, relatedness and autonomy, have seldomly been explored, yet they seem inextricably linked with well-being. It is also important to examine program qualities relating to delivery, relevance and practice opportunities. The current study examines (i) psychological need satisfaction as an outcome, using a quasi-experimental design and (ii) the processes involved in program delivery, using an explanatory sequential design. Year 9 students participating in the Geelong Grammar School (GGS) Timbertop well-being experience in Australia (n = 119) and 79 best matched well-being as usual (WBAU) students completed a psychological need satisfaction survey. A subgroup of 46 students also participated in focus groups. Mixed design analyses of variance indicated that the Timbertop Positive Education students experienced improved competence, relatedness and autonomy after the school year compared with 'WBAU' students. Findings from student focus groups also support the importance of well sequenced, active, focused and explicit learning processes for program success. This study provides support for building psychological need satisfaction with a positive education program that adopts practical, interactive and goal-oriented well-being learnings. This is encouraging and supports a context adapted replication and evaluation of the general Positive Education approach adopted by GGS in other schools.

Predicting Depression From Language-Based Emotion Dynamics: Longitudinal Analysis of Facebook and Twitter Status Updates.

BACKGROUND: Frequent expression of negative emotion words on social media has been linked to depression. However, metrics have relied on average values, not dynamic measures of emotional volatility. OBJECTIVE: The aim of this study was to report on the associations between depression severity and the variability (time-unstructured) and instability (time-structured) in emotion word expression on Facebook and Twitter across status updates. METHODS: Status updates and depression severity ratings of 29 Facebook users and 49 Twitter users were collected through the app MoodPrism. The average proportion of positive and negative emotion words used, within-person variability, and instability were computed. RESULTS: Negative emotion word instability was a significant predictor of greater depression severity on Facebook (rs(29)=.44, P=.02, 95% CI 0.09-0.69), even after controlling for the average proportion of negative emotion words used (partial rs(26)=.51, P=.006) and within-person variability (partial rs(26)=.49, P=.009). A different pattern emerged on Twitter where greater negative emotion word variability indicated lower depression severity (rs(49)=-.34, P=.01, 95% CI -0.58 to 0.09). Differences between Facebook and Twitter users in their emotion word patterns and psychological characteristics were also explored. CONCLUSIONS: The findings suggest that negative emotion word instability may be a simple yet sensitive measure of time-structured variability, useful when screening for depression through social media, though its usefulness may depend on the social media platform.

Emotional Responses to Music: Shifts in Frontal Brain Asymmetry Mark Periods of Musical Change.

Recent studies have demonstrated increased activity in brain regions associated with emotion and reward when listening to pleasurable music. Unexpected change in musical features intensity and tempo - and thereby enhanced tension and anticipation - is proposed to be one of the primary mechanisms by which music induces a strong emotional response in listeners. Whether such musical features coincide with central measures of emotional response has not, however, been extensively examined. In this study, subjective and physiological measures of experienced emotion were obtained continuously from 18 participants (12 females, 6 males; 18-38 years) who listened to four stimuli-pleasant music, unpleasant music (dissonant manipulations of their own music), neutral music, and no music, in a counter-balanced order. Each stimulus was presented twice: electroencephalograph (EEG) data were collected during the first, while participants continuously subjectively rated the stimuli during the second presentation. Frontal asymmetry (FA) indices from frontal and temporal sites were calculated, and peak periods of bias toward the left (indicating a shift toward positive affect) were identified across the sample. The music pieces were also examined to define the temporal onset of key musical features. Subjective reports of emotional experience averaged across the condition confirmed participants rated their music selection as very positive, the scrambled music as negative, and the neutral music and silence as neither positive nor negative. Significant effects in FA were observed in the frontal electrode pair FC3-FC4, and the greatest increase in left bias from baseline was observed in response to pleasurable music. These results are consistent with findings from previous research. Peak FA responses at this site were also found to co-occur with key musical events relating to change, for instance, the introduction of a new motif, or an instrument change, or a change in low level acoustic factors such as pitch, dynamics or texture. These findings provide empirical support for the proposal that change in basic musical features is a fundamental trigger of emotional responses in listeners.

Social Networking Sites, Depression, and Anxiety: A Systematic Review.

BACKGROUND: Social networking sites (SNSs) have become a pervasive part of modern culture, which may also affect mental health. OBJECTIVE: The aim of this systematic review was to identify and summarize research examining depression and anxiety in the context of SNSs. It also aimed to identify studies that complement the assessment of mental illness with measures of well-being and examine moderators and mediators that add to the complexity of this environment. METHODS: A multidatabase search was performed. Papers published between January 2005 and June 2016 relevant to mental illness (depression and anxiety only) were extracted and reviewed. RESULTS: Positive interactions, social support, and social connectedness on SNSs were consistently related to lower levels of depression and anxiety, whereas negative interaction and social comparisons on SNSs were related to higher levels of depression and anxiety. SNS use related to less loneliness and greater self-esteem and life satisfaction. Findings were mixed for frequency of SNS use and number of SNS friends. Different patterns in the way individuals with depression and individuals with social anxiety engage with SNSs are beginning to emerge. CONCLUSIONS: The systematic review revealed many mixed findings between depression, anxiety, and SNS use. Methodology has predominantly focused on self-report cross-sectional approaches; future research will benefit from leveraging real-time SNS data over time. The evidence suggests that SNS use correlates with mental illness and well-being; however, whether this effect is beneficial or detrimental depends at least partly on the quality of social factors in the SNS environment. Understanding these relationships will lead to better utilization of SNSs in their potential to positively influence mental health.

Development and feasibility of a mobile experience sampling application for tracking program implementation in youth well-being programs.

Well-being program evaluations mostly focus on identifying effective outcomes rather than measuring the actual extent to which program participants may apply learned skills in subsequent everyday lives. This study examined the feasibility of using a newly developed mobile experience sampling app called Wuzzup to study program implementation in young people participating in well-being programs. Ninety-six participants (60 females; 36 males) between the ages of 13 and 15 years (M = 13.87, SD = 0.71) were recruited to respond to two random prompts each day, for 7 days, at each of the three data collection time-points. Responses from 69 participants (72 % of initial sample) that met study criteria were retained for analysis. The average response rate was 92.89 %, with an average of 85.92 s to complete each ESM survey. Significant associations between first and second halves of the ESM week, and their respective positive affect and negative affect survey responses, demonstrate internal reliability and construct validity of the Wuzzup app to capture momentary affect and activation states of young people. This study also demonstrated the feasibility and practical utility of the Wuzzup app to profile and track an individual's learning over time.

The role of intracellular calcium stores in synaptic plasticity and memory consolidation.

Memory processing requires tightly controlled signalling cascades, many of which are dependent upon intracellular calcium (Ca(2+)). Despite this, most work investigating calcium signalling in memory formation has focused on plasma membrane channels and extracellular sources of Ca(2+). The intracellular Ca(2+) release channels, ryanodine receptors (RyRs) and inositol (1,4,5)-trisphosphate receptors (IP3Rs) have a significant capacity to regulate intracellular Ca(2+) signalling. Evidence at both cellular and behavioural levels implicates both RyRs and IP3Rs in synaptic plasticity and memory formation. Pharmacobehavioural experiments using young chicks trained on a single-trial discrimination avoidance task have been particularly useful by demonstrating that RyRs and IP3Rs have distinct roles in memory formation. RyR-dependent Ca(2+) release appears to aid the consolidation of labile memory into a persistent long-term memory trace. In contrast, IP3Rs are required during long-term memory. This review discusses various functions for RyRs and IP3Rs in memory processing, including neuro- and glio-transmitter release, dendritic spine remodelling, facilitating vasodilation, and the regulation of gene transcription and dendritic excitability. Altered Ca(2+) release from intracellular stores also has significant implications for neurodegenerative conditions.

Relaxing music counters heightened consolidation of emotional memory.

Emotional events tend to be retained more strongly than other everyday occurrences, a phenomenon partially regulated by the neuromodulatory effects of arousal. Two experiments demonstrated the use of relaxing music as a means of reducing arousal levels, thereby challenging heightened long-term recall of an emotional story. In Experiment 1, participants (N=84) viewed a slideshow, during which they listened to either an emotional or neutral narration, and were exposed to relaxing or no music. Retention was tested 1 week later via a forced choice recognition test. Retention for both the emotional content (Phase 2 of the story) and material presented immediately after the emotional content (Phase 3) was enhanced, when compared with retention for the neutral story. Relaxing music prevented the enhancement for material presented after the emotional content (Phase 3). Experiment 2 (N=159) provided further support to the neuromodulatory effect of music by post-event presentation of both relaxing music and non-relaxing auditory stimuli (arousing music/background sound). Free recall of the story was assessed immediately afterwards and 1 week later. Relaxing music significantly reduced recall of the emotional story (Phase 2). The findings provide further insight into the capacity of relaxing music to attenuate the strength of emotional memory, offering support for the therapeutic use of music for such purposes.

Pharmacobehavioural evidence for nitric oxide and noradrenaline interactions with ryanodine receptors during memory formation in the young chick.

Impairment of nitric oxide (NO) production, ryanodine receptor (RyR) calcium channel function and adrenoceptor activation have been found to prevent the formation of the long-term memory stage in young chicks trained on a single-trial discrimination avoidance task. The current study investigated whether these three activities were linked, and if so, the sequence of activation. Young chicks were trained using either a strongly or weakly reinforced variant of the single-trial discrimination avoidance task, yielding either a persistent or labile memory trace, respectively. Following strongly reinforced training, retention loss induced by a RyR inhibitor was prevented by a NO donor or noradrenaline (NA). A RyR agonist also prevented retention loss induced by either NO synthase or ß1+2-adrenoceptor inhibition. These findings were interpreted to reflect the capacity of NO, RyR-dependent calcium release and NA to modulate memory by preventing retention loss. A second set of studies used weakly reinforced training. Although the administration of a RyR agonist promoted long-term memory formation, this facilitation was compromised in the presence of a ß1+2-adrenoceptor antagonist, but not a NO synthase inhibitor. Similarly, the inhibition of RyRs interfered with the facilitation of retention induced by a NO donor, but not NA. These differential findings with weakly reinforced training suggest that NO facilitates memory formation through mechanisms involving RyR-dependent calcium release. The findings also indicate that RyRs may promote memory formation through noradrenergic activation of ß2-adrenoceptors. This study demonstrates an intricate role for RyRs underlying memory formation.

Blocking SK channels impairs long-term memory formation in young chicks.

The role of small-conductance calcium-activated potassium (SK) channels in memory formation was explored in chicks trained on a single-trial discrimination avoidance task. Blockade of SK channels using apamin (1 nM, 0.02 ng/hem, i.c.) impaired long-term memory retention when administered between 10 min prior to, and 30 min after, training. Apamin (1 nM, 0.02 ng/hem, immediately post-training, i.c.) resulted in persistent impairment of retention during the long-term memory stage by 90 min post-training until at least 24 h post-training, indicating SK channels contribute to long-term memory.

A ryanodine receptor agonist promotes the consolidation of long-term memory in young chicks.

Young chicks were trained on a weakly reinforced variant of a single-trial discrimination avoidance task which typically fails to consolidate the long-term memory stage. The ryanodine receptor (RyR) agonist 4-chloro-m-cresol (500 microM, i.c.) persistently promoted high retention until at least 24 h post-training when administered between the time of training and 20 min post-training. The consolidation of the long-term memory stage by RyR activation implicates intracellular calcium release in triggering long-term memory.

Defining the rhythmicity of memory-enhancing acoustic stimuli in the young domestic chick (Gallus gallus).

Research has demonstrated that exposure to a rhythmic auditory stimulus can promote retention of a simple memory task in an avian species. In the current study, day-old domestic chicks (Gallus gallus) were trained on a weakly reinforced discriminative avoidance task for which retention is typically lost 30 min posttraining. Exposure to rhythmic stimuli 5 min posttraining prevented memory loss, but only when sequences were highly metrical and contained sufficient repetition. These data provide further support for the claim that rhythmicity is a key feature of memory-enhancing auditory stimuli.

The effect of music on cognitive performance: insight from neurobiological and animal studies.

The past 50 years have seen numerous claims that music exposure enhances human cognitive performance. Critical evaluation of studies across a variety of contexts, however, reveals important methodological weaknesses. The current article argues that an interdisciplinary approach is required to advance this research. A case is made for the use of appropriate animal models to avoid many confounds associated with human music research. Although such research has validity limitations for humans, reductionist methodology enables a more controlled exploration of music's elementary effects. This article also explores candidate mechanisms for this putative effect. A review of neurobiological evidence from human and comparative animal studies confirms that musical stimuli modify autonomic and neurochemical arousal indices, and may also modify synaptic plasticity. It is proposed that understanding how music affects animals provides a valuable conjunct to human research and may be vital in uncovering how music might be used to enhance cognitive performance.

Evidence of a time-dependent long-term stage of memory for a spatial learning task in the chick (Callus gallus).

The generalizability of temporal parameters of memory formation previously observed for a passive avoidance task was investigated in a spatial task with day-old chicks (Callus gallus). The percentage improvement in completion time over 2 separate trials was measured, and chicks were found to complete the second trial faster at all times tested up to 2 hr, except at 55 min posttraining. In addition, retention at 120 min, but not at 30 min, posttraining was found to be impaired by protein synthesis inhibition. These findings are consistent with the timing of a long-term stage of memory formation following passive avoidance training, implying that there may be some hardwiring to the temporal characteristics of memory formation in this species.

Hemispheric dissociation of the involvement of NOS isoforms in memory for discriminated avoidance in the chick.

Previous research has indicated a role for both the neuronal (nNOS) and endothelial (eNOS) nitric oxide isoforms in memory formation. In addition, two distinct periods of activity of nitric oxide activity, dissociated by hemispheric localization, are implicated following passive avoidance training in the chick. In the present study, we trained black Australorp-white Leghorn chicks on a color discrimination avoidance task. Diphenyleneiodonium chloride (1 microM) or N-propyl-l-arginine (50 microM) was administered into either the left or right hemisphere of the chick brain in an attempt to differentiate the effects of inhibiting eNOS or nNOS, respectively. The memory loss previously observed following administration of diphenyleneiodonium chloride between 10 and 20 min posttraining was found to be lateralized to the right hemisphere, although administration of this agent into the left hemisphere around the time of training was also amnestic. In contrast, N-propyl-l-arginine caused memory loss only when administered to the left hemisphere around the time of training. These findings suggest that activation of both eNOS and nNOS isoforms may be essential for long-term memory consolidation of this task. Further, these two periods of activity are defined temporally and by hemisphere localization, although confirmation with more selective inhibitors when they become available is advised.