This article, authored by Liam Crosby and Oliver Bonnington, offers a crucial sociological perspective on the increasing use of smartphone applications for self-care related to depression and anxiety. While smartphone-based interventions have garnered optimism as a means of support for mental health conditions, with a rapidly growing supply of health-related apps (estimated at 165,000 in 2015, with 29% targeting mental health), their actual social effects and the nuances of their access and use remain under-investigated, particularly from a qualitative sociological standpoint. The authors position their study within contemporary sociological thought, which moves beyond individualised conceptions of digital health technology to highlight how these technologies are influenced by and influence wider socio-political processes.
The study aims to contribute to the conceptualization of how digital health technologies are implicated in health by investigating the motivations, experiences, and relations of individuals who use mobile apps for depression or anxiety. Focusing on people diagnosed with these conditions in England, the research explores how smartphone applications are used – physically, imaginatively, and emotionally – and how their use influences beliefs and practices for managing depression and anxiety. It also considers how these apps affect and are affected by their location within complex existing social relations. The authors adopted a thematic approach, conducting semi-structured interviews with 14 individuals who used smartphone apps as part of their self-care.
The analysis revealed three overarching themes, highlighting complex and often contradictory implications of app use:
- Apps within Context: This theme explores how access to and use of mental health apps are shaped by existing relational contexts, including formal and informal support systems. Participants often turned to apps due to perceived inadequacies, frustrations, and long waiting lists within NHS mental health services, viewing apps as an alternative when human help was insufficient or inaccessible. Users typically approached apps with a pre-existing sense of optimism and trust in technology, often adopting a casual, ‘trial-and-error’ approach facilitated by the apps’ free availability and ease of use. However, the availability and use of apps could also lead to isolating or anti-social tendencies, as some participants viewed apps as preferable alternatives to human support, potentially weakening their reliance on interpersonal connections.
- Apps’ Affective Capabilities: Providing Essential Relief via Uncomplicated Engagement: This theme focuses on how the existing relationship between users and their smartphones influences their engagement with apps, leading to immediate, short-term benefits but limited longer-term improvements. The convenience, familiarity, and discreetness of smartphones were key drivers for app use, offering instant 24/7 availability that was contrasted positively with formal care. Participants often conceptualized apps as ‘tools’ for active self-care and self-improvement, rather than ‘treatments,’ and their efficacy was seen as dependent on user engagement rather than intrinsic features. While apps provided immediate symptomatic alleviation and distraction during acute distress, their benefit was often described as a ‘stop-gap’ measure or ‘crutch,’ with users eventually feeling they had ‘outgrown’ what the apps could offer for deeper, more complex issues. Interestingly, apps could even have an emotional effect when inactive, serving as a ‘security blanket’ just by being present on the phone.
- Responsibilising, Apps, Dutiful Engagement: This theme highlights how app use reinforces a concept of personal responsibility for health, fostering disciplined, dutiful relations between users and apps. Participants expressed a strong sense of personal control and responsibility for their own wellbeing, often seeing app-use as a substitute for reliance on doctors or other support, particularly in the context of perceived NHS strain. This led to a proactive and dutiful engagement, with users feeling they ‘should’ use the apps even if personal experiences were unsatisfactory or no immediate benefit was anticipated, sometimes resulting in feelings of guilt or disappointment if not used. Furthermore, apps were often afforded a reified status, providing access to ‘objective’ knowledge about emotional states through mood-tracking, which could supersede the need for internal reflection and promote a reductionist, biomedical conceptualization of mental ill-health.
In conclusion, the study finds that while the initial positivity and techno-optimism surrounding mental health apps are evident, their actual implications are more complex. Apps, despite offering empowerment and convenience, can inadvertently contribute to isolation from interpersonal support and promote reductionist biomedical conceptualizations of mental ill-health. The research extends understanding of how digital mental health emerges from practice and how these technologies influence the social production, management, and understanding of depression and anxiety. It suggests that future research should investigate longer-term implications and compare apps with other forms of self-care and human support, urging designers, regulators, and commissioners to consider ways to mitigate responsibilizing and isolating features while maintaining flexible, empowering benefits.
Reference: Crosby, L., & Bonnington, O. (2020). Experiences and implications of smartphone apps for depression and anxiety. Sociology of Health & Illness, 42(4), 925–942. https://doi.org/10.1111/1467-9566.13076
