Review Article| Volume 51, ISSUE 1, P95-105, July 2016

A Systematic, Multi-domain Review of Mobile Smartphone Apps for Evidence-Based Stress Management


      Chronic stress presents a growing, pervasive burden in healthcare, and mobile smartphone applications (apps) have the potential to deliver evidence-based stress management strategies. This review identified and evaluated stress management apps across domains of (1) evidence-based content; (2) transparency in app development; and (3) functionality of the app interface.

      Evidence acquisition

      The iOS App Store was systematically searched. Apps with descriptions indicating that they targeted the intended audience and included evidence-related terminology, at least one evidence-based stress management strategy, and behavior change components were downloaded and evaluated by two independent raters across the three domains of evidence-based content, transparency, and functionality.

      Evidence synthesis

      A total of 902 apps were identified based on 21 searches. Of these, 60 met study criteria and were downloaded and evaluated between April and June 2015. Twenty (33%) ultimately did not deliver an evidence-based strategy. Of the delivered strategies, the most common were mindfulness and meditation (73%) and diaphragmatic breathing (25%). On average, apps addressed half of the transparency criteria, and nearly all (85%) were acceptable across usability criteria. A total of 32 apps included both evidence-based content and exhibited no problems with usability or functionality; apps affiliated with a non-profit, research-engaged institution comprised 31% of these.


      This review evaluated 60 iOS apps for stress management across domains of evidence-based content, transparency, and functionality; these apps have the potential to effectively supplement medical care. Findings further indicate that a comprehensive, multi-domain approach can distinguish apps that use evidence-based strategies from those that do not.
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        • Schmidt M.V.
        • Sterlemann V.
        • Muller M.B.
        Chronic stress and individual vulnerability.
        Ann N Y Acad Sci. 2008; 1148: 174-183
        • Thaker P.H.
        • Lutgendorf S.K.
        • Sood A.K.
        The neuroendocrine impact of chronic stress on cancer.
        Cell Cycle. 2007; 6: 430-433
        • Jackson J.S.
        • Knight K.M.
        • Rafferty J.A.
        Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course.
        Am J Public Health. 2010; 100: 933-939
        • Tamashiro K.L.
        Metabolic syndrome: links to social stress and socioeconomic status.
        Ann N Y Acad Sci. 2011; 1231: 46-55
        • Gragnoli C.
        Hypothesis of the neuroendocrine cortisol pathway gene role in the comorbidity of depression, type 2 diabetes, and metabolic syndrome.
        Appl Clin Genet. 2014; 7: 43-53
        • Garcia-Llana H.
        • Remor E.
        • Del Peso G.
        • Selgas R.
        The role of depression, anxiety, stress and adherence to treatment in dialysis patients’ health-related quality of life: a systematic review of the literature.
        Nefrologia. 2014; 34: 637-657
        • Kretchy I.A.
        • Owusu-Daaku F.T.
        • Danquah S.A.
        Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence.
        Int J Ment Health Syst. 2014; 8: 25
        • Foebel A.D.
        • Hirdes J.P.
        • Heckman G.A.
        Caregiver status affects medication adherence among older home care clients with heart failure.
        Aging Clin Exp Res. 2012; 24: 718-721
        • McGrady A.
        • McGinnis R.
        • Badenhop D.
        • Bentle M.
        • Rajput M.
        Effects of depression and anxiety on adherence to cardiac rehabilitation.
        J Cardiopulm Rehabil Prev. 2009; 29: 358-364
        • American Psychological Association
        Stress in America: Paying With Our Health. American Psychological Association, Washington, DC2014
        • EU-OSHA
        Calculating the Cost of Work-Related Stress and Psychosocial Risks—European Risk Observatory Literature Review. European Agency for Safety and Health at Work, Luxembourg2014
        • Ozdalga E.
        • Ozdalga A.
        • Ahuja N.
        The smartphone in medicine: a review of current and potential use among physicians and students.
        J Med Internet Res. 2012; 14: e128
        • Smith A.
        U.S. Smartphone Use in 2015. Pew Research Center, Washington, DC2015
        • Johnson K.W.
        • Anderson N.B.
        • Bastida E.
        • Kramer B.J.
        • Williams D.
        • Wong M.
        Macrosocial and environmental influences on minority health.
        Health Psychol. 1995; 14: 601-612
        • Matthews K.A.
        • Gallo L.C.
        Psychological perspectives on pathways linking socioeconomic status and physical health.
        Annu Rev Psychol. 2011; 62: 501-530
        • Carissoli C.
        • Villani D.
        • Riva G.
        Does a meditation protocol supported by a mobile application help people reduce stress? Suggestions from a controlled pragmatic trial.
        Cyberpsychol Behav Soc Netw. 2015; 18: 46-53
        • Chiesa A.
        • Serretti A.
        Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis.
        J Altern Complement Med. 2009; 15: 593-600
        • Brown J.L.
        • Vanable P.A.
        Cognitive-behavioral stress management interventions for persons living with HIV: a review and critique of the literature.
        Ann Behav Med. 2008; 35: 26-40
        • Brown R.P.
        • Gerbarg P.L.
        • Muench F.
        Breathing practices for treatment of psychiatric and stress-related medical conditions.
        Psychiatr Clin North Am. 2013; 36: 121-140
        • Gu J.
        • Strauss C.
        • Bond R.
        • Cavanagh K.
        How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies.
        Clin Psychol Rev. 2015; 37c: 1-12
        • Sharma M.
        • Rush S.E.
        Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review.
        J Evid Based Complementary Altern Med. 2014; 19: 271-286
        • Barrows K.A.
        • Jacobs B.P.
        Mind-body medicine. An introduction and review of the literature.
        Med Clin North Am. 2002; 86: 11-31
        • Proudfoot J.
        • Parker G.
        • Hadzi Pavlovic D.
        • Manicavasagar V.
        • Adler E.
        • Whitton A.
        Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress.
        J Med Internet Res. 2010; 12: e64
        • Avey H.
        • Matheny K.B.
        • Robbins A.
        • Jacobson T.A.
        Healthcare providers’ training, perceptions, and practices regarding stress and health outcomes.
        J Natl Med Assoc. 2003; 95(9): 836-845
        • van Velsen L.
        • Beaujean D.J.
        • van Gemert-Pijnen J.E.
        Why mobile health app overload drives us crazy, and how to restore the sanity.
        BMC Med Inform Decis Mak. 2013; 13: 23
        • Lewis T.L.
        A systematic self-certification model for mobile medical apps.
        J Med Internet Res. 2013; 15: e89
        • Aronson I.D.
        • Marsch L.A.
        • Acosta M.C.
        Using findings in multimedia learning to inform technology-based behavioral health interventions.
        Transl Behav Med. 2013; 3: 234-243
        • Macklin R.
        Can one do good medical ethics without principles?.
        J Med Ethics. 2015; 41: 75-78
        • Gillon R.
        Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics.
        J Med Ethics. 2015; 41: 111-116
        • Moorhead S.A.
        • Hazlett D.E.
        • Harrison L.
        • Carroll J.K.
        • Irwin A.
        • Hoving C.
        A new dimension of healthcare: systematic review of the uses, benefits, and limitations of social media for health communication.
        J Med Internet Res. 2013; 15: e85
        • de la Vega R.
        • Miro J.
        mHealth: a strategic field without a solid scientific soul. a systematic review of pain-related apps.
        PLoS One. 2014; 9: e101312
        • Huckvale K.
        • Car M.
        • Morrison C.
        • Car J.
        Apps for asthma self-management: a systematic assessment of content and tools.
        BMC Med. 2012; 10: 144
        • Huckvale K.
        • Morrison C.
        • Ouyang J.
        • Ghaghda A.
        • Car J.
        The evolution of mobile apps for asthma: an updated systematic assessment of content and tools.
        BMC Med. 2015; 13: 58
        • Middelweerd A.
        • Mollee J.S.
        • van der Wal C.N.
        • Brug J.
        • Te Velde S.J.
        Apps to promote physical activity among adults: a review and content analysis.
        Int J Behav Nutr Phys Act. 2014; 11: 97
        • Stevens D.J.
        • Jackson J.A.
        • Howes N.
        • Morgan J.
        Obesity surgery smartphone apps: a review.
        Obes Surg. 2014; 24: 32-36
        • Zaki M.
        • Drazin D.
        Smartphone use in neurosurgery? APP-solutely!.
        Surg Neurol Int. 2014; 5: 113
        • Wallace L.S.
        • Dhingra L.K.
        A systematic review of smartphone applications for chronic pain available for download in the United States.
        J Opioid Manag. 2014; 10: 63-68
        • Bender J.L.
        • Yue R.Y.
        • To M.J.
        • Deacken L.
        • Jadad A.R.
        A lot of action, but not in the right direction: systematic review and content analysis of smartphone applications for the prevention, detection, and management of cancer.
        J Med Internet Res. 2013; 15: e287
        • Lee H.
        • Sullivan S.J.
        • Schneiders A.G.
        • et al.
        Smartphone and tablet apps for concussion road warriors (team clinicians): a systematic review for practical users.
        Br J Sports Med. 2015; 49: 499-505
        • BinDhim N.F.
        • Hawkey A.
        • Trevena L.
        A systematic review of quality assessment methods for smartphone health apps.
        Telemed J E Health. 2015; 21: 97-104
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
      1. Health on the Net. Accessed January 26, 2015.

        • Martinez-Perez B.
        • de la Torre-Diez I.
        • Candelas-Plasencia S.
        • Lopez-Coronado M.
        Development and evaluation of tools for measuring the quality of experience (QoE) in mHealth applications.
        J Med Syst. 2013; 37: 9976
        • Williams V.S.
        • Morlock R.J.
        • Feltner D.
        Psychometric evaluation of a visual analog scale for the assessment of anxiety.
        Health Qual Life Outcomes. 2010; 8: 57
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Luxton D.D.
        • Hansen R.N.
        • Stanfill K.
        Mobile app self-care versus in-office care for stress reduction: a cost minimization analysis.
        J Telemed Telecare. 2014; 20: 431-435
        • Stoyanov S.R.
        • Hides L.
        • Kavanagh D.J.
        • Zelenko O.
        • Tjondronegoro D.
        • Mani M.
        Mobile app rating scale: a new tool for assessing the quality of health mobile apps.
        JMIR Mhealth and Uhealth. 2015; 3: e27
        • Rao A.
        • Hou P.
        • Golnik T.
        • Flaherty J.
        • Vu S.
        Evolution of data management tools for managing self-monitoring of blood glucose results: a survey of iPhone applications.
        J Diabetes Sci Technol. 2010; 4: 949-957
        • Aungst T.D.
        • Clauson K.A.
        • Misra S.
        • Lewis T.L.
        • Husain I.
        How to identify, assess and utilise mobile medical applications in clinical practice.
        Int J Clin Pract. 2014; 68: 155-162
        • Boudreaux E.D.
        • Waring M.E.
        • Hayes R.B.
        • Sadasivam R.S.
        • Mullen S.
        • Pagoto S.
        Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations.
        Transl Behav Med. 2014; 4: 363-371