Mental Health Apps Gain High Uptake but Struggle With Adherence, Retention

A meta-analysis of 79 randomized controlled trials (RCTs) found high uptake (92%) but moderate adherence and notable failure to complete outcome assessments in mental health app users, with engagement improved by reminders and human support.1

“These preliminary patterns provide a useful foundation for future experimental research,” wrote study investigator Claudia Liu, PhD, from SEED Lifespan Strategic Research Centre at Deakin University, in Australia, and colleagues. “Beyond informing future app development, these findings also hold clinical relevance. Clinicians are increasingly asked to recommend or integrate apps into care, and our results suggest which features may help sustain patient engagement. Moreover, knowledge of typical adherence benchmarks can help clinicians set realistic expectations with patients and support them in maintaining app use over time.”

In the past 5 years, telehealth and digital mental health apps have been on the rise, offering convenience, cost-effectiveness, and tailored treatment. The global market for mental health apps is expected to reach > $17 billion by 2030.2 Although RCTs support mental health apps for managing depression and anxiety, concerns remain about engagement and attrition.

In this study, investigators examined patterns of uptake, adherence, and attrition of 79 RCTs evaluating mental health apps for depression and anxiety. The team leveraged studies from a 2024 review of RCTs on depression and anxiety apps, as well as conducted an updated search in Medline and PsycINFO from January 2024 to May 2025.1

The RCTs included 92 app conditions and 78 control conditions. The sample included 49.4% with depression, 17.7% with general anxiety, 17.7% with mixed depression and anxiety, 6.3% with social anxiety, 3.8% with specific phobia, and 5.1% with panic disorder. App features included engagement reminders (70.7%), CBT-based (66.3%), symptom monitoring (52.2%), personalization features (39.1%), instructions for recommended use (38%), professional guidance (30.4%), and gamification elements (17.4%). Most trials (78.5%) included human contact. Control group types included waitlist (46.2%), placebo (24.4%), care as usual (17.9%), active therapy (5.1%), and other (6.4%).1

The analysis demonstrated the high uptake of mental health apps (92.4%; 95% prediction interval [PI], 48.4% - 99.4%) across 56 conditions. More than half of users stayed on the app (61.8%; 95% PI, 53.2%-69.7%) from 21 conditions.1

“This high uptake rate is promising, as it suggests that the vast majority of participants enrolled in these trials were willing to engage with an app,” investigators wrote.1 “However, these encouraging rates from controlled trials are unlikely to reflect real-world use because trial participants are typically more motivated than the general population. In naturalistic settings, uptake has been reported as low as 2% in some countries, underscoring the need to address barriers to digital health adoption.”

The study found users had lower attrition rates (18.6%; 95% CI, 2.4% - 68.3%). By follow-up, attribution rates increased nearly 10 points (28.4%; 95% PI, 3.0% - 83.7%). Investigators observed that study features that support accountability, including reminders and human contact, reduce dropout, while gamified elements did not improve, and might weaken, retention.1

The research also showed participants assigned to app interventions tended to drop out more than participants on waitlists, based on the estimated risk ratio of 1.49, indicating a 49% higher dropout. However, the prediction interval is wide (0.34–6.48), meaning the true effect could range from substantially lower to much higher attrition, reflecting high variability across studies. When comparing the app groups to other types of control conditions, such as active controls or placebo apps, the attrition rates were not meaningfully different.1

“When contextualized against other modalities, our pooled attrition estimates are comparable with those observed in traditional treatments: approximately 17% in face-to-face psychotherapy trials and 15% to 30% in pharmacotherapy trials,” investigators wrote.1 “This suggests that dropout is not unique to apps but rather reflects a broader challenge across mental health.”

References

1. Liu C, Torous J, Fuller-Tyszkiewicz M, et al. Uptake, Adherence, and Attrition in Clinical Trials of Depression and Anxiety Apps: A Systematic Review and Meta-Analysis. JAMA Psychiatry. Published online November 19, 2025. doi:10.1001/jamapsychiatry.2025.3439

2. The Growth of Mental Health Apps and Teletherapy: Why They’re So Popular | Jackson Health System. Jackson Health System. Published 2025. https://jacksonhealth.org/the-growth-of-mental-health-apps-and-teletherapy-why-theyre-so-popular/