Managing depression in India: Opportunities for a targeted smartphone app

Abstract

Background:

More than forty million people suffer from depression in India. A lack of awareness, stigma related to mental health issues, and limited accessibility to treatment services magnify the profound personal and societal impact of depression. Given the rise of smartphones in India, mobile technology can help alleviate some of these depression-related challenges.

Aims and method:

The aim of this paper is to investigate the essential features of an India targeted depression smartphone app. We conducted an online survey to profile the needs of individuals with depression in India, which varied based on variables such as socioeconomic background, age, level of awareness toward depression, and the extent of exposure to mental health stigma. We also conducted a systematic evaluation of depression apps currently available to Indian users to investigate the user needs that these apps met and the needs that they failed to meet. Based on our findings, we made a set of recommendations related to the essential features of a future app targeted at managing depression in India.

Results:

Presently available depression apps fall short in providing some significant features such as local language options, content in audio and video formats, and user location matched resources. These gaps make these apps less than fully relevant to a diverse set of Indian users.

Conclusions:

It is essential to provide depression-related information in a targeted manner depending upon each user’s particular needs and context. Potential customizations, such as offering content in local languages and flexible formats (e.g. audio, video, and text); and providing user-relevant diagnostic tools and location matched treatment resources can help improve the suitability of the app for diverse users.

Keywords

Depression India Asia mobile health smartphone apps

Depression is a profound problem in India. There are 45.99 million people with depression in India (Institute for Health Metrics and Evaluation [IHME], 2018). Additional factors, such as lack of awareness (Kapanee et al., 2018; Roberts et al., 2020), social stigma (Menon et al., 2015; Saraf et al., 2018), and scarcity of trained mental health professionals (Nayak et al., 2019; Thirunavukarasu & Thirunavukarasu, 2010) impede effective management of depression in the country, thereby exacerbating its negative impact.

The rise of smartphones and mobile apps in India, the sustained trend of reduced mobile internet rates, and increased data consumption per user make smartphones a promising tool to help improve the management of depression in the country (App Annie, 2019; Department of Telecommunications [DoT], 2017–18; GSMA Intelligence, 2018). While smartphone apps cannot replace medication, therapy, or other traditional methods of depression management, they can complement these methods in several important respects. By providing science-backed information in a user-friendly format – that is, content in local languages, audio and video-based modalities, reference to user location-matched resources depression apps can help improve awareness and reduce stigma related to depression. Smartphone apps can help individuals and their caregivers monitor depression by tracking mood and setting up reminders for medication and self-care tasks (Sinha Deb et al., 2018). Additionally, smartphone apps, when integrated into community healthcare, can facilitate depression screening (BinDhim et al., 2015) and treatment in underserved communities that lack trained psychiatrists (Daniel et al., 2021; Naslund et al., 2021). Notwithstanding their potential, the depression-related smartphone apps that are currently available to mobile users in India generally fall short in providing customized content pertinent to individuals from different socioeconomic backgrounds and demographics (Kumar & Mehrotra, 2017). The ability to access the app in regional languages is critical, given that only 10.60% of the total population can speak English (Census of India, 2011). However, local language features are found lacking in most depression-related apps (Mehrotra et al., 2018). Additionally, most apps are rooted in contexts that are not relevant to a large percentage of Indian users (e.g. feeling lonely at a cocktail party).

In this paper, we investigated the essential features of a targeted smartphone app for depression management in India by (i) conducting research to understand the diverse needs of individuals with depression in India; (ii) conducting an evaluation of depression apps currently available to Indian users; (iii) understanding the extent to which these apps met the needs of users and identifying significant gaps; (iv) recommending the essential features of a future app targeted at managing depression in India.

A profile of depression in India

The National Mental Health Survey reports 2.7% (current) and 5.2% (lifetime) weighted prevalence of depressive disorders in the country (National Institute of Mental Health and Neurosciences [NIMHANS], 2016). Globally, the number of individuals with depression is expected to rise from 26.35 million in 1990 to 45.70 million in 2017 (IHME, 2018). These trends robustly apply to India due to urbanization and loss of social support systems (Srivastava, 2009; Trivedi et al., 2008). Further, the COVID-19 pandemic has contributed to a global rise in mental distress (Grover et al., 2020; Torales et al., 2020).

The ubiquitous distribution of depression in India

Depression is widely distributed in India across all demographic groups. However, individuals from the lowest income quintile group (3.4%) are twice as likely as the highest income quintile population (1.9%) to be depressed (NIMHANS, 2016). Low levels of education and related socioeconomic factors often increase susceptibility to depression. For example, a cross-sectional study of adults conducted in Uttarakhand found that the risk of depression is two to three times higher for people that live in inadequate housing; have little schooling; and belong to Scheduled Caste (SCs) and Scheduled Tribes (STs), groups that are socially excluded in the Indian society (Mathias et al., 2015).

Depression in India is more prevalent in females than in males (Poongothai et al., 2009; Watson et al., 2020). Domestic violence, financial insecurity, and lack of education are significant contributors to depression in women (Bhattacharya et al., 2018; Chandra et al., 2009). Depression is also common in the geriatric population. The vulnerability of depression in this age group can be related to reduced physical activity, lack of social support systems, and the death of a spouse (Rathod et al., 2019).

That depression is ubiquitous in India, and prevalent in individuals from different age groups, socioeconomic classes, gender, and education levels, was also supported by the results of an online survey we conducted on cloudresearch’s Mechanical Turk platform with participants (N = 129) from India. The survey featured four personas of individuals dealing with depression in India and having different demographic characteristics (more details can be found in Supplemental Appendix A, Table A1). The participants were asked to evaluate the personas based on the extent to which the situational aspects of the descriptions matched the situational characteristics of an individual with depression, that they knew personally or could envision, based on impressions obtained via the media or their social groups. The options for choices in the survey included 100%, 75%, 50%, 20%, and 5%. For all the four user profiles, the percentage of participants that chose the option “75%” was the highest (see Supplemental Appendix A, Table A1). These results further supported the idea that depression is widely distributed in India, and the needs of individuals suffering from the illness are diverse.

Attitudes toward depression in India

India’s attitude toward depression and depressed individuals is characterized by a pervasive lack of awareness and high social stigma in both rural and urban sections of the population. These attitudes are prevalent even in the medical communities that are tasked to be caregivers of patients with depression.

Lack of awareness

There is a general lack of awareness about depression in India. In a study conducted with participants from a rural community, individuals believed that depression is primarily caused by stressful life events, and characterized mainly by behavioral signs (e.g. decreased social interaction) without any associated biological symptoms (Chavan et al., 2017).

The lack of awareness about depression also prevails in the urban population. An online survey we conducted with participants (N = 129) belonging to lower-middle and middle economic classes in India revealed that lack of awareness is also ubiquitous in urban communities. The participants (36.43%) strongly agreed with the statement, ‘Depression is not a real medical illness’. The participants (30.40%) also believed that ‘Individuals with depression can snap out of it if they have enough willpower’ (more details about the study can be found in Supplemental Appendix A, Table A2).

Social stigma

Other than lack of awareness, social stigma is another factor that prevents individuals from seeking treatment for depression. A study conducted across eight major cities in India found that 62% of the participants used negative terms such as ‘retard’, ‘crazy’, or ‘stupid’ or to describe people with mental illnesses and 60% of respondents claimed that mentally unhealthy people should stick to their social groups so as not to contaminate healthy people (The Live Love Laugh Foundation [TLLLF], 2018). The results of our online survey supported these stigmatizing attitudes toward depression in India. Of the 129 participants that we surveyed, 42.06% somewhat agreed, and 24.6% strongly agreed to the statement, ‘If a friend or family member had depression, I would avoid them’. For more details, see Supplemental Appendix A, Table A2.

In the absence of emotional support from their social groups, many people with depression choose to suffer in silence, instead of seeking help. Moreover, individuals that consider treatment experience stigma at the medical centers. In a study conducted in Gujarat, non-psychiatric physicians reported that they viewed depression as a sign of weakness and perceived depressed individuals to be unpredictable (Loh et al., 2018).

The challenges of depression management in India are multifaceted. A lack of awareness about depression and the social stigma associated with being afflicted with it has consistently impeded help-seeking behavior. The inability of medical professionals to recognize the culturally sensitive expressions of depression (Halbreich et al., 2007) is further contributing to a lack of diagnosis (Shetty et al., 2018), especially in the individuals from lower-socioeconomic classes (Kohli et al., 2013). The deficit of trained mental health professionals is limiting access to treatment services (Thirunavukarasu & Thirunavukarasu, 2010). Having a viable tool that can overcome these challenges is therefore critical. Smartphones and mobile apps show great promise in this regard.

Smartphone app for depression management in India

India had 345.9 million smartphone users in 2019 (Newzoo, 2019) and is expected to add more than 200 million unique mobile subscribers between 2017 and 2025 (GSMA Intelligence, 2018). Over 95% of this installed base is on the Android platform (Statcounter, 2020). Market trends suggest that the decreasing cost of Android phones will continue to fuel market growth in India.

The growth of smartphone users in the country is propelled by a sustained drop in mobile internet rates. In the years between 2014 and 2017, the mobile internet rates have dropped by 93%, and the data usage per user has increased by 25 times. Mobile data consumption in India is now 1.3 million GB per month, which is higher than the combined data usage in China and the US (DoT, 2017–18). There has also been significant growth in India’s mobile app market. Mobile app downloads in India have increased by 165% from 2016 to 2018, and the mobile platform is the primary mode of accessing the internet in the country (App Annie, 2019).

The implications of COVID-19 – the increased prevalence of psychiatric disorders (Banerjee & Bhattacharya, 2020), the rapid surge in the usage of internet and digital devices and the growing demand for telepsychiatry services (Patra & Patro, 2020), call to our attention the enormous scope of smartphone apps in the management of depression in India.

Potential of smartphone and mobile apps for depression management

Smartphones and mobile apps can bypass some of the hurdles preventing individuals from seeking help for depression, create more awareness, uproot stigmatizing attitudes, encourage early diagnosis of the illness, and help strengthen access to mental health services (Maulik et al., 2020). Digital psychological interventions have been found to be moderately effective in low- to medium-income countries (Fu et al., 2020). Smartphones-based screening tools for depression have been found to be generally feasible (BinDhim et al., 2015), and cognitive behavioral therapy apps have been effective in increasing coping self-efficacy in individuals experiencing moderate depression or anxiety (Bakker & Rickard, 2018, 2019). Smartphone-based depression interventions conducted with Indian participants have shown promising results. In a study conducted in 42 villages in Andhra Pradesh in South India, mobile-based intervention for depression was feasible and beneficial in increasing access to mental health care services and reducing depression symptoms (Maulik at al., 2018).

Examining the effectiveness of existing apps in the cultural context of India

Kumar and Mehrotra (2017) analyzed 278 depression-related free self-care apps available to Android users in India, and found that most of the apps provided information on coping with depression (18.7%) and standalone screening tools (15.5%); others included information on depression and provided interactive self-help tools (slightly more than 10% each), and a few provided online consultation services (<10%). While their work conducted an extensive evaluation of the features of depression apps available in India, they did not primarily focus on the extent of each apps’ applicability in the Indian context.

For a depression app to be specifically relevant for users in India, it needs to have additional features that are significant in India’s cultural context. The app content will be useful only if it is packaged in a manner that is compatible with the cultural norms and life situations of individuals living in the country. For instance, the experience of depression will be different for a woman living in a rural neighborhood in India than for a teenager living in an upper-class neighborhood in the United States. Prior research has pointed at the cross-cultural variations in the experience of depression (Bhugra & Mastrogianni, 2004; Haroz et al., 2017); and the influence of socio-cultural (Mahomed et al., 2018) and religious factors (Kuriyan et al., 2016) on mental health stigma and misconceptions. A smartphone app targeted at the Indian population should incorporate Indian cultural beliefs and local narratives (Banerjee et al., 2020) into its content. It’s also critical for the app content to be delivered in an engaging format (e.g. audio and video modalities) and incorporate gamification features (Wu et al., 2021) to drive engagement with users from different socio-economic and educational backgrounds.

Localization is another aspect of making the app relevant to diverse users in India. The app content cannot be consumed by users from lower socioeconomic classes and users with limited English-language proficiency if the local language option is not provided. Additionally, the resources to get professional help, referenced by the app, would be irrelevant unless they are matched with the user’s location. Similarly, for the app to be available to lower-income classes, it must be available for free or at a minimal cost and be fully functional on low-cost smartphones. The operational cost of the app, such as data charges, can also make it expensive. Offline functionality can make the app more affordable overall. Table 1 lists the various sociocultural and demographic factors that influence the experience of depression for an individual and impact the applicability of a depression app in India.

Table 1.

Influence of socio-cultural/demographic factors on the applicability of a depression app in India.

Socio-cultural/demographic factors	Influence on smartphone app applicability
Age	Depression expression, awareness, and stigma; English language proficiency; tech proficiency
Gender	Depression expression and stigma
Location (urban vs. rural)	Depression expression, awareness, and stigma; English language proficiency; tech proficiency; internet access
Education	Depression awareness and stigma; English language proficiency; tech proficiency
Income religious belief	Smartphone access; internet access; depression awareness; stigma

Considering these significant socio-cultural factors, we evaluated a set of popular depression-related apps available in India. As we elucidate below, the evaluated apps were generally not tailored to the varied needs, limitations, and contexts prevalent in India.

Selection strategy and evaluation methodology

Given that a majority of smartphone users in India use Android, we searched for the apps on the Android-specific Google Play Store in India using keywords such as ‘depression’, ‘apps for depression’, ‘depression apps’, and ‘mental health apps’. From the apps listed in the search results, we selected 10 apps that were relevant to depression management, had more than 500k downloads, and had user ratings of more than four stars. We preferentially selected apps that were locally developed in India. However, owing to the limited number of India-developed depression apps, we also included leading international apps that fit our selection criteria of relevance, rating, and downloads. Of the apps we selected for review (N = 10), two apps (Wysa, InnerHour) were developed in India and specific to the market. As an exception, we also included the online counseling platform YourDost, which did not have an app. We chose to include it amongst the depression apps as it catered to several India-specific needs we discuss below, such as featuring local narratives about depression and providing access to local resources. The remaining (N = 7) apps (Betterhelp, Calm, Sanvello, MindDoc, seven cups of tea, Youper, and Talklife) were international apps accessible to Indian users. The chosen apps provided a wide range of tools – online therapy, peer support, AI-powered CBT training materials, depression tracking, and assessment, etc., to help manage depression.

Our evaluation methodology was informed by prior research conducted by Suri (2019) on attitudes toward depression in India. We also conducted a comprehensive review of literature on the influence of key socio-cultural/demographic factors on the applicability of depression apps in India (refer to Table 1). We organized the India-relevant app features that we identified into four categories: (i) content relevance, (ii) localization, (iii) affordability, and (iv) accessibility. To further investigate these four features, we dissected them into seven specific evaluation questions. For example, under content relevance, our specific questions were focused on whether or not the app content was congruent to the Indian cultural norms. Cultural congruence meant describing the experience of depression in the local context and incorporating into the definition of depression, the cultural norms, religious beliefs, and life circumstances of individuals from different socioeconomic classes. Content relevance also meant that the app content catered to the diverse goals of individuals with different socio-cultural backgrounds. We evaluated with the following questions: We evaluated content relevance with the following questions: Does the app address India-specific needs – awareness, social stigma, and self-diagnosis with local context? We also considered the relevance of content format. We evaluated this with the question: Does the app engagingly deliver content in the form or text, audio, and video? It’s important that the content be usable to diverse users, and especially those with limited English language skills. Table 2 details the questions included in each feature category.

Table 2.

Feature categories and questions to evaluate the relevance of depression apps for Indian users.

Feature categories	Questions
Content relevance	Does the app address India-specific needs – awareness, social stigma, and self-diagnosis with local context?
Content relevance	Does the app engagingly deliver content for users with low literacy levels? E.g. in audio and video formats?
Localization	Is the app content available in regional Indian languages?
Localization	Does the app refer to local resources? E.g. local psychiatrists, therapists, and local organizations and suicide prevention centers?
Affordability	Is the app completely free to use?
Affordability	If not, is it affordable to most Indian users, and especially those from low SES groups?
Accessibility	Is the app available for offline access?

Evaluations

While every evaluated app provided some information on depression causes, symptoms, and treatment options, they were generally not tailored to the Indian context. Only one of the reviewed apps (YourDost) discussed social and cultural factors relevant to Indian users and included content such as stories of individuals in India dealing with mental health challenges. The apps mainly featured text-based content and were, therefore, inaccessible to users who are unable to read. Some apps had limited audio-based content, often in the form of guided meditations. However, none of the apps had a significant amount of video-based content, and neither did they make the same content available in multiple formats.

A critical feature missing in all of the apps was the availability of content in regional Indian languages, making them less suitable for individuals with limited English proficiency. Two of the local apps (InnerHour and YourDost) provided users access to local therapists that could communicate in regional languages.

The apps had some features that were available to the users for free. These included access to informative content, chatbot-based therapy tools, diagnostic tools, and social support forums. However, access to personalized tools and therapy sessions required users to pay for the service ($5 and more per month for a premium account), making them less affordable for individuals from lower economic classes in India.

Given that there is low connectivity in some parts of India (mostly rural neighborhoods), having offline access is critical for a depression-related app. The smartphone users often turn off data to save costs. Most of the apps had no offline access. Other apps allowed users to use features such as messaging a chatbot or downloading audio content on their phones for offline access. Table 3 provides a summary of our evaluations. A detailed version of the review is included in Supplemental Appendix B, Table B1.

Table 3.

Review of depression mobile applications to evaluate their relevance for Indian users.

App	Interventions	Relevance for India
		Content relevance	Localization	Affordability	Accessibility
		(1) Is the content India-specific?(2) Does the app offer audio/video content?	(1) Regional language coverage(2) Local resource coverage	(1) Is it free?(2) Is it affordable?	(1) Does it work offline
YourDost	Online Counseling with counselors	(1) Yes (2) Partially	(1) No (2) Yes	(1) No (2) No	(1) No
Wysa	CBT training via AI-based chatbot	(1) No (2) No	(1) No (2) No	(1) No (2) No	(1) No
Betterhelp	Online counseling with therapists via live chat, phone, and video	(1) No (2) No	(1) Partially (2) No	(1) No (2) No	(1) No
Calm	Guided meditation	(1) No (2) Partially	(1) No (2) No	(1) No (2) No	(1) Partially
Sanvello	Guided meditation, CBT coaching, online therapy	(1) No (2) Partially	(1) No (2) No	(1) Partially (2) No	(1) Partially
MindDoc	Mood tracking with journal, reports and stats	(1) No (2) Partially	(1) No (2) No	(1) Partially (2) No	(1) No
7 cups of tea	Peer support, Online counseling with trained listeners and therapists	(1) No (2) Partially	(1) No (2) No	(1) Partially (2) No	(1) No
Youper	Online therapy, AI-powered therapy exercises, depression assessment, and tracking	(1) No (2) No	(1) No (2) No	(1) Partially (2) Partially	(1) Yes
Talklife	Online peer support	(1) No (2) No	(1) No (2) No	(1) Yes (2) Yes	(1) Yes
InnerHour	Online therapy, guided meditations, emotional support via chatbot, mood tracking	(1) No (2) Partially	(1) No (2) Yes	(1) Partially (2) Partially	(1) No

Note. YourDost is an online platform and did not have a smartphone app at the time of the review.

The Path forward: Designing an illustrative India-targeted depression app

Individuals with depression in India have different needs. A smartphone app targeted at India must have features that support these diverse user requirements. Our research detailing the profile of depression in India, and the features of existing depression-related smartphone apps suggested four core user goals: (i) Gain awareness, (ii) Overcome stigma, (iii) Get diagnosed, (iv) Seek treatment. To gain more perspective into the smartphone app features corresponding to the four user goals, we mapped the core Critical User Journeys (CUJ), which is defined in the User Experience (UX) terminology as the path a user takes to reach their end goal while using a particular website or app. Table 4 lists the seven user journeys and related app features.

Table 4.

Critical user journeys (CUJ) and the related smartphone app features.

Critical user journey (CUJ)	User end goal	App features
The user wants information on the causes and symptoms of depression The user wants to distinguish the myths about depression from the scientific facts	Gain depression awareness Gain depression awareness, overcome stigma	Awareness-focused stories customized to the user context; Content in the user-preferred language; Content available in text, audio, and video format Stigma-focused stories customized to the user context; Content in the user-preferred language; Content available in text, audio, and video format
The user wants to self-manage their depression The user wants guidance on helping a close friend or family with depression The user wants to know if they have depression	Tools to track, record, manage symptoms; Peer support from other users coping with depression Gain depression awareness; Peer support from other depression caregivers Get screened for depression	Mood tracking, guided therapy, and other self-care tools; Individual forum Stories and resources for suicide prevention; Medication monitoring and other caregiver tools; Caregiver forum Depression diagnostic questionnaires (user age relevant, in user-preferred language)
The user wants to get information on locally available psychiatrists and therapists	Get screened for depression, seek treatment	Contact info of mental health service providers (matched with the user’s location)
The user wants help in choosing a psychiatrist and therapist from the locally available service providers	Get screened for depression, seek treatment	Contact info of mental health service providers with customer ratings (matched with the user’s location)

For example, if the user’s end goal is to gain more awareness about depression, then one of the user journeys is: the user wants information about the causes and symptoms of depression. To help the user accomplish this goal, the app content needs to be customized to the cultural context of India. For example, it must include content that clearly differentiates depression from transient stress and sadness; and debunks myths regarding depression that are common in India. Additionally, the content needs to be relevant to the user’s context and life situations. Presentation of the content in the user-preferred language and format (i.e. text, audio, or video) is also a critical aspect of customization.

Core design of an illustrative India-targeted depression App

Guided by the Critical User Journeys (CUJ) discussed above, we outlined the core design of an illustrative India-targeted depression app. The app’s ‘core of customization’ is seamlessly integrated into its ‘functional outcomes’ in the design (refer to Figure 1).

Figure 1.

Designing an illustrative India-targeted depression app.

The ‘core of customization’ of the app makes it more relevant to individuals from diverse socioeconomic classes and with different needs and preferences by incorporating multiple layers of customization such as (i) personalized content, that is, the content compatible with the demographic background and life circumstances of the user; (ii) multiple content formats, that is, content in different formats such as text, audio, and video so the user can opt for their preferred format; (iii) local languages, that is, the content available in regional languages to allow the user to access the content in their preferred language; (iv) local resources, that is, recommending resources such as contact details of psychiatrists, therapists, and depression support groups that are matched with the location of the user.

The ‘functional outcomes’ of the app offer content that support the different needs and goals of individuals with depression or caregivers of individuals with depression. The content takes into account the needs that are specific to the Indian context and are targeted at (i) promoting awareness about depression; (ii) reducing stigma; (iii) providing social support; (iv) offering diagnosis; (v) connecting to treatment resources.

Illustrative wireframes of India-targeted depression App

To underline our recommendations for India-targeted app features, we created illustrative app wireframes incorporating the aforementioned core of customization and functional outcomes. The wireframes represent the app’s onboarding flow, described as the series of tasks that introduce a first-time user to the app (for illustrative purposes, we named the app Joshify derived from the word ‘Josh’ in Hindi, meaning zeal).

The core of customization of the app intends to provide the user with a more customized experience of the app (see Figure 2 for details) by gathering a few details. On the location screen, for instance, the user is asked for permission to allow the app to access their location. The location information is used to recommend treatment resources that are close to the user’s location. Similarly, the language screen customizes the content to the user-preferred language. In addition to the default English-language option, the user can opt to use the app in other regional languages such as Hindi, Tamil, and Bengali. The personal details screen captures the user’s demographic details such as age, gender, education level, and monthly income. This screen aims to understand the needs and limitations of the user and offer context- relevant content.

Figure 2.

Screens illustrating the core of customization of the India-targeted depression app.

The app’s functional outcomes offer content relevant to the user’s different needs and goals for using the app (More details in Supplemental Appendix B, Figure B1). On the user goal screen, the user is asked to specify their goal for using the app, that is, whether they plan to use it for their mental well-being or their loved one’s mental well-being. Understanding the user goal allows the app to recommend relevant content to individuals with depression and the caregivers of individuals with depression. The menu screen leads the user to the home screen, where the content is organized under four sub-screens (i) the know about depression screen features engaging content aimed at improving depression awareness and overcoming stigma; (ii) the get connected screen displays moderated social forums relevant to the user goal. Either a forum for ‘individuals with depression’, ‘forum for caregivers’, or both the forums are displayed based on the user’s goal for using the app; (iii) the get diagnosed screen includes a standardized depression questionnaire relevant to the user’s age; and (iv) find treatment screen suggests local treatment resources based on the user’s location and financial limitations. Additionally, the user can access content in their preferred format, such as audio or video instead of text.

Discussion

Implications and challenges

COVID-19 has spearheaded a digital transformation of the healthcare industry. The telepsychiatry operational guidelines (Math et al., 2020) released last year make it feasible for psychiatrists to incorporate telepsychiatry in their existing clinical practice. However, individual access to telepsychiatry services is still far-fetched in rural communities that have poor access to the internet and low digital literacy. In low-resource settings, smartphone-based interventions can potentially be used to raise awareness about depression amongst non-specialist healthcare workers, and provide them with the training tools needed to screen individuals for depression in the community healthcare centers (Mehrotra et al., 2018). More research is needed to investigate how smartphone apps can be used for suicide prevention and under emergencies where in-person interaction is required. Future research should also focus on smartphone app features that can mitigate privacy concerns that prevent users from using smartphone apps (Huguet et al., 2016). More collaborations are needed between the scientific community and app developers to investigate innovative ways to design the app content based on empirically supported treatments, a feature that’s currently missing in most depression apps (Wasil et al., 2019).

Conclusion

There is a pervasive lack of awareness about depression in India. Mental health stigma is common not only in the general population but also in the medical community. Additional challenges like the limited availability of trained mental health professionals result in depression going undiagnosed and untreated in India. Depression apps can help minimize some of these challenges. They show great promise, especially in the wake of COVID-19 led digitization of healthcare. However, most depression apps in the market lack fundamental features that make them relevant to Indian users. In this article, we proposed the design of a highly customized India-targeted depression app. The proposed app disseminates information about depression and mental health stigma in a culturally compatible manner. Additionally, it incorporates different layers of user customization such as content in user preferred regional language; text, audio, and video format options for content; and user-location matched treatment resources.

Supplemental Material

sj-pdf-1-isp-10.1177_00207640211032253 – Supplemental material for Managing depression in India: Opportunities for a targeted smartphone app

Supplemental material, sj-pdf-1-isp-10.1177_00207640211032253 for Managing depression in India: Opportunities for a targeted smartphone app by Swati Ramnath and Gaurav Suri in International Journal of Social Psychiatry

Footnotes

Acknowledgements

The authors would like to thank Dr. David Gard for reading this article and sharing his insightful comments, and Courtney Ko for her help in designing the application wireframes.

Authors contributions

Both the authors participated in the review conceptualization and planning. S. Ramnath led the manuscript writing. Both G. Suri and S. Ramnath edited the review.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Swati Ramnath

Supplemental material

Supplemental material for this article is available online.

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