Evaluation of Digital Mental Health Technologies in the UnitedStates:Systematic Literature Review and Framework Synthesis

Background: Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However,there is little information on how DMHTs are evaluated and what factors influence their use.Objective: A systematic literature review was conducted to understand how DMHTs are valued in the United States from user,payer, and employer perspectives.Methods: Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the HealthTechnology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewersto identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease,epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the CriticalAppraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the AmericanPsychiatric Association's Mental Health App Evaluation Framework to extract and synthesize relevant information, and novelthemes were added iteratively as identified.Results: Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectiveswere included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularlyalignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use includedlimited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs toavoid stigma.Conclusions: Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users,although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs inmind