The World Health Organization defines well-being as follows: “Well-being is a positive state experienced by individuals and societies. Similar to health, it is a resource for daily life and is determined by social, economic and environmental conditions” [1]. In today’s society, reference is often made to the importance of working to improve young people’s mental health and well-being as adolescence is a critical, transformative, and challenging time [2]. Research indicates that 10%-20% of adolescents worldwide experience mental health problems [3,4], and in approximately half of all mental disorders, the onset of symptoms occurs before the age of 15 years [5,6]. This illustrates that mental illness in adolescence can have negative effects also on adulthood [6,7]. Today, the need for mental health care and tools for young people is high, and it is argued that provided mental health services for adolescents are not sufficient to keep up with the growing demand [8]. It is therefore important to work toward developing targeted measures and evidence-based interventions that can help young people cope with stress and different challenges [2,9]. Furthermore, it is important to provide supporting tools and resources that can promote healthy habits and behaviors that contribute to overall well-being in adolescence.

In recent years, it has been suggested that mobile devices and the internet represent ideal tools to deliver such interventions to young people [10], and an increasing number of developers and researchers have been following this suggestion [11-14]. In a systematic review, Grist et al [13] highlight the importance of digital interventions developed for young people being of good quality. Furthermore, they point out that the development of digital products, intended for young people, should be designed in collaboration with young people, in order to develop customized and high-quality products for the target group. Thus, a broad understanding of what young people think about specific digital interventions can be beneficial for developing effective products suitable for the target group.

Mobile apps (ie, apps) are tools where users can receive digital health interventions or information, these health apps have the intention of improving the user’s overall health [12]. Along those same lines, mental health apps are designed to improve mental health and well-being among their users [14-16]. These apps can be designed to address specific mental health disorders [17,18], or they can be more general, focusing on promoting mental health and preventing mental distress through a variety of tools and resources such as emotional self-monitoring and coping strategies [19,20].

One important advantage of mental health apps is their availability [16]. Users can gain access to them anytime and anywhere with a smartphone or other mobile devices. This is particularly useful for individuals who may not have easy access to mental health services due to geographic barriers or for individuals who might benefit from receiving frequent reminders or immediate support [15,16]. Furthermore, mental health apps can reach larger segments of the population compared with in-person therapy, and, in some cases, they have shown promising cost-effectiveness [10,16].

Young people spend a considerable amount of time on their smartphones and use them for entertainment, social purposes, and to access information on different topics, including mental health [21-23]. There are several mental health apps available for adolescents, but as Grist et al [13] point out, the quality of the assessment on these apps is scarce. Research on mental health apps for adolescents indicates that young people are generally satisfied with the access to and ease of use of mental health apps [13,24]. Kenny et al [25] highlight in their study that adolescents prefer mental health apps to be safe, engaging, and easily accessible. The use of mental health apps can also allow people to maintain anonymity when seeking mental health advice or guidance, which is appreciated by young people, who often have a high threshold for help-seeking due to a desire for autonomy and the negative attitudes or stigma surrounding mental health services [26-28].

Nevertheless, the level of user engagement in existing mental health apps is relatively low or moderate and repeated long-time use of mental health apps after downloading them is rare [13,29,30]. This may indicate that despite the fact that young people find mental health apps appealing, it is not sufficient to ensure sufficient use over a long span of time. Regardless of the reasons, it is possible that low user engagement could decrease the overall effectiveness of mental health apps. Research on the effectiveness of mental health apps on adolescent mental health outcomes has revealed mixed results. Some research has failed to illustrate any effect [13,31,32], and others have indicated that mental health apps are promising and have the potential to provide improvement in mental health outcomes [14,33,34]. Yet, there is broad agreement that more research on the effectiveness of mental health apps is needed to fully understand their capacity to improve mental health outcomes [13,32,33]. In order to understand more about the effect mental health apps can have on young people’s mental health, it is also beneficial to examine what young people think about mental health apps and how they should appear in order to be effective for the target group.

The aim of this study is to explore adolescents’ attitudes toward mental health apps, and their perceived usefulness, using both quantitative and qualitative data. While the quantitative study focuses more on the use and usefulness of these apps as well as on their perceived advantages and disadvantages, the qualitative study examines adolescents’ more general thoughts on mental health apps and how they may be of help to them. Together these data sets provide important insight for the development of mental health apps. The results can help to ensure more user-targeted products and more user engagement, which in turn can contribute to a greater effectiveness of mental health apps.

This study used a convergent, parallel QUAN + qual mixed methods design [35]. Quantitative and qualitative data were collected simultaneously, and the qualitative study was used to complement the results of the quantitative study. The quantitative data are based on a cross-sectional survey and the qualitative data are based on semistructured interviews. A total of 2 authors (HK and SK) analyzed the quantitative data, and the other 2 authors (HH and MR) analyzed the qualitative data. The results of the 2 data sets are integrated in the discussion.

The questionnaire in the quantitative study was anonymous and no personally identifiable information was collected. To complete the questionnaire, adolescents had to scan the QR code of their own volition. Moreover, before they could access the questionnaire, the adolescents were presented with information about the study and they were told that they agreed to participate by answering the questions. The adolescents were also informed that they could stop answering the questionnaire at any time without consequences.

The qualitative study was evaluated and approved by the Norwegian Center for Research Data (reference 631424). Adolescents of 16 years or older could consent to take part in the interview themselves, while active parental consent was required from adolescents younger than 16 years of age. Consent was retrieved via a digital consent form in Nettskjema [36]. All interview informants received a cinema gift card with a value of NOK 150 (approximately US $15) as compensation.

Of the 183 adolescents who completed the web-based questionnaire, 56 (30.6%) adolescents had used a mental health app. Among adolescents who had not used a mental health app (126/183, 68.9%), approximately half (77/126, 61.6%) said they would use one if they had a mental health problem and there were apps available to help, while 48 (38.4%) adolescents said they would not. When asked “What do you think about mental health apps in general?” 25 (13.7%) adolescents answered that they were not or not very useful, 44 (24.0%) adolescents answered “neither”, and 114 (62.3%) adolescents found them somewhat or very useful (mean 3.6, SD 1.1). The regression analysis to predict the perceived usefulness of mental health apps, identified only gender as a significant predictor (β=.35; P<.001) indicating that girls perceived mental health apps as more useful than boys.

The most frequently reported advantages of using a mental health app were as follows: “It will always be there when I need it” (107/183, 58.8%), “I don’t have to talk to someone face to face” (83/183, 45.4%), “It is more private” (75/183; 41.0%), and “I can be anonymous” (72/183, 39.3%; Table 2). The most frequently reported barriers were as follows: “It might cost money” (87/183, 47.5%), “I don’t know whether the information in them is accurate or true” (82/183, 44.8%), and “I am afraid someone will see the app on my phone” (78/183, 42.6%; Table 3). The most frequently cited media that adolescents used to find information about mental health were by far “Google” (151/183, 82.5%) and “Social media (for example Facebook, Instagram, TikTok)” (90/183, 49.2%; Table 4).

In this study, we examined adolescents’ attitudes and general thoughts toward mental health apps using a concurrent, mixed methods approach. This research is an important contribution to understanding what young people think about mental health-promoting mobile apps, as well as their thoughts on what they should include and how they should appear.

Overall, the adolescents expressed positive attitudes toward mental health apps, even though few had experience with using them. A large proportion perceived such apps as useful tools that can help them cope with normal stresses of life, which is important in order to promote well-being and prevent mental health problems [43,44]. In the quantitative section of the study, availability was the most chosen benefit of using mental health apps. This is not surprising as adolescents in Norway spend a lot of time on their phones and on social media [21]. Privacy, as well as the possibility of remaining anonymous, was the subsequent most chosen advantage. These results are in accordance with those reported in previous literature [16,25,37]. Further, in the interviews, adolescents expressed that mental health apps can be of help at any time of the day, also when in-person services are not available. However, the adolescents expressed, that for mental health apps to be accessible, they need to also be easily understandable and have no costs attached.

It is well-known that adolescents tend to be reluctant to seek help, despite the importance of obtaining help and support for improved well-being [45-47]. In this study, adolescents expressed that mental health apps can lower adolescents’ threshold for asking for help, by always being available and by offering anonymity in the help-seeking process. Several interviewees also highlighted the empowering potential of mental health apps. The adolescents valued how an app could provide them with the ability to help themselves without interference from others. Meeting young people’s need for autonomy is important to ensure that they ask for help when they need it [28]. The findings from this study concur with previous findings, which suggested that adolescents value the autonomy that mental health apps provide [48].

Further, the adolescents emphasized that mental health apps should provide an anonymous way for them to talk about their problems, with either a web-based assistant or a real person. In addition, some adolescents reported fear of someone else seeing a mental health app installed on their phone as a deterrent to using such apps. Anonymity is often mentioned as an important reason why adolescents use web-based services when searching for help or advice regarding mental health [16,49], our findings support that adolescents view anonymity as an advantage of using mental health apps, which agrees with previous findings [16,25].

Another important aspect adolescents highlighted was the difficulty they might have in judging whether the information contained in a mental health app was accurate. Most adolescents reported that they used the internet (ie, Google and social media) to search for mental health-related information. The adolescents stated that mental health apps should be developed by credible organizations or individuals that adolescents already trust. Adolescents also stated that, the information presented in the app should be clear and concise in order to be engaging for them. Previous research have also shown the importance of content and appearance to ensure engaging mental health apps [25,50].

Although adolescents generally have a positive attitude toward the increased development and use of mental health apps, few of the adolescents in our study sample were familiar with such apps. These results are in line with previous research which indicates that adolescents are not highly engaged in mental health apps [13,29]. Indeed, some adolescents believed that they had not heard of such apps due to poor marketing strategies. They stated that, if the apps were meant to target adolescents, then they should be marketed to young people directly. However, there are currently strict rules regarding advertising to children and adolescents in Norway [51], which may pose challenges in devising effective marketing strategies to reach adolescents.

By including both quantitative and qualitative data, this study provides valuable knowledge and insight into adolescents’ perspectives and opinions on mental health apps. However, there are several limitations that must be taken into consideration. In the quantitative study, the sample size was relatively small and not representative. One should therefore be careful about drawing general conclusions from the findings. However, the results can be an important contribution to the field of research on what adolescents think about mental health apps. Moreover, the interviews were of short duration, which may have influenced the depth of the answers. However, the adolescents were encouraged to speak freely, and they were not interrupted until they had concluded. Follow-up questions were asked when they brought up topics that the interviewer found interesting or considered meaningful for the adolescent to elaborate on. Furthermore, because the qualitative study was intended to complement the quantitative study, we perceive the length and depth of the interviews as sufficient.

One interview was conducted with 2 adolescents together, based on the participants’ own desires. Since they stated it would increase their sense of security during the interviews, the request was accepted. However, we cannot exclude the possibility that the presence of another adolescent influenced the answers the adolescents provided.

Mental health apps can be a useful resource for adolescents, and several apps geared toward adolescents have been developed. Our findings show that there is a lack of knowledge about the existence of mental health apps among adolescents. A large proportion of adolescents expressed that they would use these apps if they knew they were available. This study shows that apps directed toward adolescents should be easily accessible, free of charge, and provide easily understandable information. Adolescents also emphasized the significance that apps should be developed by credible sources or institutions, offer a choice between human and web-based support, and enable users to remain anonymous while seeking help. Future development of mental health apps should take these considerations into account.