*4.5. Limitations*

The study has its limitations with regard to the sample size used. The sample size was large enough to study mental health users, overall mental health app usage, and guidance-based mental health apps. However, for tracking-based apps, the number of users was considerably small since, despite the large sample size of 378 users in 2019 and 557 users in 2020, overall mental health apps were used by 38 users in 2019 and by 81 users in 2020. Although this number of users helped us to make a comparison between the users and non-users of mental health apps, they also limited the further analysis that could have been conducted on the users of mental health apps themselves. Another limitation in the study is the time span of 21 days taken for this study to include most users since some users left the study. As previously noted, mental health apps are utilized with extended periods of break, and as such, only when facing the need, the time span of the study may need to be lengthened to account for the periods of breaks in between. Furthermore, the third-party app collected the age of participants as an age range rather than an exact number. The utilization of an exact age could help divide age into further refined categories such as late adolescents and young adults. This would help to produce more accurate results with respect to the usage of mental health apps and age.

#### **5. Conclusions**

With the findings of this paper, the change in mental health app usage pre-pandemic and during-pandemic can be realized. The help-seeking behavior that was associated with females is found to be equally existing in males pre-pandemic and increased duringpandemic. In addition, it was also found that during the pandemic, adults are engaging more in mental health apps than emerging adults. This study helps in identifying the groups that are truly using these apps and those that are not since objective data were collected with regards to mental health app usage. This research shows how mental health apps are helping users through the pandemic, and hence, regulations on these apps should be enforced to ensure their safety of usage for the mental health of users. Despite the change in usage amongst users, user engagement and retention were not substantial for these apps; hence, the findings from this paper also suggest a need to adopt improved user engagement and retention techniques such as just-in-time intervention by developers of mental health apps.

Future work in this area may focus on studying the users who used mental health apps occasionally and whether they used them intensively during these times. Another future direction of study may investigate and identify the users who left mental health apps and whether they left due to improved conditions or disinterest in the mental health apps. The type of apps these users use can also be studied to identify the categories of mental health apps that have the most dropout. Furthermore, for this study, only two demographics of age and gender were considered, while future studies may also investigate the impact of culture and education as well as personality and type of mental health issues. Future studies in this domain could also look into the usage of guidance-based apps and tracking-based apps with respect to identifying user clusters that, in fact, do utilize these subcategories as per the apps' objectives and those that do not.

**Author Contributions:** Conceptualization, M.A. (Maryam Aziz), A.E. and R.A.; Data curation, M.B.A., M.A. (Majid Altuwairiqi) and R.A.; Formal analysis, M.A. (Maryam Aziz) and J.M.; Funding acquisition, M.B.A. and M.A. (Majid Altuwairiqi); Investigation, M.A. (Maryam Aziz); Methodology, M.A. (Maryam Aziz), A.E., M.B.A., M.A. (Majid Altuwairiqi), J.M. and R.A.; Supervision, A.E. and R.A.; Writing—original draft, M.A. (Maryam Aziz); Writing—review & editing, A.E. and R.A. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work received support from Zayed University, UAE, under grant number R18053 and the Scientific Research Department at Taif University, grant number 1-441-79. Open Access funding has been provided by the Qatar National Library.

**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of QATAR BIOMEDICAL RESEARCH INSTITUTE (protocol code QBRI-IRB 2021-08-102 and 12 August 2021).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** Derived data supporting the findings of this study are available from the corresponding author on request.

**Conflicts of Interest:** The authors declare no conflict of interest.
