Linking mHealth Engagement to Depression, Anxiety, and Stress Through Perceived Health Competence

Background: Mobile health (mHealth) applications are widely used for lifestyle monitoring and health promotion; however, their psychological impact on mental health outcomes remains insufficiently understood. Beyond usage frequency, the perceived usefulness of mHealth tools and underlying psychological mechanisms play a critical role in explaining their association with psychological distress. The present study examined perceived health competence as a potential mediator linking mHealth use to symptoms of depression, anxiety, and stress. Methods: This cross-sectional study included 255 adult participants who completed an online survey assessing frequency of mHealth use, perceived usefulness of mHealth applications, perceived health competence (PHCS), and psychological distress (DASS-21). Separate mediation models were tested for depression, anxiety, and stress, with perceived health competence specified as the mediator. Analyses were conducted using bootstrapped mediation procedures. Results: Perceived usefulness of mHealth applications was strongly and positively associated with perceived health competence, which in turn was consistently associated with lower levels of depression, anxiety, and stress. Mediation analyses indicated significant indirect effects of perceived usefulness on all three distress outcomes through perceived health competence. In contrast, frequency of mHealth use showed weaker and less consistent associations, with primarily small direct effects and no significant indirect effects through perceived health competence. Conclusions: The findings indicate perceived health competence is a plausible explanatory pathway statistically consistent with the association between perceived usefulness and psychological distress. The psychological benefits of mHealth applications appear to depend less on how frequently they are used and more on whether users perceive them as useful and empowering. These results underscore the importance of incorporating psychological process indicators into the design and evaluation of mHealth interventions.