Developer evidence and user satisfaction in mental health apps across China and the United States

Mental health applications (MHAs) hold promise for expanding access to care, yet user satisfaction varies across cultural contexts. Drawing on value co-creation theory, this study integrates developer and user perspectives to examine cross-country differences between China and the United States. We analyzed platforms and reviews data from leading Chinese and US app markets. On the developer side, US-based applications demonstrated substantially greater engagement in clinical pipelines and public claims than Chinese applications; however, these indicators were not significantly associated with app store ratings in the US sample and could not be meaningfully estimated in the Chinese sample due to very limited disclosure. On the user side, satisfaction drivers differed markedly: Chinese users emphasized core service functions such as online consultation, whereas US users showed stronger preferences for experiential features such as meditation practice. Across both contexts, personalized services were consistently rated as insufficient. Future development should shift MHAs from "digital products" toward "evidence-based, user-centered health tools".