Application of Smartphone Technology in the Management and Treatment of Mental Illnesses

Abstract: Background: Mental illness continues to be a significant Public Health problem and the innovative use of technology to improve the treatment of mental illnesses holds great public health relevance. Over the past decade telecommunications technology has been used to increase access to and improve the quality of mental health care. There is current evidence that the use of landline and cellular telephones, computer-assisted therapy, and videoconferencing can be effective in improving treatment outcomes. Smartphones, as the newest development in communications technology, offer a new opportunity to improve mental health care through their versatile nature to perform a variety of functions. Methods: A critical literature review was performed to examine the potential of smartphones to increase access to mental health care, reduce barriers to care, and improve patient treatment outcomes. The review was performed by searching several electronic databases using a combination of keywords related to smartphones and mental health interventions using mobile devices. Literature concerning the use of cell phones, handheld computers, and smartphones to improve access to mental health care and improve treatment outcomes was identified.Results: The majority of studies identified were feasibility and pilot studies on patients with a variety of diagnosed mental illnesses using cell phones and PDAs. Authors report that most study participants, with some exceptions, were capable of using a mobile device and found them acceptable to use. Few studies extensively measured treatment outcomes and instead reported preliminary results and presented case illustrations. Studies which used smartphones successfully used them collect data on patients and deliver multimedia interventions. Discussion: The current literature offers encouraging evidence for the use of smartphones to improve mental health care but also reflects the lack of research conducted using smartphones. Studies which examine care provider use of smartphones to improve care is encouraging but has limited generalizability to mental health care. The feasibility of patient use of smartphones is also encouraging, but questions remain about feasibility in some sub-populations, particularly schizophrenia patients. Pilot testing of mobile devices and applications can greatly increase the feasibility of using smartphones in mental health care. Patients who are unfamiliar with smartphones will likely need initial training and support in their use. Conclusion: The literature identified several ways in which smartphones can increase access to care, reduce barriers, and improve treatment outcomes. Study results were encouraging but scientifically weak. Future studies are needed replicating results of studies using cell phones and PDAs on smartphones. Larger and higher quality studies are needed to examine the feasibility, efficacy, and cost-effectiveness of smartphones to deliver multiple component interventions that improve access to mental health care and improve treatment outcomes

Regulating Mobile Mental Health Apps

Mobile medical apps (MMAs) are a fast‐growing category of software typically installed on personal smartphones and wearable devices. A subset of MMAs are aimed at helping consumers identify mental states and/or mental illnesses. Although this is a fledgling domain, there are already enough extant mental health MMAs both to suggest a typology and to detail some of the regulatory issues they pose. As to the former, the current generation of apps includes those that facilitate self‐assessment or self‐help, connect patients with online support groups, connect patients with therapists, or predict mental health issues. Regulatory concerns with these apps include their quality, safety, and data protection. Unfortunately, the regulatory frameworks that apply have failed to provide coherent risk‐assessment models. As a result, prudent providers will need to progress with caution when it comes to recommending apps to patients or relying on app‐generated data to guide treatment

Emotions in context: examining pervasive affective sensing systems, applications, and analyses

Pervasive sensing has opened up new opportunities for measuring our feelings and understanding our behavior by monitoring our affective states while mobile. This review paper surveys pervasive affect sensing by examining and considering three major elements of affective pervasive systems, namely; “sensing”, “analysis”, and “application”. Sensing investigates the different sensing modalities that are used in existing real-time affective applications, Analysis explores different approaches to emotion recognition and visualization based on different types of collected data, and Application investigates different leading areas of affective applications. For each of the three aspects, the paper includes an extensive survey of the literature and finally outlines some of challenges and future research opportunities of affective sensing in the context of pervasive computing

Content validity and methodological considerations in ecological momentary assessment studies on physical activity and sedentary behaviour : a systematic review

Background Ecological momentary assessment (EMA) is a method of collecting real-time data based on repeated measures and observations that take place in participant's daily environment. EMA has many advantages over more traditional, retrospective questionnaires. However, EMA faces some challenges to reach its full potential. The aims of this systematic review are to (1) investigate whether and how content validity of the items (i.e. the specific questions that are part of a larger EMA questionnaire) used in EMA studies on physical activity and sedentary behaviour was assessed, and (2) provide an overview of important methodological considerations of EMA in measuring physical activity and sedentary behaviour. Methods Thirty papers (twenty unique studies) were systematically reviewed and variables were coded and analysed within the following 4 domains: (1) Content validity, (2) Sampling approach, (3) Data input modalities and (4) Degree of EMA completion. Results Only about half of the studies reported the specific items (n = 12) and the source of the items (n = 11). None of the studies specifically assessed the content validity of the items used. Only a minority (n = 5) of the studies reported any training, and one tested the comprehensibility of the EMA items. A wide variability was found in the design and methodology of the EMA. A minority of the studies (n = 7) reported a rationale for the used prompt frequency, time selection, and monitoring period. Retrospective assessment periods varied from 'now' to 'in the last 3.5 hours'. In some studies there was a possibility to delay (n = 6) or deactivate (n = 10) the prompt, and some provided reminders after the first prompt (n = 9). Conclusions Almost no EMA studies reported the content validation of the items used. We recommend using the COSMIN checklist (COnsensus-based Standards for the selection of health Measurement INstruments) to report on the content validity of EMA items. Furthermore, as often no rationale was provided for several methodological decisions, the following three recommendations are made. First, provide a rationale for choosing the sampling modalities. Second, to ensure assessment 'in the moment', think carefully about the retrospective assessment period, reminders, and deactivation of the prompt. Third, as high completion rates are important for representativeness of the data and generalizability of the findings, report completion rates

The Double-edged Sword: A Mixed Methods Study of the Interplay between Bipolar Disorder and Technology Use

Human behavior is increasingly reflected or acted out through technology. This is of particular salience when it comes to changes in behavior associated with serious mental illnesses including schizophrenia and bipolar disorder. Early detection is crucial for these conditions but presently very challenging to achieve. Potentially, characteristics of these conditions\u27 traits and symptoms, at both idiosyncratic and collective levels, may be detectable through technology use patterns. In bipolar disorder specifically, initial evidence associates changes in mood with changes in technology-mediated communication patterns. However much less is known about how people with bipolar disorder use technology more generally in their lives, how they view their technology use in relation to their illness, and, perhaps most crucially, the causal relationship (if any exists) between their technology use and their disease. To address these uncertainties, we conducted a survey of people with bipolar disorder (N = 84). Our results indicate that technology use varies markedly with changes in mood and that technology use broadly may have potential as an early warning signal of mood episodes. We also find that technology for many of these participants is a double-edged sword: acting as both a culprit that can trigger or exacerbate symptoms as well as a support mechanism for recovery. These findings have implications for the design of both early warning systems and technology-mediated interventions

Employing Environmental Data and Machine Learning to Improve Mobile Health Receptivity

Behavioral intervention strategies can be enhanced by recognizing human activities using eHealth technologies. As we find after a thorough literature review, activity spotting and added insights may be used to detect daily routines inferring receptivity for mobile notifications similar to just-in-time support. Towards this end, this work develops a model, using machine learning, to analyze the motivation of digital mental health users that answer self-assessment questions in their everyday lives through an intelligent mobile application. A uniform and extensible sequence prediction model combining environmental data with everyday activities has been created and validated for proof of concept through an experiment. We find that the reported receptivity is not sequentially predictable on its own, the mean error and standard deviation are only slightly below by-chance comparison. Nevertheless, predicting the upcoming activity shows to cover about 39% of the day (up to 58% in the best case) and can be linked to user individual intervention preferences to indirectly find an opportune moment of receptivity. Therefore, we introduce an application comprising the influences of sensor data on activities and intervention thresholds, as well as allowing for preferred events on a weekly basis. As a result of combining those multiple approaches, promising avenues for innovative behavioral assessments are possible. Identifying and segmenting the appropriate set of activities is key. Consequently, deliberate and thoughtful design lays the foundation for further development within research projects by extending the activity weighting process or introducing a model reinforcement.BMBF, 13GW0157A, Verbundprojekt: Self-administered Psycho-TherApy-SystemS (SELFPASS) - Teilvorhaben: Data Analytics and Prescription for SELFPASSTU Berlin, Open-Access-Mittel - 201