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

Schizotypy as a predictor for social media use and internet addiction behaviors in emerging adults

This study examined the unique domains/symptom clusters within schizotypy as they relate to Facebook use and internet addiction behaviors, while controlling for co-morbid disorders such as depression and anxiety. Using an online survey, this study measured electronic media use, internet addiction behavior, and schizotypy in 270 undergraduate students (aged 18-30). We expected mood symptoms of anxiety and depression to predict both internet addiction and Facebook use in this sample, and controlled for these variables accordingly. We hypothesized that schizotypy would contribute significantly to the prediction of internet addiction and Facebook use above and beyond anxiety, depression, and demographic variables and anticipated that the strongest predictor of internet addiction would be positive schizotypy, followed by negative schizotypy, and lastly disorganized schizotypy. After a model comparison utilizing hierarchical linear regression, schizotypy total scores predicted internet addiction behavior as well as frequency of Facebook use in this sample. However, contrary to our expectations, disorganized schizotypy was found to be the best predictor of internet addiction. The details of these findings are discussed in addition to a call for more research into electronic media use in this population of emerging adults

Does Faith Ameliorate the Relationship between Sleep and Depression?

Depression is one of the most commonly diagnosed disorders in the world. College students are more likely to experience depression than adults. Research has established a correlational relationship between sleep and depression (American Psychiatric Association, 2013; Davidson, 2013; Franzen & Buysse, 2008, Lund, Reider, Whiting, & Prichard, 2010; Tsuno, Besset, & Ritchie, 2005; Van Bemmel, 1997) and suggests there is also a causational relationship between faith and lower rates of depressive symptoms (Baker & Cruickshank, 2009; Koenig, 2008a Koenig, 2001; Newport, Agrawal, & Witters, 2010; Reutter & Bigattie, 2014; Rosmarin et al., 2013). However, little research exists exploring how faith may ameliorate the relationship between sleep and depression. In the present study, students attending four Protestant faith-based universities completed the American College Health Association’s (ACHA) National College Health Assessment II (NCHA II) between the fall of 2009 and spring of 2012. A Protestant Faith Variable (FV), Sleep Scale (SS), and Depression Scale (DS) were constructed from the NCHA II data. Multiple regression was used to see if faith ameliorates the relationship between sleep and depression and bivariate correlations were computed to explore the relationships between faith and sleep and between faith and depression. No significant relationship between faith and sleep was found however students who reported higher faith endorsed fewer depressive symptoms. In addition, faith was found to ameliorate the relationship between sleep and depression in that it decreased the strength of the relationship between sleep and depression. These findings generate further important questions for future research, including an examination of possible behavioral mediators of faith such as social support, contemplative and religious behaviors, and meaning making

A Decision Tree Approach To The Assessment Of Posttraumatic Stress Disorder

Structured diagnostic interviews are widely considered to be the optimal method of assessing symptoms of posttraumatic stress; however few clinicians report using structured assessments to guide clinical practice. One key impediment to the use of structured assessments in clinical practice is the amount of time required for test administration and interpretation. Thus, the present research conducted an initial feasibility study using a normative sample of college-aged adults (n = 88) to develop an assessment protocol based on the clinician administered PTSD scale (caps). Decision tree analysis was utilized to identify a subset of predictor variables within the 17 caps symptom criteria variables that were most predictive of a diagnosis of posttraumatic stress disorder (PTSD). The algorithm-driven sequence of questions reduced the number of items administered by more than 75% and classified the validation sample at 100.0% accuracy for those without a diagnosis of PTSD and 85.7% accuracy for those with a diagnosis of PTSD. The present study also demonstrated the feasibility of computer administration of the algorithm-based sequence in a normative sample of college-aged adults (n = 197). The algorithm-based, computer-administered sequence had high sensitivity and specificity and excellent diagnostic agreement with the computer-administered full caps sequence. These results demonstrated the feasibility of developing a protocol to assess PTSD in a way that imposes little assessment burden while still providing a reliable diagnosis

Longitudinal Association between Video Game Use and Physical, Mental, and Social Health Outcomes in Young Adults in the United States

Background: Increasing adolescent engagement in video game use and its associations with public health outcomes has been a controversial topic over the last several decades, with studies conducted in the United States only managing to produce contradictory results. This dissertation explores the statistical associations between video game use in adolescents and various physical, mental and social health outcomes as they develop into adulthood in the United States. Methodology: Secondary data analysis was conducted, guided by Life Course Theory, utilizing publicly available data from the National Longitudinal Study of Adolescent to Adult Health. Results: Video game use during adolescence was significantly associated with the risk for development of metabolic syndrome in adulthood (p =.034). No significant association was found between video game use at any time point and increased measures of violence and aggression. A significant association was found between weekly hours of video game use and sleep problems (p = .002), depression (p = .006), anxiety / panic attacks (p = .021), and marijuana use (p = .001). No significant association was found between video game use and ADHD/ADD and drug use excluding marijuana. Conclusion: This dissertation highlights several risks and benefits associated with engaging in video game use. These findings help to inform future public health practice and research. In moderation video game use was shown to have prosocial and positive effects on youth development as they grow into adulthood. However, when video game use exceeded 30 hours or more per week, detrimental effects began to emerge, including an increased risk for the development of metabolic syndrome, sleep problems, depression, anxiety, and marijuana use. Demographic variables such as gender and race / ethnicity and Life Course Theory variables of education and marital status were shown to have greater associations across all health outcomes than video game use at any time point. Recommendations for future research on the topic are discussed, including further investigation of the more significant findings and replication of the statistical analyses using Add Health wave V data once available

First-Year GPA and Academic Service Use Among College Students With and Without ADHD

Objective: ADHD is a chronic neurodevelopmental disorder that typically results in persistent academic difficulties over time. Although most colleges offer support services, students often do not use the available services or those to which they are entitled. The present study examined predictors of academic performance among college students with and without ADHD. In addition, the rate, predictors, and outcomes of academic service use were explored. Methods: A series of multivariate analyses of variance (MANOVAs) and regression analyses were conducted using SPSS v. 21 ® software. Results: First year college students with ADHD earned significantly lower grade point averages (GPAs) relative to students without ADHD. Additionally, ADHD combined with other disorders, but not ADHD alone, predicted higher rates of service use relative to students without ADHD. Finally, the findings suggest that typically available academic services are not independently related to GPA among first-year college students with or without ADHD. Conclusion: This study replicates previous work demonstrating significantly lower GPAs among a rigorously defined sample of students with ADHD relative to students without ADHD. Second, this study indicates that traditional predictors of college success may be less meaningful for students with ADHD relative to those without ADHD. Finally, additional research needs to be conducted regarding the use and effectiveness of academic services on college campuses

Anxiety and control in African American families.

To investigate the effects of anxiety and ethnicity on parental control as well as the effects ethnicity, anxiety, and parental control have on child diagnostic severity, anxious African American and Caucasian families were compared. Sixty-nine parent-child dyads completed the study. Forty-two mothers in the sample suffered from an anxiety disorder whereas twenty-seven mothers did not meet criteria for any current or past psychopathology. Parent-child dyads were videotaped as they completed two mildly stressful tasks together. Parental and child behaviors during the interactions were coded to obtain an objective measure of parents\u27 behavior. Data were reduced to produce four behavioral composites one of which, overcontrolling, was used to assess objective ratings of parental control. Subjective parental control was assessed by two self-report measures of parenting behaviors. Four hierarchical linear regressions were conducted. It was hypothesized that parental anxiety would predict high control in Caucasian families whereas parental anxiety would predict low parental control in African American families. It was further hypothesized that parental control would positively predict child diagnostic severity in anxious Caucasian families whereas parental control would negatively predict child diagnostic severity in anxious African American families. Ethnicity did not significantly predict parental control in either group. As expected, parental anxiety predicted child diagnostic severity. Ethnicity did not significantly predict child diagnostic severity as an outcome variable. The interaction term of ethnicity and parental anxiety failed to predict both objective ratings of parental control and subjective ratings of parental control. The interaction term of ethnicity, parental control (both objective and subjective ratings), and parental anxiety failed to predict child diagnostic severity. Exploratory analyses indicated that both subjective parental control and ethnicity play integral roles along with parental anxiety in predicting child diagnostic status. Exploratory analyses further indicated that anxious Caucasian parents and highly controlling Caucasian parents are more likely than African American parents in general to have an anxious child. Findings from the current sample indicate that anxious African American and Caucasian parents do not seemingly differ with regard to control behaviors toward their children, although African Americans seem less likely to have an anxious child. Future directions are discussed in terms of matched samples of African American and Caucasian families, within group comparisons of African American families, further objective measurement, improved subjective ratings of parental control, and larger sample size

First-Year GPA and Academic Service Use Among College Students With and Without ADHD

Objective: ADHD is a chronic neurodevelopmental disorder that typically results in persistent academic difficulties over time. Although most colleges offer support services, students often do not use the available services or those to which they are entitled. The present study examined predictors of academic performance among college students with and without ADHD. In addition, the rate, predictors, and outcomes of academic service use were explored. Methods: A series of multivariate analyses of variance (MANOVAs) and regression analyses were conducted using SPSS v. 21 ® software. Results: First year college students with ADHD earned significantly lower grade point averages (GPAs) relative to students without ADHD. Additionally, ADHD combined with other disorders, but not ADHD alone, predicted higher rates of service use relative to students without ADHD. Finally, the findings suggest that typically available academic services are not independently related to GPA among first-year college students with or without ADHD. Conclusion: This study replicates previous work demonstrating significantly lower GPAs among a rigorously defined sample of students with ADHD relative to students without ADHD. Second, this study indicates that traditional predictors of college success may be less meaningful for students with ADHD relative to those without ADHD. Finally, additional research needs to be conducted regarding the use and effectiveness of academic services on college campuses

On-Campus Mental Health Service Use Among College Students With Autism: A Case Study Applying the Andersen Behavioral Model of Health Services Use

The unique set of impairments and limitations presented by students with autism spectrum disorder (ASD) make the accessing of campus-based nonacademic resources more difficult and complicated than their typically developed peers. Each year, the rate of students entering college with disabilities continues to grow, but their mental well-being is relatively poor. The purpose of this qualitative case study was to apply the conceptual framework of the Andersen behavioral model of health services use (ABMHSU) to the experiences of college students with ASD to understand and predict their utilization of campus-provided mental health resources. The participants were seven college students with ASD who were currently receiving accommodations through Disability Services Program (pseudonym) at Tumbleweed University (pseudonym). Data were collected through demographic questionnaires and virtual interviews. The data were analyzed by breaking the interview responses down into predisposing, enabling, and need-based factors described in the ABMHSU. These data were compared to past literature also using the ABMHSU. The findings indicated that the predisposing factors that influence utilization were the presence of past illness, social structure, and attitudes toward health services. The enabling factors that influenced utilization were type of regular source of care and access to regular source of care. The need-based factors that influenced utilization were perceived general state, symptoms, and diagnosis. The main conclusion drawn from this study is that connecting students to counseling is not enough; they need to be encouraged to keep going. The participants indicated that the social impairments of ASD could make maintaining relationships and communicating difficult. Discovering the reasons for the discontinuation of the utilization of mental health services will help service program personnel anticipate them and encourage engagement

Predicting Opioid Prescribing Behaviors: Influence of an Expert Opioid-Risk Evaluation

Opioid analgesics have been shown to be effective for short-term pain reduction; however, chronic opioid therapy does not improve functioning, and may lead to problems with dependence and abuse. Physicians report having difficulty discerning substance abuse or drug diversion, which can lead to over- or under- prescribing, poor pain management, and may contribute to the growing number of opioid-related overdose deaths. The primary aim of this study was to determine if a psychological opioid risk evaluation influenced opioid prescribing in physicians at the West Virginia University (WVU) Family Medicine Clinic. For this retrospective study, participants were 151 (89 female) adult patients being considered for long-term opioid therapy. Patients participated in a psychological opioid risk evaluation, which included several questionnaires and a clinical interview. This evaluation resulted in an opioid risk level (i.e., low, low-moderate, moderate, moderate-high, high) being assigned to each patient representing clinical judgment about their potential risk for misusing or abusing opioid medication. An electronic medical record review was conducted on each patient, abstracting information about if an opioid was prescribed, in addition to several other factors, which later were included in logistic regression analyses. Patients prescribed an opioid were more likely to be married or with a long term partner and have a higher level of education. Patients not prescribed an opioid were more likely to report a higher pain rating at the time of the evaluation, a history of abuse or substance abuse, or have higher total scores for questionnaires measuring pain catastrophizing, misuse or diversion behaviors, and depression symptoms. Risk status and substance abuse history significantly predicted opioid prescribing, with a decrease in risk status resulting in an increase in opioid prescribing, and those with a history of substance abuse being less likely to be prescribed an opioid; however, substance abuse did not significantly improve the overall model and was removed. Additionally, demographic variables (i.e., age, sex, ethnicity/race) were not significant predictors of prescribing as found in other studies. These findings suggest that providing physicians with additional information about their patient\u27s opioid abuse potential aids in prescribing decisions and may reduce prescribing bias based on demographic factors. Risk status may allow physicians to integrate evidence-based factors into their decision-making process in a simplified manner, and possibly improve patient care. Future work should continue to address physicians\u27 prescribing perspective, accuracy of evaluations, effect on patient care, and cost analyses for the healthcare system