Smartphones as data-collection tools for mental health
Smartphones can be used as data-collection tools for mental health. In fact, this blog post is a summary of a research paper titled “Mobile phones as medical devices in mental disorder treatment.” To download the research paper, visit our Resource Library.
One in four Europeans have suffered from at least one mental disorder during their lifetime [2]. In the USA 26.2% of the population, 60 million people, suffer from at least one form of mental disorder [3]. Mental disorders can have a significant, negative impact on sufferers’ lives, as well as on their friends and family. More than 90% of people who commit suicide have a diagnosable mental disorder [4].
Currently, the monitoring of mental disorders relies mainly on self-reporting, developed more than 50 years ago. Hence, the researchers reviewed different systems that utilise mobile phones as data-collection tools for mental health. They evaluated how their core design features and dimensions can be applied in other systems and they looked into the feasibility of using mobile phones to collect data including voice data, motion and location information.
Smartphones as data-collection tools for mental health
From a technology point of view, mobile phones offer a promising hardware platform for various applications. In developed countries almost everybody owns a mobile phone; world-wide this adds up to 4.5 billion users [5].
Smartphones are accounted for 51.8% of mobile phone sales in 2013 worldwide [6]. As of 2014, one third of the currently world-wide used mobile phones are already smartphones [5]. Their cost has dropped dramatically and functionality continues to expand.
Smartphones are also a powerful technical platform. They are powerful in terms of CPU, memory, and battery. They also have extensive communication capabilities with their built-in network interfaces for 3G/4G, Wi-Fi, and Bluetooth; and they are equipped with sensors including accelerometers, GPS, microphone, proximity sensors, etc.
A smartphone is personal and is almost always with a person [7]. This is especially useful when collecting automated data, since the smartphone acts as a wearable device located in the user’s pocket.
Moreover, studies have shown that the quality of the data collected through smartphone-based questionnaires is much higher in comparison to paper-based self-assessments [8]. Paper-based self-assessment requires that patients remember to carry them with them and fill them out, resulting in poor adherence rates, retrospective completion, and memory errors [9]. In contrast, adherence and compliance rates are significantly improved when patients their smartphone since it is always available [8].
Using smartphones for mental health
Many mental disorders are treated through a combination of pharmacotherapy and psychological treatment, such as Cognitive Behavioural Therapy (CBT). The objective of the treatment is to reduce symptoms by ingesting medication and to help patients identify and change their behaviour in a healthy manner.
A smartphone-based solution can provide real-time feedback, it allows individuals to observe their behavioural and disease patterns, and it can also be used as a reminder for medication intake. Moreover, besides having the capability to being used as sensor devices and communication tools. Therefore, remote consultations become feasible; for example, clinicians can communicate with individuals and schedule teleconsultations if needed.
Further, studies have shown that patient adherence rates for smartphone interventions are high. McTavish et al. introduced a smartphone application to support patients with alcohol addiction. 16 weeks after downloading the app, more than 70% of the initial group were still actively using it [10]. Kuhn et al. surveyed perceived helpfulness and satisfaction of post-traumatic stress disorder patients who used a smartphone application as self-management tool for their mental disorder [11]. The results presented were promising but only preliminary.
A recent project called MONARCA focused on bipolar disorder patients and used smartphone sensors as well as additional wearable sensors [12]. The analysis of acceleration data collected with smartphones revealed a correlation between physical activity levels and psychiatric assessment of degree of depression [13].
References:
[1] F.Gravenhorst, A. Muaremi, J. Bardram, A. Grunerbl, O. Mayora, G. Wurzer, M. Frost, V. Osmani, B.Arnrich, P. Lukowicz, G. Troster. Mobile phones as medical devices in mental disorder treatment. 2015.
[2] J. Alonso, M. C. Angermeyer, S. Bernert, R. Bruffaerts,T. Brugha, H. Bryson, G. d. Girolamo, R. d. Graaf, K. Demyttenaere, I. Gasquet, et al. Prevalence of mental disorders in europe: results from the european study of the epidemiology of mental disorders (esemed) project. Acta Psychiatrica Scandinavica, 109(s420):21{27, 2004.
[3] R. C. Kessler, W. T. Chiu, O. Demler, and E. E. Walters. Prevalence, severity, and comorbidity of 12-month dsm-iv disorders in the national comorbidity survey replication. Archives of general psychiatry, 62(6):617{627, 2005.
[4] Y. Conwell and D. Brent. Suicide and aging i: patterns of psychiatric diagnosis. International psychogeriatrics, 7(02):149{164, 1995.
[5] Ericsson AB. Interim ericsson mobility report. February 2014. http://www.ericsson.com/ericsson-mobility-report/.
[6] Gartner. Market share analysis: Mobile phones, worldwide, 2q13, 2013.
[7] A. K. Dey, K. Wac, D. Ferreira, K. Tassini, J.-H. Hong, and J. Ramos. Getting closer: an empirical investigation of the proximity of user to their smart phones. In Proceedings of the ACM International Conference on Ubiquitous computing, UbiComp ’11, pages 163{172, New York, NY, USA, 2011. ACM.
[8] J. E. Bardram, M. Frost, K. Szanto, M. Faurholt-Jepsen, M. Vinberg, and L. V. Kessing. Designing mobile health technology for bipolar disorder: a eld trial of the monarca system. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’13, pages 2627{2636, New York, NY, USA, 2013. ACM.
[9] A. A. Stone, S. Shiman, J. E. Schwartz, J. E. Broderick, and M. R. Huord. Patient non-compliance with paper diaries. BMJ, 324(7347):1193{1194, 5 2002.
[10] F. M. McTavish, M.-Y. Chih, D. Shah, and D. H. Gustafson. How patients recovering from alcoholism use a smartphone intervention. Journal of dual diagnosis, 8(4):294{304, 2012.
[11] E. Kuhn, C. Greene, J. Homan, T. Nguyen, L. Wald, J. Schmidt, K. M. Ramsey, and J. Ruzek. Preliminary evaluation of ptsd coach, a smartphone app for posttraumatic stress symptoms. Military medicine, 179(1):12{18, 2014.
[12] A. Puiatti, S. Mudda, S. Giordano, and O. Mayora. Smartphone-centred wearable sensors network for monitoring patients with bipolar disorder. In Engineering in Medicine and Biology Society, EMBC, 2011 Annual International Conference of the IEEE, pages 3644{3647. IEEE, 2011.
[13] V. Osmani, A. Maxhuni, A. Grunerbl, P. Lukowicz, C. Haring, and O. Mayora. Monitoring activity of patients with bipolar disorder using smart phones. In ACM Proceedings of International Conference on Advances in Mobile Computing and Multimedia (MoMM2013), DOI:10.1145/2536853.2536882, Vienna, Austria, December 2013.
Carer’s Guide to Monsenso
Identifying children’s mental health issues with mHealth technology
The World Innovation Summit for Health (WISH) released a Report on Mental Health and Well-being for children titled “Healthy Young Minds. Transforming the mental health of children.” The information included on this blog post is taken from the report.
The report revealed that half of all mental health problems emerge before individuals reach 18 years old. However, even in developed countries, only 25% receive any specialised treatment. Mental health problems place massive costs on society, since the total cost of mental illness is 3.5 of GDP in Europe. Besides causing direct health care costs, mental illness in youths also causes educational failure, adolescent crime, teenage pregnancy.
Early intervention is fundamental. Parents, doctors and teachers need to become more open and informed, since mental illness is a common part of life. Schools need to prioritise children’s well-being and “life skills” should be added to the teaching curricula alongside mathematics and literature.
It is estimated that 31% of the world’s population is aged under 18, and 10% of them (which is equivalent to 220 million children) suffer from mental illness as it is illustrated in Figure 1.
The costs of mental illness in children are quite considerable. Children with conduct disorder are four times more likely to commit a crime, take drugs, become teenage parents, depend on welfare, and attempt suicide, as it is illustrated in Table 1.
The costs of mental illness in children are quite considerable. Children with conduct disorder are four times more likely to commit a crime, take drugs, become teenage parents, depend on welfare, and attempt suicide, as it is illustrated in Table 1.
The report estimated that in the UK alone, these children may cost in criminal justice, an amount equal to three years’ average wages.
These figures are severe enough by themselves. However, on top of that, at least 50% of the children who experience mental illness during their early years, will suffer from mental illness as an adult. [7] Their lives are more likely to be impoverished and unhappy, and they are much more likely to commit suicide.
The report mentions that these statistics shouldn’t be so high. Nowadays, there are multiple and effective treatments available for children suffering from mental illness. Besides, there is also an enormous opportunity in schools and communities to make significant changes that can reduce the likelihood of the problem in the first place.
Additionally, technology, and mobile health solutions are a huge advantage! Smartphone applications can contribute to monitor and train youths about mental health.
The WISH report encourages local communities and countries to focus on 10 Action Plans to improve the mental health of children around the world.
- Community action: Every local community should implement a child well-being strategy. This plan should include an assessment of the needs of children and families; and the role of healthcare organisations, schools, and non-government organisations.
- Parity of esteem: Mental health care for children and their parents should be widely available.
- Universality: Health professionals should be trained to identify mental health problems in children, perinatal depression in mothers, and they should also be trained to treat these issues.
- Professionals: Countries should train more professionals in evidence-based treatments, especially psychological therapy.
- Well-being in Schools: The well-being of students should be the priority of every school, including the implementation of a Well-being Code of Conduct to which all teachers, parents, and students must adhere to.
- Measurement: Schools should evaluate all student’s well-being on a continuous basis.
- Add life-skills to the teaching curriculum: Schools should use evidence-based methods to provide explicit instruction in life throughout school life, especially in the early years.
- Teacher Training: All teachers should be trained to notice and promote well-being and mental health.
- Use of smartphone technology: Implement a smartphone-based program to promote mental health and well-being of the children.
- The Sustainable development goals: The sustainable development goals should include physical and mental health.
The Monsenso mHealth solution can help facilitate the achievement six of the ten points included in the WISH Action Plan.
- Use of smartphone technology and well-being at schools – The Monsenso smartphone app can help adolescents express any negative feelings they may be experiencing. This information can help care givers identify problems such as depression, anxiety, eating disorders, ADHD or even more severe diagnosis such as bipolar disorder or borderline.
- Measurement – With help from the Monsenso mHealth platform, school personnel can identify if some students present any Triggers or Early Warning signs. Once symptoms are identified in a group of students, care givers can monitor this group closely to ensure they are receiving the support and attention they need.
- Teacher training – The Monsenso web portal is so easy to use that care givers do not require any special training to use the system. However, since they are not trained as mental healthcare specialists, they will need some training to help them interpret the information provided through the self-assessments.
- Parity of esteem – In most countries, there is a lack of resources and the waiting time to schedule an appointment with a mental healthcare specialist can be up to a year. The Monsenso mHealth solution can help school personnel identify the students who are experiencing symptoms of mental illness. Once a student has been monitored for a determined period and the symptoms continue, school personnel can recommend the family to seek professional help.
- Add life-skills to the teaching curriculum – Since all students would be required to fill out the daily self-assessments to evaluate and monitor their mental health well-being, the class dialogue can be facilitated by the information on the system. Teachers can provide students with real, anonymous examples of a person experiencing symptoms. Additionally, students could be encouraged to talk to a school counsellor if they experience any of the symptoms discussed in class. Students could also be taught how to act if they notice any symptoms on their peers.
If you are interested in running a pilot with the Monsenso mHealth solution at your school, please contact us.
Reference:
Healthy Young Minds. Transforming the mental health of children. Report of the WISH Mental Health and Well-being in Children Forum 2015
Using mHealth solutions to improve patient engagement
According to Gartner, in 2015, smartphone sales reached 1.4 billion units [1], and in the first quarter of 2016, they represented 78% of total mobile phone sales. [2]
A new report by the IMS Institute for Healthcare Informatics revealed that there are now more than 165,000 mobile health apps on the market. Nearly two-thirds are focused on general wellness issues like fitness, lifestyle, stress, and diet. The remaining third consists of apps focused on specific health conditions (9%), medication info & reminders (6%), and women’s health & pregnancy (7%). Mental health apps led among disease-specific apps, followed by diabetes. [3]
Nevertheless, with telemedicine, mobile health (mHealth) solutions, and wearable devices, the future of better patient engagement is certainly favourable.
During the last few years, the development of wearable devices that can track heart rate, blood pressure, calories and step-counters have experienced an enormous growth. This type of technology is revolutionising the level of patient engagement by proving individuals with an accessible platform to monitor their progress; information that until now was not available.
Nowadays, patients are increasingly looking for health information online, including their medical records. They request access to information and tools to take control of their health. To make this possible, clinics and patients can use a software platform that allows them to share information with each other while keeping the information safe.
Mental health care is not an exception. Now, more than ever, individuals want to be involved in their treatment. Up until a few years ago, patients with a mental illness, had a very passive role in their treatment. They were required to attend weekly consultations, take their medication every day and report their symptoms to the clinician at their next consultation.
The Monsenso mHealth platform empowers patients suffering from mental and behavioural illnesses, to take control over their illness and play an active role in their treatment.
The Monsenso platform helps individuals and clinicians to monitor the illness symptoms and mood patterns continuously. It also helps them handle their medication, as well as to recognise behavioural trends and early warning signs (EWS). [4]
Based on self-reported and automatically collected sensor data, it provides timely feedback to the patient, therefore, increasing illness awareness. By using it on a daily basis, it provides insights into the illness progression. These types of personal health technologies have the potential to apply machine learning techniques that can monitor and learn to recognise a patient’s circumstances and state and supply personalised context-appropriate clinical responses. [5]
Furthermore, clinicians need truthful information to offer better-quality treatment to their patients and assist in their recovery. Traditionally, psychiatrists provide patients with paper-based self-assessments. However, on a clinical study made with bipolar patients ranging from 18 to 65 years old, the raw adherence percentage of paper-based self-assessment is 58%. [6]
Most of the time, patients forgot to complete these assessments, and most people filled them out while sitting in the waiting room. This process generates a problem since most individuals couldn’t remember with certainty how they have felt since their last appointment.
Besides, clinicians may become distracted with paper-based self-assessments during the consultation. At the same time, they are required to interpret the self-assessments and enquire about the patient’s wellbeing. Likewise, once the consultation is over, the self-assessments are probably stored in a patient’s file and seldom retrieved.
On the other hand, recent research shows that the adherence rate of self-assessments when using the Monsenso smartphone app is 88% [7], making it a more reliable source of information.
The Monsenso system is much more than an mHealth platform; it is a personal technology solution that simplifies the continuous monitoring of critical patients, provides a historical overview of a patient’s condition and underlying behaviour. Furthermore, it also offers patients a list of self-help tools facilitating patient engagement and empowering them to become self-aware.
For example, improving illness awareness is vital to the treatment of individuals suffering from bipolar disorder. It is critical that patients monitor their mood and have a good action plan that helps them cope with their risk situations; this helps patients to manage their illness [7].
During the last few years, we have witnessed the development of wearable devices, mHealth solutions, and personalized medicine. Once mental health care providers widely adopt this technology, it will enable them to improve patient engagement. MHealth solutions like the one offered by Monsenso, allow clinicians to provide better-quality treatment based on accurate, real-time data.
The smartphone self-assessments helps patients become more aware of their condition as it helps them identify and learn more about their personal triggers and early warning signs. Furthermore, the information collected by the smartphones facilitates and speeds up the dialog between patients since symptoms and early warning signs can be discussed immediately.
References:
[1] Gartner Says Worldwide Smartphone Sales Grew 9.7 Percent in Fourth Quarter of 2015. Gartner. (2016, February 18)
http://www.gartner.com/newsroom/id/3215217
[2] Gartner Says Worldwide Smartphone Sales Grew 3.9 Percent in First Quarter of 2016. Gartner. (2016, May 19)
http://www.gartner.com/newsroom/id/3323017
[3] New report finds more than 165,000 mobile health apps now available, takes a close look at characteristics & use. Satish Misra, MD. iMedicalapps. (2015, September 17) http://www.imedicalapps.com/2015/09/ims-health-apps-report/
[4] The MONARCA a Self-assessment System: A Persuasive Personal Monitoring System for Bipolar Patients. J. E. Bardram, M. Frost, K. Sz´ant´o, G. Marcu, in: Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, IHI ’12, ACM, New York, NY, USA, 2012, pp. 21–30. doi:10.1145/2110363.2110370.
[5] Supporting Disease Insight through Data Analysis: Refinements of the MONARCA Self-assessment System. M. Frost, A. Doryab, M. Faurholt-Jepsen, L. V. Kessing, J. E. Bardram. Proceedings of the 2013 ACM international joint conference on Pervasive and ubiquitous computing, UbiComp ’13, ACM, New York, NY, USA, 2013, pp. 133–142. doi:10.1145/2493432.2493507. URL http://doi.acm.org/10.1145/2493432.2493507
[6] Designing Mobile Health Technology for Bipolar Disorder: A Field Trial of the MONARCA System. Bardram, Jakob E., Frost, Mads, Szántó, Károly, Faurholt-Jepsen, Maria, Vinberg, Maj and Kessing, Lars Vedel. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, pages 2627-2636, New York, NY, USA, 2013.
[7] Increasing Awareness, Insight and Adherence in Treatment of Bipolar Disorder through Personal Health Technology: Pilot Study. Mads Frost, Maria Faurholt-Jepsen, Afsaneh Doryab, Lars Vedel Kessing and Jakob E Bardram. Paper submitted for review to JMIR Mental Health (JMH), 2015.