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Smartphones as data-collection tools for mental health

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.

Internet addiction, a new behavioural disorder

Internet addiction, a new behavioural disorder

The Internet has made our lives easier in many ways, for example it provides easy access to information and entertainment. However, when used too much, it can cause depression, obsession, anxiety and even isolation, which are all symptoms of Internet addiction. [1]

Internet addiction is described as an impulse control disorder, which includes the overuse of the Internet in every form: social media, video games, messenger, video websites, and blogs. Even though this disorder does not involve the use of an intoxicating drug, it is very similar to pathological gambling. [2]

Although studies show that more than 160 million Americans are regular Internet users, little research has been conducted on problematic Internet use. A  Centre for Internet Studies survey of 18,000 Internet users did find however that 5.7% of the sample met suggested criteria for “compulsive” Internet use. And a 2002 study in the journal CyberPsychology & Behaviour found that 60% of companies surveyed had disciplined, and more than 30% had terminated, employees for inappropriate Internet use. [3]

According to Elias Aboujaoude, a clinical assistant professor in psychiatry and behavioural sciences and director of Stanford’s Impulse Control Disorders Clinic, a small but growing number of Internet users are starting to visit their doctors for help with unhealthy attachments to cyberspace. The issue is starting to be recognized as a legitimate object of clinical attention, as well as an economic problem, given that a great deal of non-essential Internet use takes place at work. However, there is little consensus among clinicians on whether problematic Internet use is a distinct disorder or merely an expression of other psychopathologies, such as depression or obsessive-compulsive disorder.[3]

In a Stanford study, researchers conducted a nationwide household survey and interviewed 2,513 adults. Since there isn’t a generally accepted screening instrument for problematic Internet use, the researchers developed their questions by extrapolating from other compulsive and addictive conditions. [3]

The research revealed the following:

  • 68.9% were regular Internet user
  • 13.7% (more than one out of eight respondents) found it hard to stay away from the Internet for several days at a time
  • 12.4% stayed online longer than intended very often or often
  • 12.3% had seen a need to cut back on Internet use at some point
  • 8.7% attempted to conceal nonessential Internet use from family, friends and employers
  • 8.2% used the Internet as a way to escape problems or relieve negative mood
  • 5.9% felt their relationships suffered because of excessive Internet use [3]

Professor Aboujaoude stated that he found most concerning the numbers of people who hid their non-essential Internet use or used the Internet to escape a negative mood, much in the same way that alcoholics might. In a sense, “they’re using the Internet to ‘self-medicate,” he said. “And obviously something is wrong when people go out of their way to hide their Internet activity.” [3]

Internet or computer addictions manifest in several ways:

  • Information overload → Excessive online surfing leads to decreased productivity at work and fewer interactions with family members
  • Compulsions → Unbalanced time spent in online activities such as gaming, trading of stocks, gambling and even auctions often leads to overspending and problems at work
  • Cybersex addiction → Excessive surfing of porn sites often affects real-life relationships
  • Cyber-relationship addiction → Extreme use of social networking sites to create relationships rather than spending time with family or friends may destroy real-life relationships [2]

Causes of Internet addiction:

In addition to high exposure to technology, there are many other reasons why a person can become an Internet addict. For example, people suffering from anxiety and depression can have the predisposition to have an Internet addiction; their lack of emotional support makes them turn to the Internet to fill this need.

Another example is people who are overly shy, suffer from low self-esteem, have feelings of inadequacy, a fear of disapproval, and can’t seem to be able to build relationships with their peers. These people, as a consequence, end up relying on the Internet for comfort and to create fake personas as an image of who they would like to be.

Warning signs:

  • Excessive preoccupation with the Internet
  • Use of the Internet in increasing amounts of time in order to achieve satisfaction
  • Repeated, unsuccessful efforts to control, cut back or stop Internet use
  • Feelings of restlessness, moodiness, depression, or irritability when attempting to cut down the use of the Internet
  • Jeopardized or risked loss of significant relationships, job, educational or career opportunities because of Internet use
  • Lies to family members, therapists, or others to conceal the extent of involvement with the Internet
  • Use of the Internet is a way to escape from problems or feelings of hopelessness, guilt, anxiety and depression [2]

When talking to an Internet addict, friends and family members should listen without criticizing or interrupting, even when they don’t agree with the person’s behaviour. They should try to understand the addiction from the addict’s point of view.

Helping a friend or relative with a computer or internet addiction

  • Introduce the Internet addict to other people who handle their use of the Internet reasonably
  • Serve as a good role model for the Internet addict by properly managing your own use of computers and the Internet
  • Support a person’s desire for change if it appears that he or she is an Internet addict
  • Talk to the person about your concerns that he or she may be an Internet addict
  • Get the person involved in interests that aren’t related to the Internet
  • Encourage an Internet addict to seek professional counselling  [4]

Children and teenagers

Parents can help their child stay away from the computer by exposing them to social activities such as team sports. In addition to this, they should try to identify if the child is using the Internet to deal with stress or anxiety.

In the case of adolescents, it is important to get an external authority figure to provide advice on Internet and computer usage, since adolescents often reject advice from their parents.

As a general rule, parents should set the example; therefore, it is very important that they follow the same limits on Internet usage that they set for their child.

How to help a young person with an Internet addiction:

  • Serve as a good role model for the Internet addict by properly managing your own use of computers and the Internet
  • Encourage other interests and social activities
  • Talk to your child about underlying issues
  • Monitor computer use and set clear limits
  • Seek professional counselling if necessary [4]

References
[1] Computer/Internet Addiction Symptoms, Causes and Effects. Psych Guidelines
http://www.psychguides.com/guides/computerinternet-addiction-symptoms-causes-and-effects/


[2] What is Internet addiction? Unity Point Health.
http://www.addictionrecov.org/Addictions/index.aspx?AID=43


[3] Internet addiction: Too much of a good thing?  Stanford News. M Brandt. 18 October 2006.
http://news.stanford.edu/news/2006/october18/med-internet-101806.html 

[4] Steps you can take to help someone with a computer or Internet addiction. Psych Guidelines
http://www.psychguides.com/guides/getting-help-for-an-internet-addiction/

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