Technology in Psychiatry: 10 Things to Know About Mobile Mental Health

1.Not a New Idea

In a 1992 paper titled “Use of mobile phones in the behavioral treatment of driving phobias,” subjects used mobile phones while driving to talk to their therapists. Both technology and rules about driving while using a phone have changed 23 years later! Source: Flynn TM et al. Use of mobile phones in the behavioral treatment of driving phobias. J Behav Ther Exp Psychiatry. 1992;23:299-302

2. Rapid Adoption of Smartphones

Mobile phones are the most quickly adopted consumer technology in human history Smartphone ownership prevalence in the US continues to rapidly rise each year. Only 35% owned a smartphone in 2011, but by late 2014 the figure rose to 58% Source: How the internet has woven itself into American life. Pew Internet; 2014

3. Patient Ownership and Interest Psychiatric patients also own smartphones at high rates and are interested in using them to monitor their mental health

Ownership, by age group, from a survey study of 320 patients is shown on the right Source: Torous J et al. Patient smartphone ownership and interest in mobile apps to monitor symptoms of mental health conditions: a survey in four geographically distinct psychiatric clinics. JMIR Mental Health. 2014;1:e5

4. Many Commercial Apps There are over 40,000 health and fitness apps available on commercial marketplaces like Apple iTunes or Android Google Play Store While there are no official counts, there are thousands of apps that target psychiatric conditions Source: Powell AC et al. In search of a few good apps. JAMA. 2014;311:1851-8152

5. Limited Clinical Research In contrast to the commercial space, there is less clinical research on smartphone apps for psychiatry. For bipolar disorder and depression, one review found less than 15 published studies1

This is concerning as apps can have unintended adverse effects, such as one found to actually increase rates of alcohol consumption2 1. 2.

Torous J et al. A Review of Smartphone Apps for Bipolar and Major Depressive Disorders. Internet Interventions. 2015;2:169-173 Gajecki M et al. Mobile phone brief intervention applications for risky alcohol use among university students: a randomized controlled study. Addict Sci Clin Pract. 2014;9:11

6. Passive Data Is the New Frontier There is growing interest in using smartphones to collect passive data from psychiatric patients Passive data is information the phone collects, such as GPS, call logs, and voice. It is hypothesized to be more objective data Many questions remain about the privacy, ethics, and clinical utility of such data at this point

7. Big Data and Psychiatry Smartphones can collect so much information (also known as “big data”) that we need computers and statistical models to help us analyze it The three V’s of big data include 1) Velocity, 2) Volume, 3) Variety. Smartphones can already collect high volume, velocity, and variety related data Source: Torous J et al. Realizing the potential of mobile mental health: new methods for new data in psychiatry. Curr Psychiatry Rep. 2015;17:602

8. Picking an App It can be hard to identify safe, high-quality, and effective psychiatric apps Current app rating sites that may be useful include:

•PsyberGuide •Anxiety and Depression Association of America: Mobile Apps •Health Apps Library [No endorsement implied]

9. Beyond Smartphones As fitness trackers and smart watches become popular, will these become the new frontier of mobile mental health? Currently there is a lack data on the clinical utility of these technologies for psychiatry

10. Moving Forward It is important that psychiatrists remain aware of and up to date on these technologies to ensure they are designed and used in a safe, ethical, professional, and effective manner Just as with new drug development, we need to ask about clinical evidence and consider who is funding studies

About the Author: Dr Torous is a clinical fellow in psychiatry at Harvard Medical School and senior resident at the Harvard Longwood Psychiatry Residency Training Program in Boston. He chairs the Smartphone App Task Force for the American Psychiatric Association, has developed psychiatry-related smartphone apps for research, and published several research papers on the topic. Dr Torous was a recipient of the Outstanding Resident Award from the National Institute of Mental Health and will be leading a session on mobile mental health at the upcoming Institute of Psychiatric Services meeting in the Fall. Dr Torous reports no conflicts of interest concerning the subject matter of this article. Twitter: @JohnTorousMD