Smartphones in mental health: a critical review of background issues, current status and future concerns

Bauer, Michael; Glenn, Tasha; Geddes, John; Gitlin, Michael; Grof, Paul; Kessing, Lars Vedel; Monteith, Scott; Faurholt‐Jepsen, Maria; Severus, Emanuel; Whybrow, Peter C.

doi:10.1186/s40345-019-0164-x

Cited by 118 publications

(60 citation statements)

References 161 publications

(143 reference statements)

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“…Psychiatrists need to understand the risks, benefits, and limitations of technology products (Bauer et al 2020 , 2019; Monteith and Glenn 2019 ; Monteith et al 2016 ), to purchase or recommend products from vendors who provide algorithm transparency (IEEE 2019 ; ACM 2018 ), and to understand standard security practices to protect themselves and their patients. Importantly, psychiatrists should understand the limitations of their knowledge and skills, when to ask for assistance, and how to select and hire competent technology and cybersecurity consultants.…”

Section: Discussionmentioning

confidence: 99%

“…With many younger psychiatrists completing the survey, the results are not well suited for analysis of age-related impacts. The survey did not investigate the features, usability, or efficacy of any specific product such as an EMR or patient smartphone app (Melnick et al 2019 , Bauer et al 2020 ). The many challenges associated with automating clinical psychiatry, such as the impacts on physician workflow, multitasking, automation complacency and bias, data quality and algorithm bias, and patient stigma were not discussed (Bauer et al 2017 , 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…The survey focused on psychiatrists that treat patients with bipolar disorder, as patients with bipolar disorder use the Internet with the same frequency as the general public, and over 3/4 seek information on bipolar disorder online (Bauer et al 2016 ; Conell et al 2016 ). Additionally, new technology tools are often thought to be well suited for collecting and analyzing patient data from patients with bipolar disorder (Bauer et al 2020 ; Monteith et al 2016 ). This survey collected information on the types of products and communications routinely used in clinical practice, the products and websites routinely recommended to patients with bipolar disorder, the technical background of psychiatrists, and general attitudes towards the use of technology.…”

Section: Introductionmentioning

confidence: 99%

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Survey of psychiatrist use of digital technology in clinical practice

Bauer

Glenn²,

Monteith

et al. 2020

Int J Bipolar Disord

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Background Psychiatrists were surveyed to obtain an overview of how they currently use technology in clinical practice, with a focus on psychiatrists who treat patients with bipolar disorder. Methods Data were obtained using an online-only survey containing 46 questions, completed by a convenience sample of 209 psychiatrists in 19 countries. Descriptive statistics, and analyses of linear associations and to remove country heterogeneity were calculated. Results Virtually all psychiatrists seek information online with many benefits, but some experience information overload. 75.2% of psychiatrists use an EMR/EHR at work, and 64.6% communicate with patients using a new technology, primarily email (48.8%). 66.0% do not ask patients if they use the Internet in relation to bipolar disorder. 67.3% of psychiatrists feel it is too early to tell if patient online information seeking about bipolar disorder is improving the quality of care. 66.3% of psychiatrists think technology-based treatments will improve the quality of care for some or many patients. However, 60.0% of psychiatrists do not recommend technology-based treatments to patients, and those who recommend select a variety of treatments. Psychiatrists use technology more frequently when the patients live in urban rather than rural or suburban areas. Only 23.9% of psychiatrists have any formal training in technology. Conclusions Digital technology is routinely used by psychiatrists in clinical practice. There is near unanimous agreement about the benefits of psychiatrist online information-seeking, but research on information overload is needed. There is less agreement about the appropriate use of other clinical technologies, especially those involving patients. It is too early to tell if technology-based treatments or patient Internet activities will improve the quality of care. The digital divide remains between use of technology for psychiatrists with patients living in urban and rural or suburban areas. Psychiatrists need more formal training in technology to understand risks, benefits and limitations of clinical products.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survey of psychiatrist use of digital technology in clinical practice

Bauer

Glenn²,

Monteith

et al. 2020

Int J Bipolar Disord

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“…The copyright holder for this preprint this version posted November 5, 2020. ; https://doi.org/10.1101/2020.11.04.20225730 doi: medRxiv preprint Generally, the overall achieved participation durations can be estimated as relatively long, taking into account that financial compensation was humble and considering that low retention rates in app usage are well documented (Bauer et al, 2020). A study investigating smartphone-based symptom self-reports in 126 depressed adults found that approximately 50% of users removed the app within the first two weeks of the study which appears to match the observed reduction in participation rates over time (Wahle, Kowatsch, Fleisch, Rufer, & Weidt, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…due to depressive symptomatology). (Bardram & Matic, 2020;Bauer et al, 2020;Cornet & Holden, 2018;Dogan et al, 2017), thus making our sample by far the largest. This increases the generalizability of our findings.…”

Section: Discussionmentioning

confidence: 99%

Technical feasibility and acceptance of the Remote Monitoring Application in Psychiatry (ReMAP)

Emden

Goltermann

Dannlowski

et al. 2020

Preprint

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Background: Over recent years smartphone-based monitoring has been recognized as a useful instrument in psychiatric research. Due to the phasic character of affective symptoms, mobile assessments of passive sensor data as well as active self-reported data via the participants smartphone might represent a cost-efficient and highly useful tool for prospective prediction of mood changes. Despite these promising opportunities, smartphone-based monitoring in psychiatry is still limited to pilot studies often focusing on a single disorder while large-scale, transdiagnostic studies are widely absent. Objectives: The present paper describes the functionality and development of the Remote Monitoring Application in Psychiatry (ReMAP). We aimed to investigate the technical feasibility, and the acceptance of the ReMAP app for the continuous assessment of affective symptoms among different patient groups. Methods: The ReMAP app was distributed among a sample of n=997 composed of healthy control participants and psychiatric patients. Continuous passive sensor data were assessed comprising acceleration, geolocation, as well as walking distance and steps. Further, participants optionally provided standardized self-reports on mood and sleep, as well as voice samples. Technical feasibility and acceptance were assessed based on the amount and frequency of transferred data events, as well as participation duration. Preliminary results are presented while data collection is ongoing. Results: Retention rates of 90.25% for the required minimum study duration of two weeks and 33.09% for one year respectively were achieved. On average, users participated for 150 days. An average of 51.83 passive events per day per participant was collected, with an average rate of 73.50% of days during participation containing passive events. An average of 34.59 active self-report events were transferred per participant, with a considerable range across participants (0-552 events). While clinical and non-clinical participant subgroups did not differ in participation duration, or in quantity or rate of passive or active data transfer, the rate of days with transferred passive data was considerably higher and less heterogeneous in iOS (mean=91.85%, SD=21.25) as compared to Android users (mean=63.04%, SD=35.09). Conclusions: The ReMAP app is technically feasible and generally well accepted and therefore represents a viable complementary tool for the continuous assessment of affective symptoms in large-scale transdiagnostic psychiatric studies. Future studies should account for the observed systematic differences between operating systems.

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Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

et al. 2022

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Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.

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Smartphones in mental health: a critical review of background issues, current status and future concerns

Cited by 118 publications

References 161 publications

Survey of psychiatrist use of digital technology in clinical practice

Survey of psychiatrist use of digital technology in clinical practice

Technical feasibility and acceptance of the Remote Monitoring Application in Psychiatry (ReMAP)

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

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