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Wearable Devices for Mental Health: Knowns and Unknowns

Wearable Devices for Mental Health: Knowns and Unknowns

Significance for the Practicing PsychiatristSignificance for the Practicing Psychiatrist

Today’s ubiquitous fitness trackers come in a variety of forms—most contain an accelerometer to measure movement and use that information to estimate steps taken and calories burned. Many devices now include other sensors, such as a heart rate sensor, a sleep tracker, a skin conductance sensor, a light sensor, and more. Smartwatches often contain numerous sensors like those in fitness trackers but combine more computing power and connection capabilities. Many smartwatches can send and receive digital messages and download apps. Regardless of the device, all wearables collect personal data on health indicators that they share with the user.

Can a wearable device improve mental health outcomes?

The potential of wearable devices for health in general and mental health in particular is broad. Berra and colleagues1 stated “regular physical activity is one of the most powerful health promoting practices that physicians and other health care professionals can recommend for patients.” Anything that can help mental health patients partake in more physical activity will have tremendous benefits.

Combined with the strong evidence for the effectiveness of physical activity in ameliorating numerous psychiatric symptoms, the potential of wearable devices to help patients with mental illness be more active is exciting. Patients with serious mental illness have an obesity rate twice that of the general population and, on average, their life expectancy is 10 to 25 years shorter than that of the general public.2 This early mortality largely results from chronic medical conditions such as diabetes, cardiovascular disease, and hypertension. Devices that can increase physical activity will have a positive impact and may help patients live longer.

The potential to gather real-time physiological data from fitness trackers, with the addition of symptom surveys from smartwatches, is powerful. There is increasing interest in using real-time patient data as biomarkers of illness. The concept of “digital phenotyping” may help redefine how we diagnose, monitor, and treat mental illness.3 Real-time patient data can serve as an objective marker of condition severity and treatment response.

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It is also easy to imagine how wearable devices might offer medication reminders to patients; encourage and nudge patients toward healthy habits; and even provide adjunctive coaching to help with sleep, exercise, and fitness. The ability of smartwatches, and some fitness trackers as well, to offer real-time feedback and reminders may help with treatment adherence. Moreover, many of these devices include social features that allow users to form or connect in groups and begin fitness partnerships or challenges.

Will patients with mental illness want to use wearable devices?

Early evidence suggests that wearables can be used successfully across many diverse populations. A study sponsored by AARP suggests that older adults are interested in wearable devices: 25% of activity trackers are owned by those aged 55 years or older. In this study, 77% of participants found activity trackers useful and 45% reported that they increased motivation for healthier living.4

Depression, bipolar disorder, and schizophrenia don’t seem to be barriers to wearable device use either. A small study of 10 subjects (6 with depression, 1 with bipolar disorder, and 3 with schizophrenia) demonstrated that adherence to wearable devices was high (89%) and that all participants reported high satisfaction with the devices for help with motivation, goal setting, social connectivity, self-monitoring, and ease of use.2

CASE VIGNETTE

“Do you think using a wearable fitness tracker will help with my symptoms and medication side effects?” Alex is a 35-year-old man who received a diagnosis of schizophrenia at age 24. After several medication trials, his symptoms are now well controlled with an antipsychotic. Although he still experiences subtle cognitive deficits, weight gain is his chief concern today. Despite many attempts to eat healthy and lose weight, he feels stuck and asks if his psychiatrist recommends that he get a wearable device—and if so, which one is best.

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