Digital Mental Health: How to Engage With Innovation, Part 1

How safe and effective are mental health apps? What’s the impact of social media on youth? Insights here from presenters at APA 2019.

Digital mental health was a popular topic at this year’s American Psychiatric Association (APA) Annual Meeting. Over a dozen sessions focused on new technologies ranging from smartphone apps to voice analytics, virtual reality to social media. While it was impossible to attend every session, we asked the presenters from one session to share some in-depth comments and thoughts with the readers of Psychiatric Times. Their session was entitled “Revitalizing Psychiatry Through Engaging with Innovation to Increase Access and Inclusion with Care.”

In the first article of this two-part series, the presenters discuss social media use for youth, and app privacy and efficacy claims that clinicians and patients must evaluate daily. Topics that will be covered in Part 2 are voice analytics for detecting and monitoring mood, and smartphone and web-based passive data as a digital biomarker for mental health disorders.

Dr Bridianne O’Dea addresses “Does Social Media Impact Mental Health in Youth?”

Social media has become ubiquitous among young people, with up to 85% of those aged 12 to 17 years using one or more platforms.1 YouTube, Instagram, Snapchat, and Facebook are the most popular social media platforms among Western teens. As young people have quickly adapted to sharing their life online, parents have become increasingly concerned about problematic use. Teens who report that social media has a positive impact on their lives favor its ability to connect and stay in contact with others, to provide entertainment, and to increase the ease of finding news and information. However, many teens admit to concerns about bullying, relationship damage, unrealistic nature of online sharing, and time wasting. These concerns are echoed by parents who report being more concerned about their child’s technology use than drugs and alcohol.2

While many studies have examined the associations between mental health outcomes and social media use, followed by systematic reviews and meta-analyses, results remain inconclusive. Most studies are cross-sectional, with only small effect sizes found. Despite an unclear causal link between social media and poor mental health, clinicians and parents have found themselves needing to address problematic use among youth. While there are no clear diagnostic frameworks, clinicians are encouraged to examine the domains of excessive use, withdrawal symptoms, tolerance, and negative repercussions. Identifying any underlying mental illness is key. A range of self-report measures have been developed to assist in the measurement of problematic Internet and technology use.

Although no gold-standard treatments exist, cognitive-behavioral therapy adapted for Internet use has shown some promise among adults.3 Ultimately, clinicians and parents are encouraged to implement strategies that include behaviour modification (ie, non-screen time), cognitive restructuring (ie, challenging negative thoughts associated with use), and harm reduction to address co-morbidities. Parents are encouraged to promote self-regulation and autonomy, model the behaviors they wish to see in their children, and create regular time for open and honest discussions about online activities with their children. Learn more at: https://research.unsw.edu.au/people/dr-bridianne-odea

"Is That Mental Health App Safe and Effective?" >>Dr Mark Larsen addresses “Is That Mental Health App Safe and Effective?”

More than 10,000 mental health apps may be available for immediate download today, but what do we know about their safety and effectiveness? In a recent study, we intercepted the traffic from mental health smartphone apps and found that over 50% are sending data to destinations not disclosed in the privacy policy.4 In essence an app may promise not to send or share data-but it seems the majority are not keeping their word. This does not mean we should not use mental health apps but rather that caution should be exercised, especially if the app comes from a source or developer you do not recognize and trust.

Many apps are making claims on the app store that tout how effective their app is. We explored the veracity of these claims by comparing what the app is telling consumers and what has been studied and published in the peer-reviewed literature. We found that while many apps make claims, fewer than 2% can back up those claims with actual evidence using their app.5 One point to be aware of is that many apps say they are designed with “evidence-based CBT” but fail to show how well that evidence-based, derived from face-to-face interaction, translates directly into the app in question.

The takeaway lesson is that there are good apps out there, but if you rely on chance, you may not find a great one. One useful tool to consider that takes in account these concerns about privacy and evidence is the APA app evaluation model, which you can access here: https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app-evaluation-model. To learn more about Dr Mark Larsen’s work, please visit https://research.unsw.edu.au/people/dr-mark-larsen

For more presentations, please see "Digital Mental Health: How to Engage With Innovation, Part 2."

Dr Torous is Director of the Digital Psychiatry Division, Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston; Editor in Chief of JMIR Mental Health; Web Editor of JAMA Psychiatry; and Digital Psychiatry Editor for Psychiatric Times. Twitter: @JohnTorousMD. Dr O’Dea and Dr Larsen are Research Fellows at the Black Dog Institute at UNSW Sydney (University of New South Wales) in Australia.

References:

1. Jiang J. Millennials stand out for their technology use, but older generations also embrace digital life. Pew Research Center. https://www.pewresearch.org/fact-tank/2018/05/02/millennials-stand-out-for-their-technology-use-but-older-generations-also-embrace-digital-life/ May 2, 2018. Accessed May 28, 2019.

2. ReachOut Parents. ReachOut.com. https://parents.au.reachout.com/ Accessed May 28, 2019.

3. Young KS. Treatment outcomes using CBT-IA with Internet-addicted patients. J Behav Addict. 2013;2:209-215. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154573/ Accessed May 28, 2019.

4. Huckvale K, Torous J, Larsen ME. Assessment of the data sharing and privacy practices of smartphone apps for depression and smoking cessation. JAMA Netw Open. 2019;2:e192542. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730782 Accessed May 28, 2019.

5. Larsen ME, Huckvale K, Nicholas J, et al. Using science to sell apps: evaluation of mental health app store quality claims. Npj Digital Medicine. 2019;2:18. https://www.nature.com/articles/s41746-019-0093-1 Accessed May 28, 2019.