Digital Psychiatry: 7 Trends in to Watch in 2019

From Cambridge Analytica exposing millions of users’ personal Facebook data to a medical appointment booking app selling patient’s personal information to lawyers, 2018 was not a bright year for digital privacy. But as the public becomes more informed on how much identifiable data smartphones app can capture, especially from GPS, they are becoming more careful. In 2019 we can expect a focus on privacy with patients, clinicians, and policy makers all demanding more transparency and protection for app data. Ethics will finally receive due attention.  Hopefully those ‘free’ apps where the hidden cost is your personal health data will fade into history.

While the evidence for app based mental health interventions remains nascent, there is a push to begin marketing apps as therapeutics. Using language similar to that for medications, companies will attempt a new approach to selling apps in 2019 with a more medical approach. The real world evidence on how these app and technologies help (or harm) patients will determine the true success of digital therapeutics. As these apps and programs (expect a FDA approved video game for ADHD soon!) are used ‘in the wild’ and outside of a controlled clinical study-the results will be interesting to follow.

While there are a myriad of digital mental health studies examining various apps and sensors, most are actually feasibility studies. In 2019 the field will move beyond feasibility and begin to demand higher quality studies that have an appropriate control group to compare results to – what can be termed a digital placebo. One 2018 example featured the popular app HeadSpace and suggested that when compared with a placebo version, some apps may appear less effective. Again, the 2019 research will tell us the final verdict on the role of the digital placebo effect. And perhaps we will learn to harness it for good, making apps more effective mental health tools.

In 2018 the FDA’s Digital Health Software Precertification (Pre-Cert) Program progressed with pilot partners (eg Apple, Google, and others) testing the waters. The Pre-Cert program seeks to introduce a new regulatory model for digital health software like smartphone apps. In 2019, we can expect the FDA to seek to expand the program and continue to gather data from the public. The process may not be smooth as we near the end of 2018. Several senators raised questions about Pre-Cert, reflecting that the process may become more political and in the news next year.

While many mental health apps today are created in high income countries – interest in digital mental health continues to expand in both low- and middle-income countries. In 2019 we will see new regions of the world experiment with digital mental health, seeking to leapfrog brick and mortar clinics and deliver digital care to populations in need. In 2018 impressive digital health efforts already active in countries like India, will now continue to expand and flourish in the next year.

While 2018 saw increased interesting in chatbots as means to offer easy access to therapy, the evidence for both the safety and effectiveness was lacking. In the coming yearm we can expect to see continued interest, but now matched with higher quality clinical studies. The fate of chatbots as useful clinical tools or a passing fad will likely be determined by the end of next year. With recent improvement in natural language processing, chatbots can only improve and should not be underestimated in 2019-or judged by their 2018 functionality.

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; and Digital Psychiatry Editor for Psychiatric Times. Twitter: @JohnTorousMD.