As the prevalence of mental illnesses such as depression and anxiety continues to increase, doctors have turned to mobile applications to assist with treating their patients.
Director of the mHealth Competence Centre at Mobile World Capital Barcelona
One in every four people worldwide will be affected by mental or neurological disorders at some point in their lives. Around 450 million people are currently suffering from these conditions, meaning that mental disorders are amongst the main causes of illness and incapacity worldwide (1).
According to the OECD, "mental disorders represent one of the categories with the highest growth in both numbers and costs that healthcare organisations have to cope with, often representing a more significant burden than cardiovascular disease and cancer". It is estimated that mental health disorders could cost the world economy 16,100 million dollars over the next 20 years (3).
Treatments are available, but almost two thirds of those with known mental disorders either do not seek or cannot afford assistance from a medical professional. Stigma, discrimination and neglect impede care, prevention and treatment getting to people with mental disorders, according to the World Health Organisation (WHO). Where there is negligence there is little or no understanding. Where there is no understanding, there is negligence.
Michel Foucault, in his ‘History of Madness’ (2), analysing the stigma of people who suffer from mental disorders, put forward the theory that leprosy in the 15th century was followed by venereal disease. Both of them conferred isolation on the sick person and, progressively, madness joined the list of diseases that required a physical and moral exclusion space. A torturous, winding road which, in one way or another, still has an impact on today’s society. Mental illnesses, addictions and neurological disorders continue to exist in a haze of stigma and incomprehension.
Mental health is determined by a number of socioeconomic, biological and environmental factors. The idea that madness was fundamentally different from other illnesses and that it was an illness more in the mind than in the body, only developed at the end of the 18th century. This was doubtless due to Cartesian dualism, the dominant philosophical influence of the age, but medical opinion and medical impotence also played a crucial role. There is a debate as to why even to this day we separate the mind from the body, when in reality there is no ‘disease’ as such but rather people suffering from an illness. Whatever the case, most mental illnesses are unique, and require personalised care. The truth is that people suffering from depression or anxiety attacks have to confront their situation on a daily basis, which is generally inseparable from their family and social circle. Clinical intervention is sporadic and patients, or sometimes their families, have to manage the day-to-day consequences.
With digital transformation and the arrival of smartphones and tablets, new opportunities are opening up for citizens/patients to manage and care for their own health. It is necessary to distinguish between preventative apps and apps linked to a specific illness. Apps range from those that focus on how to breathe properly, relax, meditate or interpret our mood to those dealing with an anxiety attack, coping with depression of overcoming thoughts of suicide.
"A large body of clinical investigation shows that web and telephone-based apps are able to treat depression and anxiety", writes David C. Mohr (4), in the New York Times. "To be effective, behavioural intervention technologies (BITs) require repeated use over a number of weeks - which is an obstacle in that many sufferers of depression and anxiety have problems in maintaining their dedication to the time necessary to achieve significant improvements".
And he adds "The symptoms of depression can vary greatly between people and is made even more complex by other comorbid psychiatric conditions... Sometimes, worsening depression can cause cognitive changes that mean sufferers are not entirely aware of the extent of their illness or its symptoms".
As the prevalence of mental illnesses such as depression and anxiety continues to increase, doctors have turned to mobile applications as tools to assist with treating their patients. These apps can be especially useful for teenagers and young adults suffering from mental illnesses thanks to their skills in using technology as a means of communication.
Applications can be useful as a way of engaging people who are unwilling or unable to take part on face-to-face therapy, and they can also supply support between sessions. Experts believe that these apps work best when used in conjunction with drug therapy or face-to-face sessions.
Enter 'depression' in Apple’s App Store and a list of at least a hundred apps appear on the screen. There are applications that diagnose depression, monitor moods and help people to 'think more positively'. There are also therapies based on hypnosis to cope with depression and dozens more. And that is just for depression. There are apps directed at those fighting anxiety, schizophrenia, post-traumatic stress disorder (PTSD), eating disorders and additions (5).
Passive patient data that can be obtained from sensors and information about their activities can provide a great variety of information to give us a greater understanding about mental illnesses. It is probable that, at best, the patient’s therapy or monitoring sessions do not total more than two hours a month; with mobile technologies, not only can patients improve their situation but they can provide their doctor with valuable data for their course of therapy.
In the same way that neurobiological data complements professional practice but does not replace professional experience and skills, data obtained from smartphones can assist in making better clinical decisions. (6)
Nevertheless, there are still a number of issues to bear in mind.
- If data protection is essential for general healthcare it is all the more so in the case of mental health. There needs to be a guarantee that the transmission of data between the patient and the professional and vice versa complies with the established rules on security.
- The majority of apps available do not have clinical approval, and few have any validation for their impact on the client, in other words its effectiveness.
- There is also a gap in medical staff’s knowledge and training that may impede them from prescribing or recommending particular mobile apps or solutions.
These issues, far from being an obstacle, are an incentive to discover an appropriate validation model, undertake more research on their impact (effectiveness), promote knowledge and best practices amongst healthcare professionals and give confidence to patients and their families.
Fig 1. Absolute DALYs Attributable to Mental, Neurological, and Substance Use Disorders, by Age, 2010 (8)
(2) Historia de la locura en la época clásica (Madness and Civilization: A History of Insanity in the Age of Reason). Michel Foucault. Fondo de Cultura Economica. 2006
(4) David C. Mohr, Professor of Preventative Medicine and of Behaviour, is the Director of the Center for Behavioral Intervention Technologies at Northwestern University. Article in the New York Times http://nyti.ms/1qSRjJI
(6) Donker, T., Petrie, K., Proudfoot, J., Clarke, J., Birch, M. R., & Christensen, H. (2013). Smartphones for smarter delivery of mental health programs: A systematic review. Journal of Medical Internet Research.
(7) Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T (2015) The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010. PLoS ONE 10(2): e0116820. doi:10.1371/journal.pone.0116820