Digital Pyschiatry Apps Show Promise But May Present New Challenges
While digital psychiatry and mental health apps are proliferating, experts caution that they may create new legal responsibilities and question whether the hype is getting ahead of evidence supporting their use.
A smartphone app now in development monitors a person’s voice frequency and detects when mania or depression is creeping in. Another prompts patients to take daily mental health assessments and sends a report to their psychiatrist, including whether they’re feeling suicidal. Yet another encourages people to adopt mindfulness practices as they go about their day.
These are just a few examples of digital psychiatry apps that were discussed at a packed session at APA’s 2018 Annual Meeting in May. Increasingly, patients are picking from among the thousands of mental health apps now available and downloading them onto smartphones, tablets, or computers. Clinicians, too, are encouraging patients to use them in between sessions and might even be uploading symptom data from patients, according to John Torous, M.D., director of the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center in Boston. He is also a member of APA’s Committee on Mental Health Information Technology and chair of the Smartphone App Evaluation Work Group.
With smartphones available for as little as $50 at big-box retailers, virtually everyone can have access to digital psychiatry tools, Torous said. One type of app is a “symptom tracker,” which prompts people to enter their subjective experience of their mental health throughout the day or week. Other apps use sensors or smartphone hardware to capture “passive” data, such as how many hours a user has slept or how much a person has moved and where he or she has traveled using geolocation. Thousands of “interventional” apps, too, promise to coach users to better mental health.
What’s unique about digital psychiatry apps is the ease with which they allow physicians to access data, the volume of data generated, and the length of time that the data are retained, said former APA President Paul Appelbaum, M.D., the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University College of Physicians and Surgeons. “They can also provide new types of information we’ve never had access to before, like where your patients are at every moment in time or what their voice tells you at any point in time,” he said.
Apps may be able to capture other important data that a clinician cannot, in part because people tend to report symptoms at a higher severity to an app than they do a physician, Torous said. In one recent study of which he was a co-author, patients reported suicidal ideation at a much higher rate—and had far worse depression scores via the app—than when they were with the clinician during check-ins. One theory: “It may be easier to tell some things to a cell phone than a person,” Torous said, adding that more research is needed to understand this phenomenon.
Author: Linda M. Richmond