Can We Use Smartphones in the Assessment & Prediction of Mental Health?

Research Paper Title

Digital phenotyping for assessment and prediction of mental health outcomes: a scoping review protocol.

Background

Rapid advancements in technology and the ubiquity of personal mobile digital devices have brought forth innovative methods of acquiring healthcare data.

Smartphones can capture vast amounts of data both passively through inbuilt sensors or connected devices and actively via user engagement.

This scoping review aims to evaluate evidence to date on the use of passive digital sensing/phenotyping in assessment and prediction of mental health.

Methods

The methodological framework proposed by Arksey and O’Malley will be used to conduct the review following the five-step process.

A three-step search strategy will be used:

  1. Initial limited search of online databases namely, MEDLINE for literature on digital phenotyping or sensing for key terms;
  2. Comprehensive literature search using all identified keywords, across all relevant electronic databases: IEEE Xplore, MEDLINE, the Cochrane Database of Systematic Reviews, PubMed, the ACM Digital Library and Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index), Scopus; and
  3. Snowballing approach using the reference and citing lists of all identified key conceptual papers and primary studies.

Data will be charted and sorted using a thematic analysis approach.

Findings

The findings from this systematic scoping review will be reported at scientific meetings and published in a peer-reviewed journal.

Reference

Spinazze, P., Rykov, Y., Bottle, A. & Car, J. (2019) Digital phenotyping for assessment and prediction of mental health outcomes: a scoping review protocol. BMJ Open. 9(12):e032255. doi: 10.1136/bmjopen-2019-032255.

Owning & Managing a Business Can be Hazardous to your Mental Health

1.0 Introduction

Owning and Managing a Business Can be Hazardous to your Mental Health.

This article provides an overview of business ownership in the context of mental health.

If you are one of the millions of small and medium business owners around the globe, you probably have a good idea of how tough (and sometimes lonely) it can be at the top of the business – and how owning and managing your own business can be hazardous to your mental health.

It is well-known that our mental health can deteriorate, for a variety of reasons, and, if left unchecked, can lead to mental health problems.

Although depression and anxiety are likely to be the most common issues an owner faces, it is important to remember that mental health symptoms and conditions come in many forms.

2.0 Why Be a Business Owner?

Many of us are drawn to small business because working for others provides its own stresses, for example, the feeling of lost control as others make decisions we may feel unable to influence.

Being a business owner offers a level of freedom and control that we may be unable to achieve as an employee.

3.0 Factors Affecting Mental Health in Owners

Although the symptoms of mental health conditions can be similar between people, the triggers can be very different.

There are a number of factors that could lead to a deterioration in a business owner’s mental health, including:

  • Excessive stress;
  • A toxic work environment;
  • Poor leadership;
  • Uncertainty;
  • Long hours;
  • A lack of sleep; and
  • So on.

These can lead to burnout which, in turn, can lead to mental health conditions such as anxiety and depression.

Increased competition in your particular market or industry means added pressure to perform and stand out from the crowd, as well as potentially making it more difficult to be financially successful. Business costs may also be rising, possibly faster than your ability to increase sales and revenue – meaning the bottom line is impacted, aka less profit.

Using a contemporaneous example, the business uncertainty surrounding Brexit, especially for export-orientated businesses, can have a profound impact on business planning and sales generation.

4.0 A Blur between Personal, Family & Work

Small business ownership, especially, can be tough because there are few support structures for owners.

As an owner, you are responsible for everything and the lines between personal and family pressures and work are blurred or even non-existent.

Finally, the financial pressures are very real, as it is the owner’s money at stake not a large company’s money.

5.0 I’m In Control!

Business owners may be reluctant to seek, ask or talk about any mental health issues they may be facing due to the need to be perceived as having everything under control.

This means that business owners can, effectively, end up in rather stressful jobs.

With this in mind, most employees will be unaware of the stress attached to owning a business and how challenging cashflow, for example, can be. When margins are tight, paying wages can be extremely stressful. There are real life examples where owners have paid staff wages through their credit cards or overdrafts to ensure their employees get paid – mainly due to a feeling of guilt and not wanting to let them down. It can be stressful knowing that your employee’s family relies on the wage you are paying their loved one.

There is also the stress on marriages, especially if a couple is in business together.

6.0 The Value of Mentors

Other business owners understand what you, as a business owner, are going through. They understand the impact that long hours, for example, can have on the owner’s well-being and their families.

A business mentor can assist by helping the owner find ways of being more effective with their time, among other things.

7.0 Addressing Mental Health Issues

It is imperative that you do not do nothing.

There are a number of things owners can do, at both at an individual and organisational level:

  • Know the risks to mental health and well-being in your business.
    • What are the triggers?
  • Talk about mental health and well-being.
    • This helps to normalise it.
  • Leaders in your business need to be on board.
    • They must send the message to all staff that the business takes mental health seriously.
    • Role model what good mental health looks like and what we do when someone needs our help.
  • Get some education around mental health.
    • The reason that myths and fear exist is because of lack of awareness and knowledge.
    • There are workshops, coaches and even online courses now which help plug this knowledge gap.
  • Have the conversation with your people.
    • Not saying anything to someone who is struggling is not the way to go.
    • Simply asking “Are you OK?” is a really good start and shows the person that you have noticed and do care.
  • Sleep, nutrition, relationships and exercise all correlate with mental health, so check in on your people to see how they are going with these areas.
    • For example, if someone tells you that they have not been sleeping for two months, that is going to take its toll and something needs to be done.
  • Know who to go to.
    • Have an accessible list of contacts that you can call on for a range of different mental health and well-being matters.

It is important to seek support from someone who:

  • Has received appropriate training;
  • Is a registered practitioner; and
  • Has frequent supervision.

8.0 Pursing Good Mental Health

In the pursuit of good mental health, it is important to:

  • Understand our stressors;
  • Name our stressors;
  • Admit they exist; and
  • Aim to avoid them.

If our stressors cannot be avoided, we should attempt to better manage them.

Finally, when possible, it is important as a business owner to make time and take personal care of yourself.

Suicide in Older Adults: A Critical Problem

Research Paper Title

Suicide in Older Adults.

Abstract

Suicide in older adults is a critical problem that nurses and other health professionals need to address. Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.

Reference

Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.

Polycythemia, Mental Health & the Great East Japan Earthquake

Research Paper Title

Relationship between the prevalence of polycythemia and factors observed in the mental health and lifestyle survey after the Great East Japan Earthquake.

Background

The researchers have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE).

Their findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.

Methods

The researchers analysed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design:

  • Traumatic symptoms;
  • Depression status;
  • Socioeconomic factors such as residential environment; and
  • Working situation after the GEJE.

Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government.

Participants analysed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.

Results

The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13).

Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as:

  • Being aged 65 years and older;
  • Highly educated;
  • Obese (body mass index ≥ 25);
  • Hypertensive;
  • Diabetic;
  • Having liver dysfunction; and
  • A smoker being significantly related to the prevalence of polycythemia.

Conclusions

The researchers state their findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.

Reference

Sakai, A., Nakano, H., Ohira, T., Maeda, M., Okazaki, K., Takahashi, A., Kawasaki, Y., Satoh, H., Ohtsuru, A., Shimabukuro, M., Kazama, J., Hashimoto, S., Hosoya, M., Yasumura, S., Yabe, H., Ohto, H., Kamiya, K. & Fukushima Health Management Survey Group. (2020) Relationship between the prevalence of polycythemia and factors observed in the mental health and lifestyle survey after the Great East Japan Earthquake. Medicine (Baltimore). 99(1):e18486. doi: 10.1097/MD.0000000000018486.

Overview of Trauma- & Stress-Related Disorders

Trauma- and stress-related disorders result from exposure to a traumatic or stressful event.

Specific disorders include acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). These disorders cause similar symptoms but differ in how long they last.

  • ASD:
    • Typically begins immediately after the event.
    • Lasts from 3 days to 1 month.
  • PTSD:
    • Lasts for more than 1 month.
    • It may develop as a continuation of acute stress disorder or develop separately up to 6 months after the event.

Although depression and anxiety are often prominent, individuals with trauma-related disorders often have a wide variety of symptoms that may not obviously seem related to the traumatic event.

For example, individuals may:

  • Act aggressively;
  • Be unable to experience pleasure; and/or
  • Feel restless, discontented, angry, numb, or disconnected from themselves and others.

Treatment of Anxiety Disorders

When treating anxiety disorders, there are a number of things to consider:

  • Treatment of the cause if appropriate;
  • Psychotherapy;
  • Drug therapy; and/or
  • Treatment of other active disorders.

Accurate diagnosis is important because treatment varies from one anxiety disorder to another.

Additionally, anxiety disorders must be distinguished from anxiety that occurs in many other mental health disorders, which involve different treatment approaches.

If the cause is another medical disorder or a drug, medical professionals aim to correct the cause rather than treat the symptoms of anxiety.

Anxiety should subside after the physical disorder is treated or the drug has been stopped long enough for any withdrawal symptoms to abate.

If anxiety remains, anti-anxiety drugs or psychotherapy (such as behavioural therapy) is used.

For individuals who are dying, certain strong pain relievers, such as morphine, may relieve both pain and anxiety.

If an anxiety disorder is diagnosed, drug therapy or psychotherapy (such as behavioral therapy), alone or in combination, can significantly relieve the distress and dysfunction for most individuals.

Benzodiazepines (such as diazepam) are commonly prescribed for acute anxiety.

For many individuals, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), work as well for anxiety disorders as they do for depression.

Specific treatments depend on which anxiety disorder is diagnosed.

All of the anxiety disorders can occur along with other psychiatric conditions.

For example, anxiety disorders often occur along with an alcohol use disorder.

It is important to treat all of these conditions as soon as possible.

Treating the alcohol use disorder without treating the anxiety is unlikely to be effective since the individual may be using alcohol to treat the anxiety.

On the other hand, treating the anxiety without addressing the alcohol disorder may be unsuccessful because daily changes in the amount of alcohol in the blood can cause levels of anxiety to fluctuate.

Diagnosis of Anxiety Disorders

A diagnosis of anxiety disorder is via a medical professional’s evaluation, based on specific criteria.

Deciding when anxiety is severe enough to be considered a disorder can be complicated.

Individual ability to tolerate anxiety varies, and determining what constitutes abnormal anxiety can be difficult.

Medical professionals usually use the following specific established criteria:

  • Anxiety is very distressing.
  • Anxiety interferes with functioning.
  • Anxiety is long-lasting or keeps coming back

Medical professionals look for other disorders that may be causing anxiety, such as depression or a sleep disturbance.

They may also ask whether relatives have had similar symptoms, because anxiety disorders tend to run in families.

Medical professionals also do a physical examination. Blood and other tests may be done to check for other medical disorders that can cause anxiety.

Symptoms of Anxiety Disorders

Anxiety can arise suddenly, as in panic, or gradually over minutes, hours, or days.

Anxiety can last for any length of time, from a few seconds to years.

It ranges in intensity from barely noticeable qualms to a full-blown panic attack, which may cause shortness of breath, dizziness, an increased heart rate, and trembling (tremor).

Anxiety disorders can be so distressing and interfere so much with an individual’s life that they can lead to depression.

Individuals may develop a substance use disorder.

Individuals who have an anxiety disorder (except for certain very specific phobias, such as fear of spiders) are at least twice as likely to have depression as those without an anxiety disorder.

Sometimes individuals with depression develop an anxiety disorder.

Use Your Smartphone to Spot Schizophrenia, Soon

Speaking into your smartphone for two minutes could reveal whether you have a mental health condition!

That is according to the developers of an app that analyses facial expressions and speech to diagnose schizophrenia.

The company behind the app, AICure, hopes it could be used to better support and monitor people with schizophrenia, and eventually those who have other mental health conditions.

The current version was developed to measure symptoms of schizophrenia like low mood and difficulty thinking, which are normally harder to measure than symptoms like hallucinations and delusions.

To do this, the app tracks facial movements, as well as the content, tone and pitch of a person’s speech. Some people with schizophrenia move more slowly, and show less emotion on their faces. The app can then send a score to the person’s doctor, rating these symptoms.

However, it is not designed to spot other symptoms associated with the condition, such as hallucinations.

AICure tested the app with 21 people who have schizophrenia and nine people who do not. The participants made weekly recordings over 12 weeks. Each person was also evaluated by a clinician at Mount Sinai Hospital in New York at the start and end of the study.

The results of this small trial suggest that the app’s ratings “are highly correlated” with those of a clinician, states AICure. However, AICure does not yet have enough data to prove its app works, because the sample size is very small. The results can be viewed more as a proof of concept than as a diagnostic tool, which is a little way off.

Reference

Hamzelou, J. (2019) Smartphone App Could Spot Signs of Schizophrenia. New Scientist. 28 September 2019, pp.7.