Smartphone App – Mental Health Matters

Do You Have a Lockdown-Induced Smartphone Addiction?

Published on 04/19/2021 by Andrew MarshallLeave a comment

We are probably all aware that we (or others) spend too much time glued to our electronic devices, but endless months of pandemic-induced ‘house arrest’ may have tipped some people towards a full-blown addiction.

Below are six signs lockdown has left you with a smartphone addiction and what to do about it.

You Can’t Sleep	The blue light emitted by phones and other devices messes with melatonin – the hormone that makes you sleepy – making it harder to drift off.
You Feel Anxious	Just because you check your phone a lot does not mean you are addicted, but if the mere thought of not having it to hand worries you, this could indicate you have become dependent.
You’re Stressed Out by Social Media	Constantly scrolling through your news feed means you are more likely to compare yourself to others, feel like you are missing out or get annoyed by what you see and read.
You Can’t Stop Checking Your Phone	A classic sign of addiction is feeling compelled to look at your phone every time you stand still or sit down, while eating dinner and even during activities where it is dangerous to do so – such as driving.
You Lose Time	If you find yourself coming back to reality after a scrolling session and wondering where the last hour has gone, it could indicate you have a problem.
You Text More Than Talk	You may find yourself communicating with people via text more often than face to face. This can, in turn, increase feelings of isolation.

How to Break the Cycle

Try a Social Media Fast	Set a time limit to stay offline and stick to it.
Track your Usage	Apps such as Moment and BreakFree help you monitor the time you spend scrolling. You might be quite shocked by the results.
Texting!	Instead of texting your friend, arrange for a chat or a socially distanced coffee.
Table Manners	Power down during every meal and definitely turn your phone off while driving. Even better – put it somewhere well out of reach, like the boot.
Exercise More	It sounds simple but every moment spent working out is a moment not wasted online. Physical activity also releases endorphins which improve your mood – bonus!

Updating the Development of Mobile Computing Technology & the Delivery of Psychological Interventions

Published on 03/12/2021 by Andrew MarshallLeave a comment

Research Paper Title

Ecological momentary interventions for mental health: A scoping review.

Background

The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these “ecological momentary interventions” were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed.

Therefore the aim of this study was to provide an overview of the definitions given for “ecological momentary interventions” in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions.

Methods

A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardised extraction worksheet. Selected articles were then thematically categorised.

Results

The search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states.

Conclusions

With the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.

Reference

Balaskas, A., Schueller, S.M., Cox, A.L. & Doherty, G. (2021) Ecological momentary interventions for mental health: A scoping review. PLoS One. doi: 10.1371/journal.pone.0248152. eCollection 2021.

New Mental Health Care App for RN Families

Published on 01/26/2021 by Andrew MarshallLeave a comment

Royal Navy families can now access mental health support online.

The Naval Families Federation has launched a 12-month pilot scheme to provide free access to the Headspace app for families of regular and reserve RN personnel.

Working with support from Navy Command and the Royal Navy Family and People Support organisation, 3,000 licences have been bought.

To access the offer, the family member should visit www.nff.org.uk/headspace where they will be guided through the veriﬁcation process.

Can a COVID-19 Contact Tracing App Improve Psychological Distress?

Published on 01/08/2021 by Andrew Marshall1 Comment

Research Paper Title

Downloading a government-issued COVID-19 contact tracing app may improve psychological distress in the outbreak among employed adults: a prospective study.

Background

Downloading of a COVID-19 contact tracing app may be effective in reducing anxiety about COVID-19 and psychological distress of users.

Therefore, the objective of this 2.5-month prospective study aimed to investigate the association of downloading of a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government with fear and worry about COVID-19 and psychological distress in a sample of employed adults of Japan.

Methods

A total of 996 full-time employed respondents to an online survey on 22 to 26 May 2020 (baseline) were invited to participate in a follow-up survey on 07 to 12 August 2020 (follow-up). High level of worrying about COVID-19 and high psychological distress were defined by scores on a single-item scale and the K6 scale, respectively, both at baseline and follow-up. The app was released between the two surveys on 17 June. Participants were asked at follow-up if they downloaded the app.

Results

A total of 902 (90.6%) out of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress, but not with fear and worry about COVID-19, at follow-up after controlling for baseline variables.

Conclusions

The study provided first evidence that a COVID-19 contact tracing app may be beneficial for the mental health of employed adults using a government-issued tracing app under the COVID-19 outbreak.

Reference

Kawakami, N., Sasaki, N., Kuroda, R., Tsuno, K. & Imamura, K. (2020) Downloading a government-issued COVID-19 contact tracing app may improve psychological distress in the outbreak among employed adults: a prospective study. JMIR Mental Health. doi: 10.2196/23699. Online ahead of print.

Can We Use Gamification in Mobile Mental Health Interventions?

Published on 10/28/2020 by Andrew MarshallLeave a comment

Research Paper Title

Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial.

Background

40% of all general practitioner (GP) appointments are related to mental illness, although less than 35% of individuals have access to therapy and psychological care, indicating a pressing need for accessible and affordable therapy tools.

The ubiquity of smartphones offers a delivery platform for such tools. Previous research suggests that gamification-turning intervention content into a game format-could increase engagement with prevention and early-stage mobile interventions.

This study aimed to explore the effects of a gamified mobile mental health intervention on improvements in resilience, in comparison with active and inactive control conditions. Differences between conditions on changes in personal growth, anxiety and psychological wellbeing, as well as differences in attrition rates, were also assessed.

Methods

The eQuoo app was developed and published on all leading mobile platforms.

The app educates users about psychological concepts including emotional bids, generalisation, and reciprocity through psychoeducation, storytelling, and gamification.

In total, 358 participants completed in a 5-week, 3-armed (eQuoo, “treatment as usual” cognitive behavioural therapy journal app, no-intervention waitlist) randomized controlled trial. Relevant scales were administered to all participants on days 1, 17, and 35.

Results

Repeated-measures ANOVA revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks.

The app also significantly increased personal growth, positive relations with others, and anxiety. With 90% adherence, eQuoo retained 21% more participants than the control or waitlist groups.

Intervention delivered via eQuoo significantly raised mental well-being and decreased self-reported anxiety while enhancing adherence in comparison with the control conditions.

Conclusions

Mobile apps using gamification can be a valuable and effective platform for well-being and mental health interventions and may enhance motivation and reduce attrition.

Future research should measure eQuoo’s effect on anxiety with a more sensitive tool and examine the impact of eQuoo on a clinical population.

Reference

Litvin, S., Saunders, R., Maier, M.A. & Luttke, S. (2020) Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial. PLoS One. 15(9), pp.e0237220. doi: 10.1371/journal.pone.0237220. eCollection 2020.

Gamification & Mobile Mental Health Interventions

Published on 10/06/2020 by Andrew MarshallLeave a comment

Research Paper Title

Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial.

Background

40% of all general-practitioner appointments are related to mental illness, although less than 35% of individuals have access to therapy and psychological care, indicating a pressing need for accessible and affordable therapy tools.

The ubiquity of smartphones offers a delivery platform for such tools.

Previous research suggests that gamification-turning intervention content into a game format-could increase engagement with prevention and early-stage mobile interventions.

Methods

The eQuoo app was developed and published on all leading mobile platforms. The app educates users about psychological concepts including emotional bids, generalisation, and reciprocity through psychoeducation, storytelling, and gamification.

In total, 358 participants completed in a 5-week, 3-armed (eQuoo, “treatment as usual” cognitive behavioral therapy journal app, no-intervention waitlist) randomized controlled trial. Relevant scales were administered to all participants on days 1, 17, and 35.

Results

Repeated-measures ANOVA revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks.

The app also significantly increased personal growth, positive relations with others, and anxiety.

With 90% adherence, eQuoo retained 21% more participants than the control or waitlist groups.

Conclusions

Intervention delivered via eQuoo significantly raised mental well-being and decreased self-reported anxiety while enhancing adherence in comparison with the control conditions.

Mobile apps using gamification can be a valuable and effective platform for well-being and mental health interventions and may enhance motivation and reduce attrition.

Future research should measure eQuoo’s effect on anxiety with a more sensitive tool and examine the impact of eQuoo on a clinical population.

Reference

A Brief Outline of Online Mental Health Services in China During the COVID-19 Outbreak

Published on 06/19/2020 by Andrew MarshallLeave a comment

Research Paper Title

Online Mental Health Services in China During the COVID-19 Outbreak.

Background

At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from Wuhan in Hubei province, started to spread throughout China. As a result of the rapidly increasing numbers of confirmed cases and deaths, both medical staff and the public have been experiencing psychological problems, including anxiety, depression, and stress. Since January 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on 26 January, then the notice on establishing psychological assistance hotlines for the epidemic on 02 February, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on 07 February 7.

During the severe acute respiratory syndrome epidemic in 2003, internet services and smartphones were not widely available. Therefore, few online mental health services were provided for those in need. The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak. Fast transmission of the virus between people hinders traditional face-to-face psychological interventions. By contrast, provision of online mental health services is safe. To date, several types of online mental health services have been implemented widely for those in need during the outbreak in China.

Firstly, as of 08 Febreuary 2020, 72 online mental health surveys associated with the COVID-19 outbreak could be searched for via the WeChat-based survey programme Questionnaire Star, which target different populations, including medical staff (23 of the surveys), patients with COVID-19 (one survey), students (18 surveys), the general population (nine surveys), and mixed populations (21 surveys); in Hubei province (five surveys), other provinces (15 surveys), all provinces, municipalities, and autonomous regions (36 surveys), and unspecified areas of China (16 surveys). One such multi-centre survey involving 1563 medical staff, with the centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems.

Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. As of 08 February, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health.

Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (e.g. on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue, by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly.

In general, online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions.

Reference

Liu, S., Yang, L., Zhang, C., Xiang, Y., Liu, Z., Hu, S. & Zhang, B. (2020) Online Mental Health Services in China During the COVID-19 Outbreak. Lancet Psychiatry. 7(4), pp.e17-e18. doi: 10.1016/S2215-0366(20)30077-8. Epub 2020 Feb 19.

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

Published on 05/05/2020 by Andrew MarshallLeave a comment

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:

Initial limited search of online databases namely, MEDLINE for literature on digital phenotyping or sensing for key terms;
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
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.

Are E-Mental Health Applications for Depression Beneficial?

Published on 04/20/202004/20/2020 by Andrew MarshallLeave a comment

Research Paper Title

E-mental health applications for depression: an evidence-based ethical analysis.

Background

E-mental health applications (apps) are an increasingly important factor for the treatment of depression.

To assess the risks and benefits for patients, an in-depth ethical analysis is necessary.

The objective of this paper is to determine the ethical implications of app-based treatment for depression.

Methods

An evidence-based ethical analysis was conducted.

The material was meta-reviews and randomised control studies (RCTs) on app-based treatment.

Based on the empirical data, an ethical analysis was conducted using the 3-ACES-approach by Thornicroft and Tansella.

Results

Apps may empower autonomy, offer an uninterrupted series of contacts over a period of time, show evidence-based benefits for patients with subclinical and mild-to-moderate-symptoms, are easily accessible, may be used for coordinating information and services within an episode of care, and are on the whole cost-effective.

Their risks are that they are not suitable for the whole range of severity of mental illnesses and patient characteristics, show severe deficits in the data privacy policy, and a big variability in quality standards.

Conclusions

The use of apps in depression treatment can be beneficial for patients as long as:

The usefulness of an app-based treatment is assessed for each individual patient;
Apps are chosen according to symptom severity as well as characteristics like the patient’s level of self-reliance, their e-literacy, and their openness vis-à-vis apps; and
Manufacturers improve their privacy policies and the quality of apps.

Reference

Rubeis, G. (2020) E-mental health applications for depression: an evidence-based ethical analysis. European Archives of Psychiatry and Clinical Neuroscience. doi: 10.1007/s00406-019-01093-y. [Epub ahead of print].

Testing the Effectiveness of Smartphone Apps Delivered to School Students to Prevent Depression at Scale.

Published on 03/18/2020 by Andrew MarshallLeave a comment

Research Paper Title

A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study.

Background

Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years.

Despite advances in treatment, there has been limited progress in addressing the burden at a population level.

Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression.

Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs.

Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes.

The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.

Methods

A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted.

In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator.

The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia.

At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition.

Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline.

Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.

Results & Conclusions

This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale.

Results from this trial will provide much-needed insight into the feasibility of this approach.

They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.

Reference

Werner-Seidler, A., Huckvale, K., Larsen, M.E., Calear, A.L., Maston, K., Johnston, L., Torok, M., O’Dea, B., Batterham, P.J., Schweizer, S., Skinner, S.R., Steinbeck, K., Ratcliffe, J., Oei, J.L., Patton, G., Wong, I., Beames, J., Wong, Q.J.J., Lingam, R., Boydell, K., Salmon, A.M., Cockayne, N., Mackinnon, A. & Christensen, H. (2020) A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study. Trials. 21(1), pp.2. doi: 10.1186/s13063-019-3901-7.