With sensors, smartphones, wearable devices, and mobile apps, you can track just about every aspect of your physical health — from your nutrition to your physical activity to your vital signs. But a range of new apps are showing that beyond tracking steps, counting calories, and recording heart rate, your smartphone can track your mental health in addition to your physical health. App developers are already tackling some of the biggest mental health issues in the United States.
Before we look at these apps, though, it should be useful to ask: what is the status of mental health and mental illness in the U.S.? According to the National Institute of Mental Health, mental illnesses are common in the U.S., and can be characterized as mental, behavioral, or emotional disorders. In 2012, there were an estimated 43.7 million U.S. adults with a mental illness, a figure that represents about 18.6 percent of all U.S. adults.
Anxiety disorders — from post-traumatic stress disorder to obsessive-compulsive disorder to specific phobias — are among the most common mental illnesses, and affect 25.1 percent of 13- to 18-year-olds and 18.1 percent of adults. Attention deficit hyperactivity disorder, a common childhood disorder that can continue through adolescence and adulthood, affects 9.0 percent of 13- to 18-year-olds and 4.1 percent of the adults. Autism spectrum disorder affects 1 in 68 children, and is almost five times more common in boys (1 in 42) than in girls (1 in 189).
A variety of eating disorders affect Americans, including anorexia nervosa, which affects 0.6 percent of adults; binge eating disorder, which affects 2.8 percent of adults; and bulimia nervosa, which affects 0.6 percent of adults. Eating disorders also affect 2.7 percent of 13- to 18-year-olds. Mood disorders, like bipolar disorder, dysthymic disorder, and major depression, affect 9.5 percent of adults and 14.0 percent of 13- to 18-year-olds. Personality disorders, including Antisocial Personality Disorder, Avoidant Personality Disorder, and Borderline Personality Disorder, affect 9.1 percent of adults. Schizophrenia affects 1.1 percent of adults.
So what are mobile apps doing to improve our mental health? For some, that starts with finding a reliable way to detect changes in mental health status just using the types of sensors that are found in the smartphones that Americans so commonly carry. As Tom Simonite reports for MIT Technology Review, an app developed by researchers at Dartmouth College can collect motion, audio, and location data from a smartphone’s sensors, and analyze the patterns in that data to accurately predict changes in mental health. When 48 students let the app collect information from their Android smartphones during a 10-week term, the data correlated with changes in stress, depression, and loneliness that appeared when they took the type of surveys that doctors use to assess patients’ mental health.
The app, named StudentLife and developed by Dartmouth professor Andrew Campbell, collects data on a phone’s motion and location, the timing of text messages and calls, and at times activates the device’s microphone to detect whether a conversation is taking place nearby.
Algorithms process all of that data into logs of a person’s physical activity, the places that he or she visits, communication patterns, sleeping patterns, and even estimates of how frequently he or she engages in face-to-face conversation. Changes in these patterns correlated with changes in depression, loneliness, and stress. The data could be used to augment the data that doctors collect via simple surveys when individuals seek help, and Campbell is planning research into how the app might alert individuals or their caregivers that their mental health might be changing.
Apps are just getting started at detecting behavioral changes and prompting healthcare providers to take action — an idea that could help sufferers of a wide variety of mental illnesses as it becomes more widely trialed and implemented. Simonite notes that a startup called Ginger.io has created an app similar to Campbell’s, and in partnership with healthcare providers, is testing the idea of intervention based on app data. In a trial with patients with diabetes, changes in patient behavior triggered an alert to nurses, who were then able to check with the patient to make sure that he or she was taking prescribed medication on schedule.
Ginger.io’s CEO Anmol Madan told Technology Review that Campbell’s study lends further credence to the idea that the data collected by a smartphone app can be useful in doctors’ assessment of patients’ mental health, and that Ginger.io has also discovered associations between its data and clinical scales for depression. But Madan says that much larger studies are necessary to convince healthcare providers to change their approach.
However, many clinical psychologists are interested in the potential of mobile apps to provide them with more information about their patients, and a SelfEcho survey of practicioners found that 73 percent of respondents think that a software system that collects and aggregates data on patients between visits would help them track patients’ progress. Additionally, 68 percent of respondents saw value in integrating additional data into their practices.
SelfEcho has developed a software for mental healthcare providers, who can enroll patients to use self reports and smartphone sensors to record data about their daily lives. Clinicians can track patients’ progress over time and find out what is and isn’t working in the treatment plan. SelfEcho tracks a variety of metrics, including a base module of mood, sleep, physical health, medication, and environmental data; depression, including positivity, hopefulness, pleasure, physical activity, and guilt; anxiety, including worry, restfulness, physical symptoms, efficacy, rumination, and social interactions; behavioral regulation; and personal relationships, including both feelings and situations. Therapists can use these insights to make better diagnoses, identify triggers, and track patient progress.
Some mental health apps are available both to consumers and healthcare providers, like My M3, an app that provides a simple three-minute test to detect depression, anxiety, bipolar disorder, and post-traumatic stress disorder. Patients can take the anonymous and free test to help themselves and their doctor understand if they’re likely to have a mood disorder, and can monitor their mental health over time. The app aims to get patients a more accurate diagnosis and treatment despite the time constraints of office visits, and to help underserved populations of patients receive effective treatment.
Others use more sophisticated technology to gain insight into mental health. BeyondVerbal, an “emotions analytics company,” recently launched its Wellness API that enables app developers to create “emotionally-aware” apps and services that use a smartphone or microphone-equipped wearable device to track emotional well-being over time and in correlation with activities and events — relying just on the user’s voice. The technology uses recordings of a user’s voice “to extract, decode, and measure human moods, attitudes and decision-making characteristics,” according to a press release on the API. BeyondVerbal says that the API will enable apps to identify trends in people’s emotional states, and correlate those trends with daily activities, lifestyle choices, and physical activity. A press release on the API’s launch notes that it automatically provides insight on a variety of metrics, including the user’s most dominant emotions, and scores on positivity and mood.
Still other apps focus on providing support to specific populations who could use help in their day-to-day lives, like POS REP, a proximity-based social network for military veterans. With veterans’ suicide rates at record levels, the app helps veterans to find each other and to find health centers and care. POS REP’s CEO, Anthony Allman, told the Los Angeles Times that the app aims to give veterans the resources necessary to prevent chronic homelessness and suicide, and to provide the social support to those suffering from post-traumatic stress.
A variety of other mental health-focused apps already exist, and the ones that have the most potential to leverage the power of new technology seem to be those that take a data-driven approach to tracking and improving mental health. As with Apple’s HealthKit framework and the many health-focused apps that developers are expected to introduce with it, the area of mental health apps is very young. Developers have both technical and legal challenges to work out, especially with the HIPAA regulations that should apply to apps that handle personal health information.
But their ability to build apps that know before we do when our mental health changes, or place important insights into the hands of clinicians thanks to our smartphones’ sensors, shows that the movement toward lifelogging and the quantified self can be about more than tracking multitudes of minute data points. Instead, the technology we carry in our pockets has the potential to make a real difference in the lives of the many Americans who live with some kind of illness, mental or physical.