Netflix’s documentary “The Social Dilemma” has cast a spotlight on the dark side of social media and the technologies that have been killing us softly over the last decade.
As big tech continues to make headlines for their addictive algorithms and manipulative methods, digital health innovators have entered the market asking: How might we design tech products to heal us rather than make us sick?
Wearables and health apps have flooded the market as consumer demand surged in the wake of the COVID19 health crisis. Headspace, a meditation and mindfulness app, has seen up to a 90% increase in time spent on mobile devices in the U.S. during the week of March 1st, week over week.
Your smart-phone can now enable you to self-monitor your health throughout the day, and track everything from your step count to your heart rate variability, but does this translate to better health? In this blog, we examine the peer-reviewed research on wearables and health apps to understand their current efficacy in managing mental illness.
Let’s take a step back: What are wearables?
Wearable devices or ‘wearables’, as the name implies, are electronic devices that are embedded in clothing, clothing accessories (think Apple Watches or Fitbits), or even in the skin, that transmit data to a computing system that could be internal or external to the device, for analysis and feedback (e.g., your smartphone). They can track continuous bits of data, from heart rate to skin conductance (skin becomes a greater conductor of electricity when it is sweating), and can provide more insight into your health than just reporting how you feel at any given moment. Besides Fitbits, recent reviews on Wearables can be useful in tracking overall health of users, and recent reviews suggest it’s promising, but may need physicians to play a role in recommending the apps and monitoring their use (Heidel & Hagist, 2020).
But do they offer any benefit for mental health?
Some interesting results from a recent experiment on wearables and stress management, which has a tremendous impact on mental health, says yes it can. In a randomized controlled trial (one of the best forms of scientific evidence, besides large scale reviews), showed that after a 4-week intervention period of app based mindfulness training, the treatment group reported experiencing 15.8% fewer negative instances of stress, 13.0% fewer distressing symptoms, and 28.2% fewer days feeling anxious or stressed compared with a control group (Smith et al., 2020). Interestingly, the stress in this case was measured by a physiological monitoring device that measured respiratory changes in real time.
A recent review however warns that it may be too early to comment on the effectiveness for predicting depression relapse in young children and adolescents, but the devices seem to offer the advantage of easy, passive data collection (Sequeira et al., 2020).
How do consumers feel about these devices?
Research seems to indicate that interest in using wearable devices is strong, particularly when devices are seen as being effective. It was also reported that users who negatively view typical therapies may be more willing to try wearable devices, as they seem to be a less direct form of treatment (Hunkin, King, & Zajac, 2020). Echoing the results from the previous study, interviews with young adults seem to suggest these devices are largely accepted, especially if they could measure changes in sleep patterns, mood or activity levels as signs of mental deterioration. The research also points out that Wearables and mobile apps could be viable technological options to help detect deterioration in young people in order to intervene early and avoid delay in accessing mental health services. However, immediate action following detection is required for the patient to trust and use the intervention (Dewa et al., 2019).
So what can these devices do for mental health?
Some interesting research has shown that location tracking, in conjunction with measuring heart rate, heart rate variability, and skin conductance, can provide unique insight into how a user’s environment might trigger a stress response or change of mental state (Birenboim et al., 2019). Devices that measure sleep quality (sleep cycles play a major role in our mental and physical health) show promising economic advantages to larger clinical machines, and seem to offer a more accurate measurement of typical sleep patterns by the user. Plus, these devices are less obtrusive than clinical devices for measuring sleep, which may impede sleep quality, a recent systematic review found (Guillodo et al., 2020).
Although still in its infancy, new wearable devices using machine learning are showing promising results in providing a broader characterization of depressive symptoms (Jin et al., 2020). Essentially, these devices capture patterns of speech frequencies and behavior (hand swing movement), and use machine learning to sort through the endless amounts of data, and then weighing it to give more accurate predictions. So far, this research is showing great validity with existing measures of depression and anxiety.
There’s a Better way.
When looking through the most recent reviews on wearables and mental well-being, there seems to be quite a bit of work that still needs to be done, particularly when it comes to reliability. However, the cost efficiency, the ease, and the convenience of collecting data through wearables is unmatched… not to mention that because the devices are often unobtrusive, they won’t skew the results like larger clinical devices in a lab setting may.
Wearables can empower users with the data and insights to take control of their health beyond traditional pharmaceutical interventions. The road to living better, starts with understanding where you are now, and getting the support to make incremental changes. These devices may also provide new avenues to diagnosing mental illness earlier, supplementing the current DSM5 gold standard with self-reported health data tracked overtime.
Beyond the individual experiences of digital health, perhaps one of the biggest benefits is the speed at which data can be collected with these devices. This can speed up the research process in finding cures for diseases faster than traditional data collection methods. When this is done securely with privacy built in by design, the potential for tech to heal us, individually and collectively, has never been more promising.
Birenboim, A., Dijst, M., Scheepers, F. E., Poelman, M. P., & Helbich, M. (2019). Wearables and location tracking technologies for mental-state sensing in outdoor environments. The Professional Geographer, 71(3), 449-461.
Dewa, L. H., Lavelle, M., Pickles, K., Kalorkoti, C., Jaques, J., Pappa, S., & Aylin, P. (2019). Young adults’ perceptions of using wearables, social media and other technologies to detect worsening mental health: A qualitative study. PloS one, 14(9), e0222655.
Guillodo, E., Lemey, C., Simonnet, M., Walter, M., Baca-García, E., Masetti, V., ... & Berrouiguet, S. (2020). Clinical Applications of Mobile Health Wearable–Based Sleep Monitoring: Systematic Review. JMIR mHealth and uHealth, 8(4), e10733.
Heidel, A., & Hagist, C. (2020). Potential Benefits and Risks Resulting From the Introduction of Health Apps and Wearables Into the German Statutory Health Care System: Scoping Review. JMIR mHealth and uHealth, 8(9), e16444.
Hunkin, H., King, D. L., & Zajac, I. T. (2020). Perceived acceptability of wearable devices for the treatment of mental health problems. Journal of Clinical Psychology, 76(6), 987-1003.
Jin, J., Gao, B., Yang, S., Zhao, B., Luo, L., & Woo, W. L. (2020). Attention-Block Deep Learning Based Features Fusion in Wearable Social Sensor for Mental Wellbeing Evaluations. IEEE Access, 8, 89258-89268.
Sequeira, L., Perrotta, S., LaGrassa, J., Merikangas, K., Kreindler, D., Kundur, D., ... & Strauss, J. (2020). Mobile and wearable technology for monitoring depressive symptoms in children and adolescents: A scoping review. Journal of Affective Disorders, 265, 314-324.
Smith, E. N., Santoro, E., Moraveji, N., Susi, M., & Crum, A. J. (2020). Integrating wearables in stress management interventions: Promising evidence from a randomized trial. International Journal of Stress Management, 27(2), 172.