Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees' Experiences, Views, and Understanding

The clinical implications of digital technology

The proliferation of digital technology within the lives of children and young people (CYP) provides arguably one of the most significant clinical and ethical paradigm shifts in Child and Adolescent Psychiatry. One can argue that mental health research has taken a myopic approach to understanding the interaction between young people's technology use and their mental health. Mental health clinicians also need a better understanding of the digital lives of CYP and how technology may be supporting or harming their mental health. Within this paper, we argue that greater longitudinal research is required, particularly in vulnerable groups, and that there is an essential need for a standardised digital use assessment (DUA) tool, which assimilates CYP use of technology and their vulnerabilities/resilience to online risks. We subsequently offer a series of questions clinicians can use to explore technology use by CYP. Such an aide memoire may empower clinicians to have wider discussions around digital technology use with CYP, while also helping to develop appropriate safety and management plans.

Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management

Background

Individuals with bipolar disorder (BD) are increasingly turning to smartphone applications (apps) for health information and self-management support. While reviews have raised concerns regarding the effectiveness and safety of publicly available apps for BD, apps surveyed may not reflect what individuals with BD are using. The present study had two aims: first, to characterize the use of health apps to support mood and sleep amongst people with BD, and second, to evaluate the quality, safety and functionality of the most commonly used self-management apps.

Methods

A web-based survey was conducted to explore which apps people with BD reported using to support self-management of mood and sleep. The characteristics of the most commonly nominated apps were described using a standardized framework, including their privacy policy, clinical foundations, and functionality.

Results

Respondents (n = 919) were 77.9% female with a mean age of 36.9 years. 41.6% of participants (n = 382) reported using a self-management app to support mood or sleep. 110 unique apps were nominated in relation to mood, and 104 unique apps nominated in relation to sleep; however, most apps were only mentioned once. The nine most frequently nominated apps related to mood and sleep were subject to further evaluation. All reviewed apps offered a privacy policy, however user control over data was limited and the complexity of privacy policies was high. Only one app was developed for BD populations. Half of reviewed apps had published peer-reviewed evidence to support their claims of efficacy, but little research was specific to BD.

Conclusion

Findings illustrate the potential of smartphone apps to increase the reach of psychosocial interventions amongst people with BD. Apps were largely created by commercial developers and designed for the general population, highlighting a gap in the development and dissemination of evidence-informed apps for BD. There may be risks in using generic health apps for BD self-management; clinicians should enquire about patients’ app use to foster conversations about their particular benefits and limitations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40345-022-00256-6.

Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review

BACKGROUND

There is a persistent need for mental ill-health prevention and intervention among at-risk and vulnerable subpopulations. Major disruptions to life, such as the COVID-19 pandemic, present an opportunity for a better understanding of the experience of stressors and vulnerability. Faster and better ways of psychological screening and tracking are more generally required in response to the increased demand upon mental health care services. The argument that mental and physical health should be considered together as part of a biopsychosocial approach is garnering acceptance in elite athlete literature. However, the sporting population are unique in that there is an existing stigma of mental health, an underrecognition of mental ill-health, and engagement difficulties that have hindered research, prevention, and intervention efforts.

OBJECTIVE

The aims of this paper are to summarize and evaluate the literature on athletes' increased vulnerability to mental ill-health and digital mental health solutions as a complement to prevention and intervention, and to show relationships between athlete mental health problems and resilience as well as digital mental health screening and tracking, and faster and better treatment algorithms.

METHODS

This mini review shapes literature in the fields of athlete mental health and digital mental health by summarizing and evaluating journal and review articles drawn from PubMed Central and the Directory of Open Access Journals.

RESULTS

Consensus statements and systematic reviews indicated that elite athletes have comparable rates of mental ill-health prevalence to the general population. However, peculiar subgroups require disentangling. Innovative expansion of data collection and analytics is required to respond to engagement issues and advance research and treatment programs in the process. Digital platforms, machine learning, deep learning, and artificial intelligence are useful for mental health screening and tracking in various subpopulations. It is necessary to determine appropriate conditions for algorithms for use in recommendations. Partnered with real-time automation and machine learning models, valid and reliable behavior sensing, digital mental health screening, and tracking tools have the potential to drive a consolidated, measurable, and balanced risk assessment and management strategy for the prevention and intervention of the sequelae of mental ill-health.

CONCLUSIONS

Athletes are an at-risk subpopulation for mental health problems. However, a subgroup of high-level athletes displayed a resilience that helped them to positively adjust after a period of overwhelming stress. Further consideration of stress and adjustments in brief screening tools is recommended to validate this finding. There is an unrealized potential for broadening the scope of mental health, especially symptom and disorder interpretation. Digital platforms for psychological screening and tracking have been widely used among general populations, but there is yet to be an eminent athlete version. Sports in combination with mental health education should address the barriers to help-seeking by increasing awareness, from mental ill-health to positive functioning. A hybrid model of care is recommended, combining traditional face-to-face approaches along with innovative and evaluated digital technologies, that may be used in prevention and early intervention strategies.