Psychiatry in the Digital Age: A Blessing or a Curse?

Algorithmic surveillance in the era of the mental health appsphere

Digital mental health applications, also known as mHealth apps, are designed to help users manage their mental health using technology such as mobile devices and smartphones. However, there has been little critical engagement surrounding their impact on marginalized communities, and Black people in Canada. This article aims to explore how state and private actors conceptualize the digitalization of mental health access, leading to the creation and implementation of these apps. It is important to consider the links and interconnections between the platform and the app, and to be cautious and curious before adopting yet another app that claims to manage and mitigate moods and address mental health needs. We should be considering the implications of what comes with this access and apparent ease of use.

How Can Digital Mental Health Enhance Psychiatry?

The use of digital technologies is constantly growing around the world. The wider-spread adoption of digital technologies and solutions in the daily clinical practice in psychiatry seems to be a question of when, not if. We propose a synthesis of the scientific literature on digital technologies in psychiatry and discuss the main aspects of its possible uses and interests in psychiatry according to three domains of influence that appeared to us: 1) assist and improve current care: digital psychiatry allows for more people to have access to care by simply being more accessible but also by being less stigmatized and more convenient; 2) develop new treatments: digital psychiatry allows for new treatments to be distributed via apps, and practical guidelines can reduce ethical challenges and increase the efficacy of digital tools; and 3) produce scientific and medical knowledge: digital technologies offer larger and more objective data collection, allowing for more detection and prevention of symptoms. Finally, ethical and efficacy issues remain, and some guidelines have been put forth on how to safely use these solutions and prepare for the future.

Smartphone application use patterns for mental health disorders: A systematic literature review and meta-analysis

BACKGROUND

Mobile mental health applications play a significant role in mental health care to fill gaps in care for mental disorders. Despite the growth in mobile phone apps for mental health conditions, patients' mental health smartphone application use, perceived usefulness, and future interest in using apps for mental disorders have not been systematically examined.

METHODS

The authors designed and conducted this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Articles reporting mobile/smartphone applications used for mental disorders describing ownership, application use, perceived helpfulness, future interest to use, use patterns, and attitudes were included. PubMed/MEDLINE, EMBASE, PsychINFO, Scopus, and Google Scholar were searched. Published articles from 2014 up to October 2022 were included. The methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. The heterogeneity test, publication bias, funnel plots and Egger's test were applied. The outcome was calculated by metaprop command using a random-effects model.

RESULTS

Ten studies met the eligibility criteria. The pooled prevalence of smartphone ownership, application use for current mental health disorders, perceived usefulness, and future interest in using the app for their mental health problem was 88.63%, 23.29%, 72.80%, and 78.97%, respectively. Heterogeneity and publication bias were detected.

CONCLUSIONS

The results of this study indicate that despite a considerable number of smartphone users, perceived usefulness, and future interest in using smartphone mental health applications among patients with mental disorders, only about one-fifth use an application for mental health disorders. The results show that there is a large potential to increase the use of apps for patients to support self-care in the growing era of digital mental health. Further research with consumers and mental health professionals is recommended to address barriers and improve mhealth app utilization.

REGISTRATION

Prospero international prospective register of systematic reviews with ID: CRD42022359416.

A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design

BACKGROUND

Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users' continued adoption and practice of self-care for their mental health.

OBJECTIVE

The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users' perceptions on mental self-care and feedback on the platform design and incorporates them into the design.

METHODS

The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach.

RESULTS

In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses.

CONCLUSIONS

The design process and findings presented in the study are important in developing a user-centric platform to optimize users' acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users' perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web.

Digital Transformation in Healthcare: Technology Acceptance and Its Applications

Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.

Can Translational Social Neuroscience Research Offer Insights to Mitigate Structural Racism in the United States?

Social isolation and conflict due to structural racism may result in human suffering and loneliness across the life span. Given the rising prevalence of these problems in the United States, combined with disruptions experienced during the COVID-19 pandemic, the neurobiology of affiliative behaviors may offer practical solutions to the pressing challenges associated with structural racism. Controlled experiments across species demonstrate that social connections are critical to survival, although strengthening individual resilience is insufficient to address the magnitude and impact of structural racism. In contrast, the multilevel construct of social resilience, defined by the power of groups to cultivate, engage in, and sustain positive relationships that endure and recuperate from social adversities, offers unique insights that may have greater impact, reach, and durability than individual-level interventions. Here, we review putative social resilience-enhancing interventions and, when available, their biological mediators, with the hope to stimulate discovery of novel approaches to mitigate structural racism. We first explore the social neuroscience principles underlying psychotherapy and other psychiatric interventions. Then, we explore translational efforts across species to tailor treatments that increase social resilience, with context and cultural sensitivity in mind. Finally, we conclude with some practical future directions for understudied areas that may be essential for progress in biological psychiatry, including ethical ways to increase representation in research and developing social paradigms that inform dynamics toward or away from socially resilient outcomes.

Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review

This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13369-022-07292-5.

The impact of COVID-19 on the doctor-patient relationship in China

A strong doctor-patient relationship (DPR) is crucial to the effectiveness of treatment. It is imperative to maintain a good DPR during treatment. During 2019, Coronavirus Disease 2019 (COVID-19) brought new challenges to already difficult doctor-patient relationships. This paper summarized the current state of the DPR, compared the changes between China and other countries after the outbreak of COVID-19, and listed the solutions proposed by various countries. Finally, the author suggested some solutions in order to improve the DPR according to China's own circumstances.