Search

Introduction Mental illness affects approximately one in five persons in any given year and is the leading cause of disability worldwide. (1-3) Nevertheless, there are approximately nine specialty care providers [...], The application of digital technology to psychiatry research is rapidly leading to new discoveries and capabilities in the field of mobile health. However, the increase in opportunities to passively collect vast amounts of detailed information on study participants coupled with advances in statistical techniques that enable machine learning models to process such information has raised novel ethical dilemmas regarding researchers' duties to: (i) monitor adverse events and intervene accordingly; (ii) obtain fully informed, voluntary consent; (iii) protect the privacy of participants; and (iv) increase the transparency of powerful, machine learning models to ensure they can be applied ethically and fairly in psychiatric care. This review highlights emerging ethical challenges and unresolved ethical questions in mobile health research and provides recommendations on how mobile health researchers can address these issues in practice. Ultimately, the hope is that this review will facilitate continued discussion on how to achieve best practice in mobile health research within psychiatry. L'application des technologies numeriques a la recherche psychiatrique entraine rapidement de nouvelles decouvertes et capacites en matiere de sante mobile. Cependant, la multiplication des opportunites de recueillir passivement d'immenses quantites d'informations detaillees sur les participants aux etudes combinee aux progres des techniques statistiques permettant aux modeles d'apprentissage automatique de traiter de telles informations a souleve de nouveaux dilemmes ethiques concernant l'obligation des chercheurs: (i) de surveiller les effets indesirables et d'intervenir en consequence; (ii) d'obtenir un consentement pleinement eclaire et volontaire; (iii) de proteger la vie privee des participants; et enfin, (iv) d'ameliorer la transparence des puissants modeles d'apprentissage automatique afin de garantir une application ethique et impartiale dans le domaine des soins psychiatriques. Ce rapport identifie les defis qui en decoulent ainsi que les questions ethiques non resolues en matiere de sante mobile. Il formule egalement des recommandations sur la facon dont les chercheurs en sante mobile peuvent resoudre ces problemes dans la pratique. A terme, nous esperons que ce rapport favorisera la poursuite des discussions portant sur les moyens de definir des methodes de recherche adequates pour la sante mobile en psychiatrie. La aplicacion de la tecnologia digital a la investigacion en psiquiatria esta conduciendo rapidamente a descubrimientos y capacidades nuevas en el ambito de la salud movil. No obstante, el incremento de las oportunidades para recopilar pasivamente grandes volumenes de informacion detallada sobre los participantes en los estudios, junto con los avances en las tecnicas de estadistica que permiten a los modelos de aprendizaje automatico procesar tal informacion, ha planteado nuevos dilemas eticos relativos a los deberes de los investigadores: (i) hacer un seguimiento de los eventos adversos e intervenir en consecuencia; (ii) obtener un consentimiento voluntario plenamente informado; (iii) proteger la privacidad de los participantes; y (iv) aumentar la transparencia de los modelos potentes de aprendizaje automatico para asegurar que puedan aplicarse de manera etica y justa en la atencion psiquiatrica. En este analisis se destacan tanto los desafios eticos nuevos como las cuestiones eticas aun sin resolver en la investigacion sobre la salud movil y se formulan recomendaciones sobre como los investigadores de la salud movil pueden abordar dichas cuestiones en la practica. En ultima instancia, se espera que este analisis facilite un debate continuo sobre como lograr las mejores practicas en la investigacion de la salud movil dentro de la psiquiatria.

Researchers, clinicians and patients are increasingly using real-time monitoring methods to understand and predict suicidal thoughts and behaviours. These methods involve frequently assessing suicidal thoughts, but it is not known whether asking about suicide repeatedly is iatrogenic. We tested two questions about this approach: (a) does repeatedly assessing suicidal thinking over short periods of time increase suicidal thinking, and (b) is more frequent assessment of suicidal thinking associated with more severe suicidal thinking? In a real-time monitoring study (n = 101 participants, n = 12 793 surveys), we found no evidence to support the notion that repeated assessment of suicidal thoughts is iatrogenic. [ABSTRACT FROM AUTHOR]

Adolescent decision-making has been described as impulsive and suboptimal in the presence of incentives. In this study we examined the neural substrates of adolescent decision-making using a perceptual discrimination task for which small and large rewards were associated with correctly detecting the direction of motion of a cloud of moving dots. Adults showed a reward bias of faster reaction times on trials for which the direction of motion was associated with a large reward. Adolescents, in contrast, were slower to make decisions on trials associated with large rewards. This behavioral pattern in adolescents was paralleled by greater recruitment of fronto-parietal regions important in representing the accumulation of evidence sufficient for selecting one choice over its alternative and the certainty of that choice. The findings suggest that when large incentives are dependent on performance, adolescents may require more evidence to accumulate prior to responding, to be certain to maximize their gains. Adults, in contrast, appear to be quicker in evaluating the evidence for a decision when primed by rewards. Overall these findings suggest that rather than reacting hastily, adolescents can be incentivized to take more time to make decisions when large rewards are at stake., Psychology

Background: Wearable physiological monitoring devices enable the continuous measurement of human behavior and psychophysiology in the real world. Although such monitors are promising, their availability does not guarantee that participants will continuously wear and interact with them, especially during times of psychological distress. Objective: This study aimed to evaluate the feasibility and acceptability of using a wearable behavioral and physiological monitor, the Empatica E4, to continuously assess a group of suicidal adolescent inpatients. Methods: Participants (n=50 adolescent inpatients) were asked to wear an Empatica E4 on their wrist for the duration of their inpatient stay. In addition to assessing behavioral metadata (eg, hours worn per day), we also used qualitative interviews and self-report measures to assess participants' experience of wearing the monitor. Results: Results supported the feasibility and acceptability of this approach. Participants wore the monitor for an average of 18 hours a day and reported that despite sometimes finding the monitor uncomfortable, they did not mind wearing it. Many of the participants noted that the part of the study they enjoyed most was contributing to scientific understanding, especially if it could help people similar to them in the future. Conclusions: These findings provide promising support for using wearable monitors in clinical samples in future studies, especially if participants are invested in being part of a research study. [ABSTRACT FROM AUTHOR]

Background: Smartphone-based monitoring in natural settings provides opportunities to monitor mental health behaviors, including suicidal thoughts and behaviors. To date, most suicidal thoughts and behaviors research using smartphones has primarily relied on collecting so-called "active" data, requiring participants to engage by completing surveys. Data collected passively from smartphone sensors and logs may offer an objectively measured representation of an individual's behavior, including smartphone screen time., Objective: This study aims to present methods for identifying screen-on bouts and deriving screen time characteristics from passively collected smartphone state logs and to estimate daily smartphone screen time in people with suicidal thinking, providing a more reliable alternative to traditional self-report., Methods: Participants (N=126; median age 22, IQR 16-33 years) installed the Beiwe app (Harvard University) on their smartphones, which passively collected phone state logs for up to 6 months after discharge from an inpatient psychiatric unit (adolescents) or emergency department visit (adults). We derived daily screen time measures from these logs, including screen-on time, screen-on bout duration, screen-off bout duration, and screen-on bout count. We estimated the mean of these measures across age subgroups (adults and adolescents), phone operating systems (Android and iOS), and monitoring stages after the discharge (first 4 weeks vs subsequent weeks). We evaluated the sensitivity of daily screen time measures to changes in the parameters of the screen-on bout identification method. Additionally, we estimated the impact of a daylight time change on minute-level screen time using function-on-scalar generalized linear mixed-effects regression., Results: The median monitoring period was 169 (IQR 42-169) days. For adolescents and adults, mean daily screen-on time was 254.6 (95% CI 231.4-277.7) and 271.0 (95% CI 252.2-289.8) minutes, mean daily screen-on bout duration was 4.233 (95% CI 3.565-4.902) and 4.998 (95% CI 4.455-5.541) minutes, mean daily screen-off bout duration was 25.90 (95% CI 20.09-31.71) and 26.90 (95% CI 22.18-31.66) minutes, and mean daily screen-on bout count (natural logarithm transformed) was 4.192 (95% CI 4.041-4.343) and 4.090 (95% CI 3.968-4.213), respectively; there were no significant differences between smartphone operating systems (all P values were >.05). The daily measures were not significantly different for the first 4 weeks compared to the fifth week onward (all P values were >.05), except average screen-on bout in adults (P value = .018). Our sensitivity analysis indicated that in the screen-on bout identification method, the cap on an individual screen-on bout duration has a substantial effect on the resulting daily screen time measures. We observed time windows with a statistically significant effect of daylight time change on screen-on time (based on 95% joint confidence intervals bands), plausibly attributable to sleep time adjustments related to clock changes., Conclusions: Passively collected phone logs offer an alternative to self-report measures for studying smartphone screen time characteristics in people with suicidal thinking. Our work demonstrates the feasibility of this approach, opening doors for further research on the associations between daily screen time, mental health, and other factors., (© Marta Karas, Debbie Huang, Zachary Clement, Alexander J Millner, Evan M Kleiman, Kate H Bentley, Kelly L Zuromski, Rebecca G Fortgang, Dylan DeMarco, Adam Haim, Abigail Donovan, Ralph J Buonopane, Suzanne A Bird, Jordan W Smoller, Matthew K Nock, Jukka-Pekka Onnela. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

Background: Wearable physiological monitoring devices enable the continuous measurement of human behavior and psychophysiology in the real world. Although such monitors are promising, their availability does not guarantee that participants will continuously wear and interact with them, especially during times of psychological distress., Objective: This study aimed to evaluate the feasibility and acceptability of using a wearable behavioral and physiological monitor, the Empatica E4, to continuously assess a group of suicidal adolescent inpatients., Methods: Participants (n=50 adolescent inpatients) were asked to wear an Empatica E4 on their wrist for the duration of their inpatient stay. In addition to assessing behavioral metadata (eg, hours worn per day), we also used qualitative interviews and self-report measures to assess participants' experience of wearing the monitor., Results: Results supported the feasibility and acceptability of this approach. Participants wore the monitor for an average of 18 hours a day and reported that despite sometimes finding the monitor uncomfortable, they did not mind wearing it. Many of the participants noted that the part of the study they enjoyed most was contributing to scientific understanding, especially if it could help people similar to them in the future., Conclusions: These findings provide promising support for using wearable monitors in clinical samples in future studies, especially if participants are invested in being part of a research study., (©Evan Kleiman, Alexander J Millner, Victoria W Joyce, Carol C Nash, Ralph J Buonopane, Matthew K Nock. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.09.2019.)