jmetaB03609d73da76f33cc410b174252c738d481ff6b4e1c2e65fee374b169f9d8cebd9@631ad085bb5f3d4e7077c362fe9bc47b8532fb5ae611165bcb7ddb8845e682eerss.item metarss.netMÔk<item><title>Apps Put a Psychiatrist in Your Pocket</title><link>https://spectrum.ieee.org/mood-tracker</link><description><![CDATA[ <img src="https://spectrum.ieee.org/media-library/illustration-of-a-person-holding-a-phone-with-many-bubbles-floating-around-them.png?id=52260117&width=1200&height=600&coordinates=0%2C839%2C0%2C839"/><br/><br/><p> <strong>Nearly every day since</strong> she was a child, Alex Leow, a psychiatrist and computer scientist at the University of Illinois Chicago, has played the piano. Some days she plays well, and other days her tempo lags and her fingers hit the wrong keys. Over the years, she noticed a pattern: How well she plays depends on her mood. A bad mood or lack of sleep almost always leads to sluggish, mistake-prone music. </p><p> In 2015, Leow realized that a similar pattern might be true for typing. She wondered if she could help people with psychiatric conditions track their moods by collecting data about their typing style from their phones. She decided to turn her idea into an app. </p><p> After conducting a pilot study, in 2018 Leow launched <a href="https://www.biaffect.com/" rel="noopener noreferrer" target="_blank"><u>BiAffect</u></a>, a research app that aims to understand mood-related symptoms of bipolar disorder through keyboard dynamics and sensor data from usersâ smartphones. Now in use by more than 2,700 people who have volunteered their data to the project, the app tracks typing speed and accuracy by swapping the phoneâs onscreen keyboard with its own nearly identical one. </p><p> The software then generates feedback for users, such as a graph displaying hourly keyboard activity. Researchers get access to the donated data from usersâ phones, which they use to develop and test machine learning algorithms that interpret data for clinical use. One of the things Leowâs team has observed: When people are manicâa state of being overly excited that accompanies bipolar disorderâthey type âferociously fast,â says Leow. </p><p class="shortcode-media shortcode-media-rebelmouse-image rm-resized-container rm-resized-container-25 rm-float-left" data-rm-resized-container="25%" style="float: left;"> <img alt="Three screenshots of BiAffects app show a healthy patient, with a range of time spent lying down, a bipolar patient with little time spent prone, and one with depression and significant time spent lying down." class="rm-shortcode rm-resized-image" data-rm-shortcode-id="df63c94f9e0b8b7470e6accb44a871ce" data-rm-shortcode-name="rebelmouse-image" id="27200" loading="lazy" src="https://spectrum.ieee.org/media-library/three-screenshots-of-biaffects-app-show-a-healthy-patient-with-a-range-of-time-spent-lying-down-a-bipolar-patient-with-little.jpg?id=52263413&width=980" style="max-width: 100%"/> <small class="image-media media-caption" placeholder="Add Photo Caption..." style="max-width: 100%;">Compared to a healthy user [top], a person experiencing symptoms of bipolar disorder [middle] or depression [bottom] may use their phone more than usual and late at night. BiAffect measures phone usage and orientation to help track those symptoms. </small><small class="image-media media-photo-credit" placeholder="Add Photo Credit..." style="max-width: 100%;">BiAffect</small> </p><p> BiAffect is one of the few mental-health apps that take a passive approach to collecting data from a phone to make inferences about usersâ mental states. (Leow suspects that fewer than a dozen are currently available to consumers.) These apps run in the background on smartphones, collecting different sets of data not only on typing but also on the userâs movements, screen time, call and text frequency, and GPS location to monitor social activity and sleep patterns. If an app detects an abrupt change in behavior, indicating a potentially hazardous shift in mental state, it could be set up to alert the user, a caretaker, or a physician. </p><p> Such apps canât legally claim to treat or diagnose disease, at least in the United States. Nevertheless, many researchers and people with mental illness have been using them as tools to track signs of depression, schizophrenia, anxiety, and bipolar disorder. âThereâs tremendous, immediate clinical value in helping people feel better today by integrating these signals into mental-health care,â says <a href="https://corporatelearning.hms.harvard.edu/faculty-staff/john-torous" rel="noopener noreferrer" target="_blank">John Torous</a>, director of digital psychiatry at Beth Israel Deaconess Medical Center, in Boston. Globally, <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders" rel="noopener noreferrer" target="_blank"><u>one in 8 people</u></a> live with a mental illness, including <a href="https://pubmed.ncbi.nlm.nih.gov/37815563/" rel="noopener noreferrer" target="_blank"><u>40 million </u></a>with bipolar disorder. </p><p> These apps differ from most of the more than <a href="https://www.psychiatry.org/news-room/apa-blogs/mental-health-apps-evidence-not-so-plentiful" rel="noopener noreferrer" target="_blank"><u>10,000</u></a> mental-health and mood apps available, which typically ask users to actively log how theyâre feeling, help users connect to providers, or encourage mindfulness. The popular apps <a href="https://daylio.net/" rel="noopener noreferrer" target="_blank"><u>Daylio</u></a> and <a href="https://apps.apple.com/us/app/moodnotes-mood-tracker/id1019230398" rel="noopener noreferrer" target="_blank"><u>Moodnotes</u></a>, for example, require journaling or rating symptoms. This approach requires more of the userâs time and may make these apps less appealing for long-term use. A 2019 <a href="https://www.jmir.org/2019/9/e14567/" rel="noopener noreferrer" target="_blank"><u>study</u></a> found that among 22 mood-tracking apps, the median user-retention rate was just 6.1 percent at 30 days of use. </p><p class="pull-quote">App developers are trying to avoid the pitfalls of previous smartphone-psychiatry startups, some of which oversold their capabilities before validating their technologies.</p><p> But despite <a href="https://spectrum.ieee.org/a-software-shrink-apps-and-wearables-could-usher-in-an-era-of-digital-psychiatry" target="_self"><u>years of research on passive mental-health apps</u></a>, their success is far from guaranteed. App developers are trying to avoid the pitfalls of previous smartphone psychiatry startups, some of which oversold their capabilities before validating their technologies. For example, Mindstrong was an early startup with an app that tracked taps, swipes, and keystrokes to identify digital biomarkers of cognitive function. The company raised US $160 million in funding from investors, including $100 million in 2020 alone, and went bankrupt in February 2023. </p><p> Mindstrong may have folded because the company was operating on a different timeline from the research, according to an <a href="https://www.statnews.com/2023/02/28/mindstrong-mental-health-technology-prediction/#:~:text=An%20examination%20by%20STAT%20shows,the%20investors%20who%20back%20it." rel="noopener noreferrer" target="_blank"> <u>analysis</u></a> by the health-care news website Stat. The slow, methodical pace of science did not match the startupâs need to return profits to its investors quickly, the report found. Mindstrong also struggled to figure out the marketplace and <a href="https://www.statnews.com/2023/02/06/mindstrong-demise-future-mental-health-care/" rel="noopener noreferrer" target="_blank"><u>find enough customers willing to pay for the service</u></a>. âWe were first out of the blocks trying to figure this out,â says <a href="https://www.thomasinselmd.com/about" rel="noopener noreferrer" target="_blank"><u>Thomas Insel</u></a>, a psychiatrist who cofounded Mindstrong. </p><p> Now that the field has completed a âhype cycle,â Torous says, app developers are focused on conducting the research needed to prove their apps can actually help people. âWeâre beginning to put the burden of proof more on those developers and startups, as well as academic teams,â he says. Passive mental-health apps need to prove they can reliably parse the data theyâre collecting, while also addressing serious privacy concerns. </p><h2>Passive sensing catches mood swings early</h2><div class="ieee-sidebar-small"> <h3>Mood Sensors</h3> <p> <strong>Seven metrics apps use to make inferences about your mood</strong> </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of a series of keys. " class="rm-shortcode" data-rm-shortcode-id="8ff9cb99579bc0347599d7c6c60437e7" data-rm-shortcode-name="rebelmouse-image" id="2442b" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-a-series-of-keys.png?id=52263477&width=980"/> <small class="image-media media-photo-credit" placeholder="Add Photo Credit...">All icons: Greg Mably</small></p> <p> <strong>Keyboard dynamics</strong>: Typing speed and accuracy can indicate a lot about a personâs mood. For example, people who are manic often type extremely fast. </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of a pair of curved arrows." class="rm-shortcode" data-rm-shortcode-id="49e0734f912326cc3f704bb58ff9b81c" data-rm-shortcode-name="rebelmouse-image" id="2802a" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-a-pair-of-curved-arrows.png?id=52263488&width=980"/> </p> <p> <strong>Accelerometer: </strong>This sensor tracks how the user is oriented and moving. Lying in bed would suggest a different mood than going for a run. </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of a phone and text bubble icon." class="rm-shortcode" data-rm-shortcode-id="85f5c3951c38f62972d7ccb7566c4aba" data-rm-shortcode-name="rebelmouse-image" id="03e42" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-a-phone-and-text-bubble-icon.png?id=52263480&width=980"/> </p> <p> <strong>Calls and texts:</strong> The frequency of text messages and phone conversations signifies a personâs social isolation or activity, which indicates a certain mood. </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of an arrow pointing downward" class="rm-shortcode" data-rm-shortcode-id="6c0c71bbffdb5ebe7da613175e210688" data-rm-shortcode-name="rebelmouse-image" id="b815a" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-an-arrow-pointing-downward.png?id=52263478&width=980"/> </p> <p> <strong>GPS location: </strong>Travel habits signal a personâs activity level and routine, which offer clues about mood. For example, a person experiencing depression may spend more time at home. </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of a speaker and sound coming off" class="rm-shortcode" data-rm-shortcode-id="9b011057d3ea5c57500b0e78ab05077e" data-rm-shortcode-name="rebelmouse-image" id="6d347" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-a-speaker-and-sound-coming-off.png?id=52263443&width=980"/> </p> <p> <strong>Mic and voice:</strong> Mood can affect how a person speaks. Microphone-based sensing tracks the rhythm and inflection of a personâs voice. </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of multicolored "z's."" class="rm-shortcode" data-rm-shortcode-id="4c3748cd3d8a9b58232396e1b8484ff0" data-rm-shortcode-name="rebelmouse-image" id="dcced" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-multicolored-z-s.png?id=52263438&width=980"/> </p> <p> <strong>Sleep:</strong> Changes in sleep patterns signify a change in mood. Insomnia is a common symptom of bipolar disorder and can trigger or worsen mood disturbances. </p> <p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="An illustration of colored bars." class="rm-shortcode" data-rm-shortcode-id="a8769d8f097a4cd2b3387bfd16e84086" data-rm-shortcode-name="rebelmouse-image" id="cecad" loading="lazy" src="https://spectrum.ieee.org/media-library/an-illustration-of-colored-bars.png?id=52263437&width=980"/> </p> <p> <strong>Screen time: </strong> An increase in the amount of time a person spends on a phone can be a sign of depressive symptoms and can interfere with sleep. </p> </div><p> A crucial component of managing psychiatric illness is tracking changes in mental states that can lead to more severe episodes of the disease. Bipolar disorder, for example, causes intense swings in mood, from extreme highs during periods of mania to extreme lows during periods of depression. Between <a href="https://www.nature.com/articles/s41398-021-01500-w" rel="noopener noreferrer" target="_blank"><u>30 and 50 percent</u></a> of people with bipolar disorder will attempt suicide at least once in their lives. Catching early signs of a mood swing can enable people to take countermeasures or seek help before things get bad.</p><p>But detecting those changes early is hard, especially for people with mental illness. Observations by other people, such as family members, can be subjective, and doctor and counselor sessions are too infrequent. </p><p> Thatâs where apps come in. Algorithms can be trained to spot subtle deviations from a personâs normal routine that might indicate a change in moodâan objective measure based on data, like a diabetic tracking blood sugar. âThe ability to think objectively about my own thinking is really key,â says retired U.S. major general <a href="https://www.generalgreggmartin.com/" target="_blank"><u>Gregg Martin</u></a>, who has bipolar disorder and is an advisor for BiAffect. </p><p> <span></span>The data from passive sensing apps could also be useful to doctors who want to see objective data on their patients in between office visits, or for people transitioning from inpatient to outpatient settings. These apps are âproviding a service that doesnât exist,â says <a href="https://profiles.ucsd.edu/colin.depp" rel="noopener noreferrer" target="_blank"><u>Colin Depp</u></a>, a clinical psychologist and professor at the University of California, San Diego. Providers canât observe their patients around the clock, he says, but smartphone data can help close the gap. </p><p> Depp and his team have developed an app that uses GPS data and microphone-based sensing to determine the frequency of conversations and make inferences about a personâs social interactions and isolation. The app also tracks âlocation entropy,â a metric of how much a user moves around outside of routine locations. When someone is depressed and mostly stays home, location entropy decreases. </p><p> Deppâs team initially developed the app, called <a href="https://clinicaltrials.gov/study/NCT02035202" rel="noopener noreferrer" target="_blank"><u>CBT2go</u></a>, as a way to test the effectiveness of cognitive behavioral therapy in between therapy sessions. The app can now intervene in real time with people experiencing depressive or psychotic symptoms. This feature helps people identify when they feel lonely or agitated so they can apply coping skills theyâve learned in therapy. âWhen people walk out of the therapistâs office or log off, then they kind of forget all that,â Depp says. </p><p> Another passive mental-health-app developer, <a href="https://www.ellipsishealth.com/" rel="noopener noreferrer" target="_blank"><u>Ellipsis Health</u></a> in San Francisco, uses software that takes voice samples collected during telehealth calls to gauge a personâs level of depression, anxiety, and stress symptoms. For each set of symptoms, deep-learning models analyze the personâs words, rhythms, and inflections to generate a score. The scores indicate the severity of the personâs mental distress, and are based on the same scales used in standard clinical evaluations, says Michael Aratow, cofounder and chief medical officer at Ellipsis. </p><p> Aratow says the software works for people of all demographics, without needing to first capture baseline measures of an individualâs voice and speech patterns. âWeâve trained the models in the most difficult use cases,â he says. The company offers its platform, including an app for collecting the voice data, through health-care providers, health systems, and employers; itâs not directly available to consumers. </p><p> In the case of BiAffect, the app can be downloaded for free by the public. Leow and her team are using the app as a research tool in clinical trials sponsored by the U.S. National Institutes of Health. These <a href="https://clinicaltrials.gov/study/NCT04358900" target="_blank"><u>studies</u></a> aim to validate whether the app can reliably monitor mood disorders, and determine whether it could also track <a href="https://clinicaltrials.gov/study/NCT04112368" rel="noopener noreferrer" target="_blank"><u>suicide risk in menstruating women</u></a> and <a href="https://journals.sagepub.com/doi/full/10.1177/20552076221143234" rel="noopener noreferrer" target="_blank"><u>cognition in people with multiple sclerosis</u></a>. </p><p>BiAffectâs software tracks behaviors like hitting the backspace key frequently, which suggests more errors, and an increase in typing â@â symbols and hashtags, which suggest more social media use. The app combines this typing data with information from the phoneâs accelerometer to determine how the user is oriented and movingâfor example, whether the user is likely lying down in bedâwhich yields more clues about mood.</p><p class="shortcode-media shortcode-media-rebelmouse-image"> <img alt="Screenshot of Ellipsis Health sample patient\u2019s case management dashboard with text about the patient\u2019s health and popup window showing high risk score" class="rm-shortcode" data-rm-shortcode-id="912316afef9054a98132f45118e6d8cc" data-rm-shortcode-name="rebelmouse-image" id="996fb" loading="lazy" src="https://spectrum.ieee.org/media-library/screenshot-of-ellipsis-health-sample-patient-u2019s-case-management-dashboard-with-text-about-the-patient-u2019s-health-and-popu.jpg?id=52260434&width=980"/> <small class="image-media media-caption" placeholder="Add Photo Caption...">Ellipsis Health analyzes audio captured during telehealth visits to assign scores for depression, anxiety, and stress.</small><small class="image-media media-photo-credit" placeholder="Add Photo Credit...">Ellipsis Health</small> </p><p>The makers of BiAffect and Ellipsis Health donât claim their apps can treat or diagnose disease. If app developers want to make those claims and sell their product in the United States, they would first have to get regulatory approval from the U.S. Food and Drug Administration. Getting that approval requires rigorous and large-scale clinical trials that most app makers donât have the resources to conduct.<br/></p><h2>Digital-health software depends on quality clinical data</h2><p> The sensing techniques upon which passive apps relyâmeasuring typing dynamics, movement, voice acoustics, and the likeâare well established. But the algorithms used to analyze the data collected by the sensors are still being honed and validated. That process will require considerably more high-quality research among real patient populations. </p><p class="shortcode-media shortcode-media-rebelmouse-image rm-resized-container rm-resized-container-25 rm-float-left" data-rm-resized-container="25%" style="float: left;"> <img alt="Illustration of a hand holding a phone upwards, with many colored bubbles floating around them." class="rm-shortcode rm-resized-image" data-rm-shortcode-id="93e8607adec6b7f8acba6a0afa441ebd" data-rm-shortcode-name="rebelmouse-image" id="5cc15" loading="lazy" src="https://spectrum.ieee.org/media-library/illustration-of-a-hand-holding-a-phone-upwards-with-many-colored-bubbles-floating-around-them.jpg?id=52260452&width=980" style="max-width: 100%"/> <small class="image-media media-photo-credit" placeholder="Add Photo Credit..." style="max-width: 100%;">Greg Mably</small> </p><p> For example, clinical studies that include control or placebo groups are crucial and have been lacking in the past. Without control groups, companies can say their technology is effective âcompared to nothing,â says Torous at Beth Israel. </p><p> Torous and his team aim to build software that is backed by this kind of quality evidence. With participantsâ consent, their app, called <a href="https://www.digitalpsych.org/lamp.html" rel="noopener noreferrer" target="_blank"><u>mindLAMP</u></a>, passively collects data from their screen time and their phoneâs GPS and accelerometer for research use. Itâs also customizable for different diseases, including schizophrenia and bipolar disorder. âItâs a great starting point. But to bring it into the medical context, thereâs a lot of important steps that weâre now in the middle of,â says Torous. Those steps include conducting clinical trials with control groups and testing the technology in different patient populations, he says. </p><p> How the data is collected can make a big difference in the quality of the research. For example, the rate of samplingâhow often a data point is collectedâmatters and must be calibrated for the behavior being studied. Whatâs more, data pulled from real-world environments tends to be âdirty,â with inaccuracies collected by faulty sensors or inconsistencies in how phone sensors initially process data. It takes more work to make sense of this data, says <a href="http://www.caseybennett.com/" rel="noopener noreferrer" target="_blank"><u>Casey Bennett</u></a>, an assistant professor and chair of health informatics at DePaul University, in Chicago, who uses BiAffect data in his research. </p><p> One approach to addressing errors is to integrate multiple sources of data to fill in the gapsâlike combining accelerometer and typing data. In another approach, the BiAffect team is working to correlate real-world information with cleaner lab data collected in a controlled environment where researchers can more easily tell when errors are introduced. </p><p> Who participates in the studies matters too. If participants are limited to a particular geographic area or demographic, itâs unclear whether the results can be applied to the broader population. For example, a night-shift worker will have different activity patterns from those with nine-to-five jobs, and a city dweller may have a different lifestyle from residents of rural areas. </p><p> After the research is done, app developers must figure out a way to integrate their products into real-world medical contexts. One looming question is when and how to intervene when a change in mood is detected. These apps should always be used in concert with a professional and not as a replacement for one, says Torous. Otherwise, the appâs assessments could be dangerous and distressing to users, he says. </p><h2>When mood tracking feels like surveillance</h2><p> No matter how well these passive mood-tracking apps work, gaining trust from potential users may be the biggest stumbling block. Mood tracking could easily feel like surveillance. Thatâs particularly true for people with bipolar or psychotic disorders, where paranoia is part of the illness. </p><p> Keris Myrick, a mental-health advocate, says she finds passive mental-health apps âboth cool and creepy.â Myrick, who is vice president of partnerships and innovation at the mental-health-advocacy organization <a href="https://www.inseparable.us/who-we-are/" rel="noopener noreferrer" target="_blank"><u>Inseparable</u></a>, has used a range of apps to support her mental health as a person with schizophrenia. But when she tested one passive sensing app, she opted to use a dummy phone. âI didnât feel safe with an app company having access to all of that information on my personal phone,â Myrick says. While she was curious to see if her subjective experience matched the appâs objective measurements, the creepiness factor prevented her from using the app enough to find out. </p><p class="pull-quote">Keris Myrick, a mental-health advocate, says she finds passive mental-health apps âboth cool and creepy.â</p><p> Beyond usersâ perception, maintaining true digital privacy is crucial. âDigital footprints are pretty sticky these days,â says <a href="https://ischool.umd.edu/directory/katie-shilton/" rel="noopener noreferrer" target="_blank"> <u>Katie Shilton</u></a>, an associate professor at the University of Maryland focused on social-data science. Itâs important to be transparent about who has access to personal information and what they can do with it, she says. </p><p> âOnce a diagnosis is established, once you are labeled as something, that can affect algorithms in other places in your life,â Shilton says. She cites the misuse of personal data in the <a href="https://www.nytimes.com/2018/04/04/us/politics/cambridge-analytica-scandal-fallout.html" rel="noopener noreferrer" target="_blank"><u>Cambridge Analytica scandal</u></a>, in which the consulting firm collected information from Facebook to target political advertising. Without strong privacy policies, companies producing mental-health apps could similarly sell user dataâand they may be particularly motivated to do so if an app is free to use. </p><p> Conversations about regulating mental-health apps have been ongoing <a href="https://spectrum.ieee.org/the-fda-takes-on-mobile-health-apps" target="_self"><u>for over a decade</u></a>, but a Wild Westâstyle lack of regulation persists in the United States, says Bennett of DePaul University. For example, there arenât yet protections in place to keep insurance companies or employers from penalizing users based on data collected. âIf there arenât legal protections, somebody is going to take this technology and use it for nefarious purposes,â he says. </p><p> Some of these concerns may be mediated by confining all the analysis to a userâs phone, rather than collecting data in a central repository. But decisions about privacy policies and data structures are still up to individual app developers. </p><p> Leow and the BiAffect team are currently working on a new internal version of their app that incorporates natural-language processing and generative AI extensions to analyze usersâ speech. The team is considering commercializing this new version in the future, but only following extensive work with industry partners to ensure strict privacy safeguards are in place. âI really see this as something that people could eventually use,â Leow says. But she acknowledges that researchersâ goals donât always align with the desires of the people who might use these tools. âIt is so important to think about what the users actually want.â <span class="ieee-end-mark"></span> </p>]]></description><pubDate>Sun, 19 May 2024 15:00:02 +0000</pubDate><guid>https://spectrum.ieee.org/mood-tracker</guid><category>Mood tracker</category><category>Mood tracker app</category><category>Mood tracking app</category><category>Digital health</category><category>Digital psychiatry</category><dc:creator>Gwendolyn Rak</dc:creator><media:content medium="image" type="image/png" url="https://spectrum.ieee.org/media-library/illustration-of-a-person-holding-a-phone-with-many-bubbles-floating-around-them.png?id=52260117&width=980"/></item>
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