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Beyond the Wrist: Rethinking Wearable Technology for Mental Health

US News & World Report - Health logo US News & World Report - Health 8/10/2018 David Levine
Woman at home using Augmented Reality Glasses at home: "The best evidence for using virtual reality is pain distraction and for relaxation." © (Getty Images) "The best evidence for using virtual reality is pain distraction and for relaxation."

You may not remember 2014 as a particularly revolutionary year, but in the digital world, it was. At the annual Consumer Electronics Show that year, the smartwatch made its breakthrough, to the extent that there was a special Wrist Revolution section showcasing watches with the power and capacity of smartphones. A year later, Apple released the Apple Watch, which quickly became the market leader.

Since then so-called wearable technology for the wrist, including watches and fitness bands, has, well, grabbed Americans by the wrist. According to a 2016 essay in PLOS Medicine, 1 in 6 U.S. consumers used wearable technology, and it predicted that 110 million fitness devices were likely to be sold in 2018.

That same essay asked, "Will consumer wearable technology ever be adopted or accepted by the medical community?" It answered its own question with a resounding yes: "consumer health wearables are predicted to become the next 'Dr. Google.'"

[Read: Wearable Technology Gets Emotional.]

Indeed, the tech doctor has moved well beyond the wrist. Wearable devices that are able to track a growing number of medically important vital signs, risk factors and personal habits can be found in clothing, jewelry and monitors affixed to the skin. Even smartphones can track such information, and while not technically a "wearable," it's hard to find anyone who doesn't have a smartphone in his or her pocket, purse or hand nearly every waking hour of the day and on the nightstand every sleeping hour of the night.

Tracking Important Health Data

The data from wearable devices is being used to help physicians treat patients with a number of diseases, including mental illness. In one of many examples, researchers looked at people with serious mental illness, including schizophrenia spectrum and mood disorders. This population tends to be less physically active than the general population, and increased activity has been shown to improve symptoms of the diseases. The researchers enrolled participants with serious mental illness in a six-month intervention; some were given a Fitbit activity tracking device and smartphone to use. Those participants said the devices helped encourage them to be more physically active and reach daily step goals by allowing them to self-monitor their activity.

[See: Apps to Mind Your Mental Health.]

The PLOS Medicine essay listed several ways that wearables can track important data:

  • Heart rate: an oximeter built into a ring
  • Muscle activity: an electronic sensor embedded into clothing
  • Stress: an electodermal sensor incorporated into a wristband
  • Female fertility: body temperature tracking
  • Levels of mental attention: non-gelled electroencephalogram, or EEG, electrodes
  • Levels of social interaction: proximity detections to others using Bluetooth- or Wi-Fi-enabled devices

Dr. John Torous, a staff psychiatrist and faculty member of Harvard Medical School, is elbows deep in mental health technology. He is director of the digital psychiatry division at Beth Israel Deaconess Medical Center, leads the American Psychiatric Association's work group on the evaluation of smartphone apps and is an advisor to the smartphone mood study within the National Institutes of Health's All of Us research program, which is gathering data from 1 million or more people living in the U.S. to promote research and improve health care. Torous says that while smartwatches and fitness bands are useful, "the challenge is, as everyone knows from personal experience, you put it on your wrist, and after how many weeks does it end up in your drawer?"

The difficulty in maintaining adherence to wearables, Torous says, can be overcome by making them less of a choice. At a panel at the APA's annual meeting, he chaired a session looking at new approached to wearables. One panelist, from a pharmaceutical company, announced FDA approval for the first digital pill, with a computer chip to monitor stomach acid levels and send the data to a smartphone. "I can imagine that as an interesting way to track how you take medication," he says. Another device, from a company called Spire, markets activity trackers that stick to clothing. "They assured me it survives the dry cleaning test," he says.

[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]

A 'Treasure Trove' of Diagnostic Data

Several tech companies make smart skin patches to deliver medicines such as insulin or pain relievers or to test for relapse of substance abuse, says Dr. Steven Chan, a psychiatrist at the University of California—San Francisco who researches health information technologies and the digital health industry. And coming soon to a psychiatrist's office near you: augmented reality glasses. "The best evidence for using virtual reality is pain distraction and for relaxation," he says. It could also test how patients respond to triggers for, say, alcohol use or anxiety in public speaking.

Heart rate is among the most interesting pieces of data for Dr. Peter Yellowlees, a professor of psychiatry at the University of California—Davis. Research finds that heart rate varies over a 24-hour cycle and that there is a secondary, background rhythm that can be picked up over longer monitoring periods. "A lot of research is looking into, could you measure mood on this secondary rhythm? That is actually quite promising," says Yellowlees, who is also vice president of the American Telemedicine Association.

Yellowlees also foresees improvements in facial, voice and movement recognition software as critical mental health tools because some mental illnesses are correlated to changes in the face, the voice and physical movement. "The big new data will be video data. That will be really interesting in the mental health world," he says. "I can easily see the day where I would ask someone with schizophrenia or autism to bring videos of them at work and play their whole lives – and they will have them. We all have tons of videos available, and that is a treasure trove of future diagnostic assessment."

Copyright 2017 U.S. News & World Report


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