How Technology Could Progress Adolescent Psychiatry

Anna Van Meter, PhD

Source: Matthew Libassi/Feinstein Institutes for Medical Research, used with permission

Technology is transforming every aspect of our lives and that is especially true for the field of psychiatry. As we have explored extensively in this blog, there has been great progress in our ability to use natural language processing, social media activity, and other digital tools to inform assessments and diagnostic procedures and support clinical care decisions.

To learn more about the potential new tech advances hold, particularly in adolescent psychiatry, I sat down with Anna Van Meter, Ph.D., whose research focus is around pediatric mood disorders.

Michael: In my opinion, technology holds the key for the field of psychiatry, do you agree or disagree? And how so?

Anna: I think technology has a lot of potential to improve psychiatric care. We are already seeing benefits in our ability to understand patients’ symptoms and to deliver care to people who might not otherwise get it. I think there is still likely to be a role for traditional approaches, including clinical interviews and face-to-face psychotherapy, but technology can augment these approaches to make them more effective and accessible.

Michael: Tell us about your focus of research?

Anna: My research is focused primarily on young people who are affected by mood disorders and associated mental health concerns like sleep problems and suicidal thoughts or behaviors. I am particularly interested in using technology to identify young people who are experiencing these problems as early as possible, so that action can be taken before their mental health and well-being are significantly disrupted. For many young people, a population that is among those least likely to make use of traditional mental health services, I also see an important role for technology in the delivery of services outside of a medical office.

Michael: You work with a certain patient population (adolescents) why do you focus on the younger patients?

Anna: Adolescence is the developmental period during which most mood disorders start. Often, mood disorders, including depression and bipolar disorder, are chronic and affect people through adulthood. I am motivated to help people as close to the onset of their symptoms as possible. We have the greatest opportunity to change the course of the illness and ensure a good quality of life by intervening early.

Michael: Tell me about your IMPACT lab?

Anna: IMPACT stands for Investigating Mood Pathology: Assessment, Course, Treatment. The name reflects my interest in addressing both the assessment and treatment of mood disorders over time. These are episodic illnesses, so long-term monitoring and proactive intervention are important. My lab includes both undergraduate and graduate student mentees, as well as paid research coordinators. I enjoy mentoring and find that my work benefits from the fresh perspectives the students and coordinators bring. We also collaborate with a number of other groups, which creates great opportunities to learn and to expand the number of people we can help.

Michael: Give some examples of some exciting advancements?

Anna: One advancement I am excited about is digital phenotyping. This refers to the use of individuals’ digital data to create a profile of their typical behavioral patterns. This can be done with different types of data; for me, data from smartphone sensors are among the most promising. People are rarely far from their phones, and we can infer a lot from how they interact with their phones. For example, just tracking when someone’s phone is typically locked or unlocked can provide a proxy for when they are awake or asleep. If someone’s phone is usually locked from midnight to 7 am and then suddenly the phone is only locked from 3 am to 7 am, you might be alerted to a sleep problem indicative of a change in mental status, which would be important to follow up on. This can all be done with no burden to the patient, which makes it much easier to monitor symptoms and intervene as needed over a long period of time.

Michael: Look into your crystal ball, where is the field of psychiatry headed?

Anna: A lot of resources – both time and money – have been invested in better understanding the etiology of mental health disorders, with mixed success. I expect that biologically oriented endeavors, like neuroimaging and genetics, will continue, but I am hopeful that other avenues that have the potential to help people more immediately – like technology – will start to get more attention.

Michael: Paint an ideal scenario of how technology will blend with clinical care in the future?

Anna: I don’t think we know enough yet to predict how technology will best inform clinical care, but I hope that the data we collect will inform the process. Rather than investigators deciding what should be used and trying to impose that on others, we need to pay attention to what patients and clinicians want and what technology-based tools fit easily in their day-to-day. We could find something that provides perfect data about patient well-being, but if patients won’t use it or clinicians can’t easily use it to inform practice, it’s not going to make a real difference.

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Michael: Any issues or concerns that we as a field need to overcome?

Anna: Stigma is a major obstacle in mental healthcare. It affects individuals’ willingness to seek care, it affects the level of resources invested, it affects our ability to get a collateral report, it affects institutions’ willingness to make research opportunities available, the list goes on. Therapy apps (as one example) have capitalized on this by providing care to people from the privacy of their homes and, in most cases, with primarily text-based support, which seems anonymous. However, the data privacy practices of these and other mental health apps are often poor; what may seem anonymous is actually less private than going to an office and meeting with a professional. There needs to be regulations guiding how individuals’ data can be used. For those of us who work within healthcare systems, there are a lot of rules, but the average consumer isn’t paying attention to the origin of a product or app. If industry mishandles people’s data, it won’t be long before trust in mental health technology erodes. This will make it harder for everyone to do this important work.

This brings up another obstacle related to differences in the approach taken by industry versus academia – tech companies move quickly and focus on making “sticky” products that people want to use. I many cases, this can be at direct odds with what is most beneficial to, or respectful of, the patient. In academia, we tend to focus on efficacy, which is important, but things move at a snail’s pace and are often obsolete (in terms of the technology used) by the time enough evidence is collected to support use. Collaboration between industry and academia is likely to produce the best results.

Michael: What keeps you going? Can you share an example of a patient or success that motivates you?

Anna: One of my past patients had a significant influence on my career trajectory. She traveled a couple of hours with her mom to the hospital where I worked, so that she could receive a specific type of therapy that was developed for youth with bipolar disorder. This was a huge inconvenience for the family, but in a way, they were “lucky” because they could drive to get help. A majority of young people with bipolar disorder don’t live within driving distance of a medical center that provides therapy specifically developed to address their symptoms. This got me thinking about how we could leverage technology to make evidence-based treatments more widely accessible. This same patient also talked at times about how unlucky she felt – how she was the only person she knew experiencing mental health concerns.

As a clinician, I was certain she did know others experiencing mental health symptoms, but stigma keeps people from talking about their experiences and exacerbates isolation. These conversations directly influenced one of my ongoing projects, which aims to provide a safe online community for youth with mental health disorders. The feedback from members of the community about how much they appreciate being able to talk with peers and get support from others who understand what they’re going through has been extremely rewarding.

Michael: What’s next for you – where is your research headed?

Anna: I am in the early stages of a couple of projects that use technology to identify signals of impending symptom onset in adolescents, so I will be kept busy with those for the next couple of years. I am also on the Board of Directors of Helping Give Away Psychological Science, which is a non-profit dedicated to making evidence-based assessment and treatment accessible to improve community mental health. I am trying to think carefully about potential impact when I choose where to spend my time. There are so many interesting things to be involved in, but many are limited in terms of how they can help people suffering now, I try to imagine the person who could benefit before saying yes.