By Dr. Alaa Abd-Alrazaq, Arfan Ahmed, Mowafa Househ
Information and communication technologies (ICTs) are one of the many interventions available to support adolescents living with a psychological disorder. The World Health Organization (WHO) has developed guidelines for adolescent mental health, which include advice for mental health organizations to exploit ICTs for providing mental health interventions. These technologies come in several forms and provide both benefits and challenges.
Telemedicine is a technological approach that has the potential to increase the access of adolescents to mental health professionals, especially rural youth living in both developed and developing countries. It is also a promising technology for people who do not have the time or money for face-to-face appointments or are afraid of the stigma. The technology may be used for providing several psychiatric services, including consultations, diagnosing, therapy, patient education, and medication management. However, there is minimal evidence for the effectiveness of telemedicine in diagnosing or treating adolescent mental health. Further, there is doubt about the effectiveness of telemedicine for follow-up therapy or emergencies and its ability to create a personal and empathetic atmosphere.
Mobile applications, which are implemented on smartphones or tablets, have the potential to improve the quality and accessibility of mental health. In recent years, the number of mobile apps in the field of mental health has increased dramatically. Mental health apps can be used for self-management, therapy, diagnosis, education, training, and counseling. They offer several benefits, such as anonymity, convenience, accessibility, constant availability, and cheapness. However, numerous mental health apps provide non-evidence-based interventions, and there is a lack of evidence to support their effectiveness for children and youths. Moreover, some mental health apps have contained harmful content.
Wearables are used for monitoring mental states and detecting early warning signs of relapse through continuously and passively collecting objective biometrics such as heart rate, breathing, body temperature, physical activity, speech, movement, and sleeping. They are usually based on sensors embedded in smartphones, wristwatches, earrings, rings, glasses, clothing, and mobile devices. Sensors could be microphones, touch screens, cameras, accelerometers, altimeters, gyroscopes, thermometers, or electromyography sensors, to name a few. Wearables acquire huge, objective, and continuous data; are usually comfortable for patients; allow users and healthcare providers to have immediate access to data; can assess different biometrics simultaneously, and are usually affordable and widely available. The main shortcoming of wearables is that acquired data need expensive storage and sophisticated analysis tools to extract useful information.
Artificial intelligence (AI) methods are used to build models that can detect those who are at high risk or show any symptoms of possible mental disorders or to predict therapeutic responses. For instance, in 2017, Facebook launched an ambitious initiative to prevent suicide through AI. Predictive analytics would be used to recognize a pattern of suicidal thoughts from posts to develop a model that can detect people at increased risk for suicide, which would then send resources and contact them to intervene effectively in time. The main challenge of conducting predictive analytics in mental health is the unique, multivariate, and multimodal nature of mental disorders, where countless variables in several levels (e.g., biological, intrapsychic, interpersonal, and sociocultural) are required to build a predictive model for a particular aspect of a mental disorder. There is also a major problem of usage of personal data without consent, the lack of transparency for validating the algorithms, and the problem of false-positive and false-negatives in detecting conditions.
Further, AI is utilized in developing chatbots for mental health. Given that chatbot users communicate with a machine instead of a human, chatbots may be appropriate for those who find it difficult to disclose their mental issues to a clinician or caregiver due to stigmatization. Chatbots can be used for several purposes in mental health: therapy, training, screening, education, self-management, counseling, and diagnosing. Utilizing AI in chatbots may enable them to develop their own rules; thereby, they may generate inappropriate responses that may harm users. This is what happened to Microsoft’s Tay chatbot on Twitter, which was tricked by users to start insulting them, and this led Microsoft to take it down after only 16 hours. Another challenge in developing AI chatbots is the need for vast data sets to train them.
Virtual reality (VR) and augmented reality (AR) have great potential to understand, assess, and treat adolescent mental health problems. While VR immerses users in a computer-generated interactive world, AR merges computer-generated stimuli (e.g., graphics, sounds, information) with the real world. With VR and AR, patients are exposed gradually to different situations in a reproducible and controllable way and are trained on how to deal with them based on evidence-based psychological interventions. VR and AR are considered safe and affordable alternatives to impractical, risky, and expensive interventions (e.g., treatments of driving, and flight phobia). These technologies can be used for managing people with a phobia, post-traumatic stress disorder, autism spectrum disorders, psychotic disorders, and anxiety disorders. Although the effectiveness of VR in treating adults with mental health problems has been supported by many studies, much work is needed to support the effectiveness of VR in adolescent mental health. VA and AR may cause side effects (e.g., nausea, imbalance, and motion sickness) and harm, especially those who have panic attacks, heart disease, and epilepsy.
ICTs have the potential to address stigma and social isolation in adolescents with mental disorders and the inaccessibility of mental health services through social media platforms. Adolescents with mental health problems can use social media (e.g., Facebook, Twitter, Instagram, YouTube) to express their feelings, thoughts, and illness experiences, to seek advice, and to support each other. A survey showed that adolescents with mental disorders are more likely to convey their personal opinions via blogging and to make friendships on social media in comparison with those who do not have mental disorders. However, they are considered the most common source of cyberbullying among adolescents. Further, adolescents may get unreliable advice from peers on social media, which may cause harm to them. There is also a risk that adolescents become over-reliance on online friendships, thereby affecting their communications in offline environments.
Initially developed for entertainment, games are now considered a valuable support in various areas such as education, advertising, and simulation training. Serious games can be defined as a specific type of game whose primary purpose is beyond pure entertainment. Traditional therapy in the form of conversations, questionnaires, and observations are often perceived as inconvenient among young patients as adolescents may struggle to communicate their feelings, thoughts, and emotions due to development constraints. They may also lack the ability to accept that they suffer from unhealthy or problematic behavior. Adolescents feel uncomfortable talking to strangers about their problems, putting their trust in a therapist, and engaging in meaningful conversation can be a lengthy process while often returning low success rates. Ironically, studies have highlighted the use of games and moreover technology in general as a cause for concern for mental health issues due to their addictive nature.
Digital tools offer a vast potential to improve adolescent mental health. However, much of the research within this domain lacks scientific rigor, and more work is needed to establish an evidence-based functionality that can be used effectively within clinical practice. Furthermore, using digital tools in adolescent mental health may create a digital divide, where individuals who cannot use or do not have access to digital tools will not benefit from them for their mental health.