June 2023

In This Issue: HSR&D Research on Telehealth

Passive Mobile Self-Tracking of Mental Health by Veterans with Serious Mental Illness

Feature Article

Takeaway: Mental health tools are needed that support ongoing assessment, self-management, and interventions for Veterans with serious mental illness. Technologies are available that can passively monitor mental health status and behavior, support wellness and recovery, and quickly detect mental health problems. This project is studying passive mobile sensing using smart phone data to detect changes in behavior and predict worsening of illness in real time.

Serious mental illness is common, often disabling, and requires years of assessment and adjustments in treatment. Stress or reduced treatment adherence can lead to rapid worsening in symptoms and functioning with consequences that include relapse, job loss, homelessness, incarceration, hospitalization, and suicide. In usual care, patient visits and communication with clinicians are relatively infrequent, leaving little opportunity to rapidly adjust treatments. Tools are needed that support assessment and intervention by passively monitoring the mental health status of patients with serious mental illness, allowing them to self-track their behaviors and predict worsening of mental health.

This ongoing project (October 2020–April 2024) is studying passive mobile sensing with Veterans in treatment for serious mental illness using smart phone data that models changes in behaviors such as sociability, activity, and sleep. These provide warning signs of relapse and can identify and predict worsening of illness in real time. This project is:

• Designing user-centered, passive mobile self-tracking to support Veterans’ management of their mental health.
• Studying the feasibility, acceptability, and safety of passive self-tracking of mental health that includes feedback of mental health status to the Veteran.
• Using mobile sensor and phone use data, along with weekly interviews, to develop individualized estimates of sociability, activities, and sleep.
• Studying the predictive value of using data on sociability, activities, and sleep to identify exacerbations of psychiatric symptoms.

Methods

To inform informatics development and implementation, the project team conducted interviews with mental health clinicians, and focus groups and usability tests with patients. A clinical trial is being conducted with Veterans who are providing data from their mobile devices, responding to surveys, and using a dashboard. Analytic models are being constructed using machine learning methods.

Early Findings

• Many Veterans with serious mental illness would like to have informatics tools that support illness management and recovery. While there are challenges to informatics adoption in this population, these can be anticipated and addressed.
• Clinicians are supportive of technological approaches. An important challenge is incorporating informatics into workflow, ensuring that clinicians can operate at the top of their skill set.
• People with chronic illnesses self-manage their illnesses on a daily basis. Passive mobile data has the potential to support illness self-management and allow organizations to provide proactive supports.

Sample Dashboard Photos

Anticipated Impact

If this project meets its intended goals, VA will have a mobile analytics platform that continuously monitors the behaviors and symptoms of Veterans with serious mental illness, supporting assessments, treatments, and outcomes.

Principal Investigator

Alexander S. Young, MD, MSHS, is associate director of Health Services at VA’s VISN 22 Mental Illness Research, Education, and Clinical Center and affiliated with HSR&D’s Center for the Study of Healthcare Innovation, Implementation, and Policy in Los Angeles.

Related research by this investigator

Young AS, Choi A, Cannedy S, et al. Passive mobile self-tracking of mental health by Veterans with serious mental illness: Protocol for a user-centered design and prospective cohort study. JMIR Research Protocols. August 5, 2022;11(8):e39010.

Young AS, Cohen AN, Niv N, et al. Mobile phone and smartphone use by people with serious mental illness. Psychiatric Services. March 1, 2020;71(3):280–283.

View study abstract.