iOS和Android上的本机心理健康监控:现在不是时候了吗?

Vinith Johnson and Girish Subramanyan

Vinith Johnson和 Girish Subramanyan

Imagine for a minute that it’s morning and you’ve just woken up. Bleary-eyed still, you fumble for your smartphone. Because, well, what else would you do? It’s 2020, we’re currently in the middle of a global pandemic and, for better or for worse, approximately 81% of the U.S. population owns a smartphone.¹

想象一下,现在是早晨,您刚刚醒来。 眼睛仍然有些失血,您为智能手机而摸索。 因为,那么,您还要做什么? 到2020年,我们目前正处于全球大流行的中期,无论好坏,大约81%的美国人口拥有智能手机。¹

Maybe it’s hiding under your pillow. Or maybe it’s sitting on your nightstand. Perhaps, without realizing it, you’d slipped it under your bed before you dozed off for good last night.

也许它藏在你的枕头下。 也许它正坐在您的床头柜上。 也许,没有意识到这一点,您就把它滑到床下,直到昨晚睡个好觉。

Let’s all just admit it: smartphones are so ubiquitous now that it’s hardly a newsworthy phenomenon. Intentionally or otherwise, they’ve evolved to be our digital tethers to the world outside of our homes and our minds.

让我们所有人都承认这一点:智能手机现在无处不在,几乎没有新闻价值。 有意或无意地,它们已发展成为我们在家中和思想之外的世界的数字系绳。

Fortunately, most of the time, the damned thing leaves you alone. Sure, you get those annoying notifications whenever you receive a new communication in one of your apps: Messages, Gmail, Facebook, WhatsApp, etc. But, generally speaking — and to the extent that you believe you have any choice in the matter at all — you can decide what to do with your device when you wake up.

幸运的是,大多数时候,该死的事情让你一个人呆着。 当然,每当您在以下一个应用程序中收到新的通讯时,您都会收到这些烦人的通知:邮件,Gmail,Facebook,WhatsApp等。但是,一般而言,在一定程度上,您认为自己在此事上有任何选择—您可以决定醒来时如何处理设备。

You can stare at it and silently vow, “No. Not today,” opting instead to start your morning off on a healthy note, perhaps with a serving of chia seed pudding and twenty minutes of Vipassana meditation. Or, you could unlock it (now, simply by glancing at the screen no less) and launch the app of your choice, be it Instagram, Snapchat or TikTok.

您可以凝视它,然后静静地发誓:“不。 不是今天,”相反,选择以健康的气息开始您的早晨,也许要品尝一份正大种子布丁和二十分钟的内观禅修。 或者,您可以解锁它(现在,只需浏览一下屏幕即可)并启动您选择的应用程序,无论是Instagram,Snapchat还是TikTok。

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It’s likely that this app — or series of apps — that you first check every morning is something else entirely. Looked at in a certain way, there’s potentially so much bad news in the world these days, one couldn’t be blamed for indulging in a little early morning digital escapism.

您每天早晨首先检查的这个应用程序(或一系列应用程序)可能完全是另外一回事。 从某种角度看,这些天世界上可能有太多坏消息,不能因为沉迷于早早的数字逃避现实而受到指责。

But, what if when you first wake up, Siri or Google Assistant, without being annoyingly intrusive, greets you silently on your smartphone’s screen and inquires: “How’s it going, Sam? How are you feeling today?” And you had the opportunity to respond, say, by selecting one of several canned responses, such as:

但是,如果您第一次醒来时,Siri或Google Assistant却没有被烦人的干扰,却在智能手机的屏幕上默默地打招呼并询问:“ Sam怎么样了? 你今天感觉如何?” 这样,您就有机会通过选择以下几种罐头响应之一来做出响应,例如:

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And, for the sake of discussion, let’s say you click on “Not so well, actually” and a smart chat ensues between you and said smart assistant.

并且,为了讨论起见,假设您单击“实际上不太好”,然后您与所说的智能助手之间便进行了智能聊天。

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Being well-designed and meticulously tailored for empathy, this assistant would channel its inner therapist and respond sympathetically: “I’m sorry to hear that. Can you tell me more about how you’re feeling? (Pick one)”

经过精心设计和精心设计以适应共鸣,这位助理将引导其内在的治疗师并同情地回应:“我很遗憾听到这个消息。 您能告诉我更多有关您的感觉吗? (选一个)”

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And, let’s say this morning you tap “Down”(because it feels like the most accurate descriptor, given how you are feeling right now).

并且,假设今天早上您点按“向下”(因为考虑到您现在的感觉,这感觉像是最准确的描述符)。

And, now let’s suppose that the smart assistant responds: “Tell me about that. What’s getting you down?”

而且,现在让我们假设智能助手做出了响应:“告诉我。 是什么让你沮丧?”

Assured that your boss has no way of eavesdropping on this conversation (you’re still in your bed, after all), you thumb type: “I can’t stand my job anymore! Even if it’s all on Zoom these days, it’s still meaningless, soul-crushing work.”

确保您的老板无法窃听此对话(毕竟您仍在床上),然后拇指键入:“我再也受不了了! 即使这些天都在Zoom上,它仍然是毫无意义的令人伤心的工作。”

Harnessing existing technology known as natural language processing, the smart assistant responds, “Sorry to hear that your work is getting you down, Sam. Would you like to try a mental exercise to help you feel better?”

聪明的助手利用称为自然语言处理的现有技术,回答道:“很抱歉听到您的工作令您失望,Sam。 您想尝试一下心理锻炼来帮助您感觉好些吗?”

Today, you decide that you don’t have the time.

今天,您决定没有时间。

But, for the sake of argument, imagine that every morning, Siri or Google Assistant — or whatever catchy name this AI chatbot would be given — checks in with you in the manner described and for more days than not, over the past week, you respond that you feel “Down” or “Depressed”. And on the eighth day, when you again click on “Depressed”, the assistant responds: “I’m sorry to hear that, Sam. Would you like to look into whether you might be clinically depressed?”

但是,为争辩起见,想象一下,每天早上,Siri或Google Assistant(或该AI聊天机器人会使用的俗名)都会按照所述方式与您签到,过去一周里,您花费了不多的时间回答您感到“沮丧”或“沮丧”。 第八天,当您再次单击“沮丧”时,助手将回答:“很抱歉,萨姆。 您想研究一下您是否可能在临床上感到沮丧吗?”

Curious, you tap “Yes”.

很好奇,您点击“是”。

You’re now presented with some basic information about clinical depression (Major Depressive Episode) and how it’s different from the downs of what we colloquially refer to as the ordinary “ups and downs of life”. Intrigued, you read on. You’re dismayed to find that you recognize in yourself many of the symptoms of depression. The smart assistant asks you, then, whether you would like to take a screening for clinical depression.

现在,您将获得一些有关临床抑郁症(严重抑郁症)的基本信息,以及它与我们俗称的“生活的起伏”的区别。 感兴趣,您继续阅读。 您很沮丧地发现自己能识别出许多抑郁症的症状。 然后,智能助手会询问您是否要对临床抑郁症进行筛查。

You decide that you have a little extra time on your hands this morning and that, for the sake of your mental health, you ought to. So, you tap:

您决定今天早上有一点多余的时间,为了精神健康,应该这样做。 因此,您点击:

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Without so much as even getting out of your own bed, you are now being administered an engaging version of the Patient Health Questionnaire-9 (PHQ-9), a validated screening instrument for clinical depression that is used not infrequently in primary care settings and mental health practices.

现在,您甚至都无法起床,而现在正在为您提供有吸引力的版本的《患者健康状况调查表9》(PHQ-9),这是一种经过验证的临床抑郁症筛查工具,在基层医疗机构中很少使用。精神卫生习惯。

It’s possible, in other words, that elementary software could be packaged with your smartphone that would allow you to monitor your mental health and decide whether you need to be screened for depression (or any number of mental disorders) utilizing validated clinical instruments. Since a sizable majority of the U.S. population owns a smartphone and a single mental illness — depression — is now the most common cause of disability worldwide, an interesting question arises: Why isn’t this a feature that you can opt into already?

换句话说,您的智能手机可能会打包基本软件,使您可以监控心理健康并决定是否需要使用经过验证的临床工具筛查是否患有抑郁症(或任何数量的精神障碍)。 由于美国人口中的绝大多数拥有智能手机,而一种精神疾病(抑郁症)现在已成为全球范围内导致残疾的最常见原因,因此出现了一个有趣的问题:为什么您不可以选择使用此功能?

IN THE SAN Francisco Bay Area, where we reside, many of us have, for some time now, jumped onto the “quantified self” bandwagon; we routinely monitor different aspects of our health using smart devices, including wearables such as a FitBit and Apple Watch: the number of steps we take daily, how much and how vigorously we exercise otherwise, what our heart rate is throughout the day, and how much and how solidly we sleep each night. Some among the more fanatical of us might even prick our fingertips each morning to measure fasting glucose to determine where along the path to insulin resistance we are.

在我们居住的旧金山湾区,我们中的许多人已经有一段时间了,跳上了“量化的自我”潮流。 我们会定期使用智能设备(包括FitBit和Apple Watch等可穿戴设备)监测健康状况的各个方面:我们每天采取的步骤数,进行其他运动的程度和强度,全天的心率以及如何每晚我们睡得多么牢固。 我们当中一些更狂热的人甚至每天早晨甚至可以刺我们的指尖,以测量空腹血糖,从而确定我们在胰岛素抵抗路上所处的位置。

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Last year, Apple offered women the ability to track and predict their menstrual cycles with the new Cycle Tracking feature in their Health app. Undeniably, various aspects of quantified health are now embedded into the major smartphone operating systems.

去年,苹果为妇女提供跟踪和新预测其月经周期的能力周期 跟踪他们的健康应用程序的功能。 不可否认,量化健康状况的各个方面现已嵌入到主要的智能手机操作系统中。

So, why is it that we’re only allowed to track the number of steps we’ve taken or hours we’ve slept or stairs we’ve climbed? Other than measuring basic parameters of sleep, why is it that we still don’t have an easy way to track our mental health or receive any kind of coaching to improve it? What if Apple and Google — the current market leaders of smartphone operating systems in the U.S.² — had the moxie to take the plunge into mental health? What kind of societal impact would it have?

那么,为什么只允许我们跟踪已执行的步数或睡眠时间或爬楼梯的原因呢? 除了测量睡眠的基本参数外,为什么我们仍然没有一种简单的方法来跟踪我们的心理健康或接受任何形式的指导以改善其心理状况? 如果苹果和谷歌(目前是美国智能手机操作系统的当前市场领导者)又不由自主地投入精神健康领域,该怎么办? 它会产生什么样的社会影响?

What if Apple and Google — the current market leaders of smartphone operating systems in the U.S.— had the moxie to take the plunge into mental health?

如果苹果和谷歌(目前是美国智能手机操作系统的当前市场领导者)如果不愿意让精神健康陷入困境该怎么办?

THE STATISTIC IS similar and sobering to many of us who spend our lives immersed in some way, shape or form studying or treating mental illness: approximately one in five adults in the U.S. suffers from a mental disorder on an annual basis.³ This​ represents approximately 46.6 million adults annually in the U.S. Among them, almost a quarter have what is considered a serious mental illness — or approximately 10 million adults annually.³

对于我们许多以某种方式,身材或形式沉浸在研究或治疗精神疾病中的人们来说,这种情况是令人震惊的。在美国,每年约有五分之一的成年人患有精神疾病。³在美国,每年约有4,660万成年人,其中,近四分之一患有严重的精神疾病,即每年约有1,000万成年人。³

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What’s striking, however, is that 57% of U.S. adults with any mental disorder do not receive treatment annually. And, even among those with serious mental disorders, over one-third — 35% — do not receive treatment on an annual basis.³

然而,令人惊讶的是,美国患有精神疾病的成年人中有57%的人每年没有得到治疗。 而且,即使是患有严重精神疾病的人,也有超过三分之一(35%)的人每年没有得到治疗。³

Naturally, you might wonder: who are these individuals who do not receive treatment and why on Earth don’t they?

自然,您可能会怀疑:这些人谁没有得到治疗,为什么他们在地球上没有?

DR. RON KESSLER, the McNeil​ Family Professor of Health Care Policy at​ Harvard Medical School, an epidemiologist who has made a career for himself studying the social determinants of health, tackled this question head on in several studies that used face-to-face interviews as part of large mental health surveys.⁴

博士 哈佛医学院麦克尼尔家庭健康护理政策家庭教授RON KESSLER是一名流行病学家,他一直致力于研究健康的社会决定因素,并在数项使用面对面访谈的研究中解决了这个问题作为大型心理健康调查的一部分。⁴

When Kessler and his colleagues analyzed their data, what they found was that among people with a mental illness who decided to not seek treatment, the main reasons cited were:

当凯斯勒(Kessler)和他的同事分析他们的数据时,他们发现,在决定不寻求治疗的患有精神疾病的人中,所列举的主要原因是:

  1. Low-perceived need for treatment

    对治疗的需求低
  2. Desire to handle problems on one’s own even when there was a perceived need for treatment

    即使有明显的治疗需要,也希望自己解决问题

This was the case particularly for people with mild to moderate mental distress and less so for people with more serious mental distress. A conclusion of these papers was that improving population mental health literacy may be more important even than improving external (or structural) barriers to treatment.

对于轻度至中度精神困扰的人尤其如此,而对于精神较重的人则更少。 这些论文的结论是,提高人群的心理健康素养可能甚至比改善治疗的外部(或结构性)障碍更为重要。

Given these findings, one could ask: is it feasible for smartphones to help bridge the gap between the burden of mental illness in the population at large and the segment of this population that actually receives treatment? In other words, can smartphones help screen for mental disorders and then provide treatments directly or refer individuals to treatment? Additionally, could smartphones educate individuals about mental disorders and mental well-being in the way that the FitBit app does for physical health? (For the uninitiated, FitBit presents small snippets of information about physical health that motivate individuals to make incremental changes in their lives in order to achieve better health outcomes).

鉴于这些发现,人们可能会问:智能手机是否可以帮助弥合整个人口的精神疾病负担与实际接受治疗的这一人群之间的差距? 换句话说,智能手机能否帮助筛查精神障碍,然后直接提供治疗或让个人接受治疗? 此外,智能手机是否可以像FitBit应用程序为身体健康所做的方式来教育个人有关精神障碍和心理健康的信息? (对于刚起步的人,FitBit会提供有关身体健康的小片段信息,这些信息片段会激励个人改变生活,以实现更好的健康结果)。

We feel that these are important and highly topical questions to contemplate. Consider, for example, the disconcerting finding that the incidence of mental illness in the U.S. appears to be increasing, particularly among adolescents. According to a report from the Centers of Disease Control and Prevention, the suicide rate among individuals in the U.S. between the ages of 10 and 24 rose by an alarming 56% from 2007 to 2017.⁵ Indeed, suicide is now the leading cause of death in the U.S. in this age group. Suicide rates have climbed nearly 30 percent from 1999 to 2016 among Americans of all ages and ethnic backgrounds⁵. Additionally, based on a survey conducted by the CDC, 40% of U.S. adults reported struggling with mental health or substance abuse associated with COVID-19.⁶

我们认为这些是需要考虑的重要且高度主题性的问题。 例如,考虑令人不安的发现,即在美国,精神疾病的发病率似乎正在上升,尤其是在青少年中。 根据美国疾病控制与预防中心的报告,从2007年到2017年,美国10至24岁之间的自杀率上升了惊人的56%.⁵实际上,自杀现在是导致死亡的主要原因在美国这个年龄段的人群中。 从1999年到2016年,所有年龄段和种族背景的美国人的自杀率都上升了近30%。 此外,根据美国疾病预防控制中心(CDC)进行的一项调查,美国40%的成年人报告称与COVID-19相关的精神健康或药物滥用困扰。

40% of U.S. adults reported struggling with mental health or substance abuse associated with COVID-19.

美国40%的成年人报告说与COVID-19相关的精神健康或药物滥用困扰。

What’s more, pre-pandemic, there existed a popular notion that technology use — especially smartphone use — and social media engagement were contributing to these findings. It’s a hypothesis that was bantered about regularly in lay and professional audiences. Correlational data across multiple studies confirm a linkage between screen time and social media use, but data supporting a directly causal role of technology in harming mental health is scant.⁷ Unfortunately, it’s the case that designing methodologically sound studies to evaluate causality has proven to be difficult.

更重要的是,在大流行前,人们普遍认为技术的使用(尤其是智能手机的使用)和社交媒体的参与推动了这些发现。 这个假设经常在非专业和专业观众中开玩笑。 多项研究的相关数据证实了筛选时间与社交媒体使用之间的联系,但是支持技术在损害心理健康方面具有直接因果作用的数据很少。⁷不幸的是,事实证明,设计合理的方法研究以评估因果关系难。

Nevertheless, given the findings that have been published and the notions percolating through the national dialogue about the harmful effects of technology on mental health, we wondered if there weren’t a moral imperative for technology companies to help mitigate any impending mental health crisis by investing in potential technology-enabled solutions.

但是,鉴于已经发表的研究结果以及关于技术对精神健康的有害影响的全国对话所渗透的观念,我们想知道科技公司是否没有道德上的必要性,以通过投资来减轻任何迫在眉睫的精神健康危机在潜在的技术支持的解决方案中。

Smartphones, by virtue of their ubiquity, can directly liaise with users who may have mental disorders by offering technology-enhanced solutions that provide digital empathy, for example. Such a solution might look like an artificial intelligence-enabled chatbot that checks in regularly on the self-reported mental state of the user as described in the example at the beginning of this article. Indeed, several such AI chatbots exist currently: Woebot, the brainchild of Dr. Alison Darcy, a clinical research psychologist at Stanford and founder and CEO of Woebot Labs, a San Francisco startup; Tess by X2AI, another startup located in San Francisco; and Youper, yet another San Francisco startup in the AI mental health chatbot space. Smartphones are also capable of passively collecting many types of data from user devices to make a composite assessment of their mental state, a concept that has been coined “digital phenotyping”.⁸A digital mental health technology startup that is currently employing passive digital phenotyping as part of its care delivery platform is Mountain View-based Mindstrong Health.

智能手机凭借其普遍存在,可以通过提供技术增强型解决方案(例如提供数字移情功能)直接与可能患有精神疾病的用户联系。 这样的解决方案可能看起来像启用了人工智能的聊天机器人,该机器人定期检查用户的自我报告的心理状态,如本文开头的示例中所述。 的确,当前有几个这样的AI聊天机器人Woebot ,斯坦福大学临床研究心理学家,旧金山创业公司Woebot Labs的创始人兼首席执行官Alison Darcy博士的发明; 位于旧金山的另一家创业公司X2AI的 Tess; 和Youper ,这是AI心理健康聊天机器人领域的另一家旧金山创业公司。 智能手机还能够被动地从用户设备收集多种类型的数据,以对其心理状态进行综合评估,这一概念被称为“数字表型”。⁸数字心理健康技术初创公司目前正在采用被动式数字表型作为其一部分。其护理交付平台的一部分是基于Mountain View的Mindstrong Health

Smartphones are also capable of passively collecting many types of data from user devices to make a composite assessment of their mental state, a concept that has been coined “digital phenotyping”.

智能手机还能够被动地从用户设备收集多种类型的数据,以对其精神状态进行综合评估,这一概念被称为“数字表型”。

With these two categories of information — user self-report and passively acquired information about the individual — smartphones are indeed well-positioned to monitor users for underlying mental disorders and, importantly, to offer screenings, education, and referral services at a population level in a way that has not been possible before.

有了这两类信息(用户自我报告和被动获取的有关个人的信息),智能手机的确可以很好地定位以监视用户的潜在精神障碍,并且重要的是,可以提供智能手机在人群中的筛查,教育和推荐服务。一种前所未有的方式。

Other smartphone-based interventions such as applications that provide Cognitive Behavioral Therapy (CBT) have been on the market for a few years now.⁹ These apps deliver a kind of didactic psychotherapy that is among the best-studied and most efficacious psychotherapies for a number of mental disorders. In turn, they empower individuals to learn how to manage their own stress, anxiety and depression. In practice, for more moderate to severe conditions, CBT is often paired with pharmaceutical interventions during treatment by mental health clinicians. However, the efficacy of these apps (as opposed to therapist-delivered CBT, itself) has been periodically questioned by the scientific community, which has called for better studies of these apps versus standardly-administered CBT.¹⁰

其他基于智能手机的干预措施(例如提供认知行为疗法(CBT)的应用程序)已经投放市场了几年。⁹这些应用程序提供了一种有说服力的心理疗法,在许多研究中都得到了最深入的研究和最有效的心理治疗。精神障碍。 反过来,它们使个人能够学习如何处理自己的压力,焦虑和沮丧。 在实践中,对于更中度到重度的疾病,在心理健康医生的治疗过程中,经常将CBT与药物干预相结合。 但是,科学界定期质疑这些应用程序的功效(与治疗师提供的CBT本身相反),科学界呼吁与标准管理的CBT相比,对这些应用程序进行更好的研究。¹

Additionally, the integration of these apps for patient treatment within the larger healthcare system could also stand to be improved. Along with developing a better evidence base through well-designed and rigorous clinical trials and better integration, there are other concerns that we identify here that presumably discourage smartphone operating system leaders such as Apple and Google from offering routine mental health monitoring on their platforms.

此外,在大型医疗保健系统中将这些应用程序用于患者治疗的集成也有望得到改善。 除了通过精心设计和严格的临床试验以及更好的集成来建立更好的证据基础之外,我们在这里还发现了其他一些问题,这些问题可能阻止了苹果和谷歌等智能手机操作系统的领导者在其平台上提供常规的心理健康监测。

Chief among these concerns, we believe, is the potentially calamitous intersection of the stigma associated with mental disorders and the never quite certain privacy of user data. Despite numerous efforts to fight negative bias, the unfortunate reality is that people living with mental disorders continue to face societal stigma.¹¹ While​ people on the whole seem to be more willing to accept the biological underpinnings of mental disorders and to seek treatment relative to times past, a multitude of people still have a negative view of those suffering from mental disorders. For centuries on end, as Foucault elaborated upon in his doctoral dissertation, human beings have been particularly and harshly judgmental towards those who struggle with mental disorders, especially those illnesses that present with severely non-normative thoughts and behaviors.¹²

我们认为,这些担忧中最主要的是与精神障碍相关的污名的潜在灾难性交集,以及用户数据从未完全确定的隐私。 尽管人们为消除负面偏见做出了许多努力,但不幸的现实是,患有精神疾病的人继续面对社会的污名化.¹虽然总体上,人们似乎更愿意接受精神障碍的生物学基础并寻求相对于精神障碍的治疗过去,许多人仍然对患有精神疾病的人持消极看法。 几个世纪以来,正如福柯在其博士论文中所阐述的那样,人类对于那些患有精神疾病的人,尤其是那些表现出严重非规范性思想和行为的疾病,特别苛刻。

Human beings have been particularly and harshly judgmental towards those who struggle with mental disorders, especially those illnesses that present with severely non-normative thoughts and behaviors.

对于那些患有精神疾病的人,尤其是那些表现出严重非规范性思想和行为的疾病,人类尤其严厉地判断。

Here, we believe that well-regarded celebrities who live with mental disorders and who partner with technology companies as part of advertising campaigns to discuss how they use technology-enabled solutions to monitor and treat their mental disorders have the potential to make ground-breaking and lasting changes to the ways in which society, at large, views these conditions and those afflicted by them.

在这里,我们相信,患有精神障碍并与技术公司合作作为广告活动一部分的备受推崇的名人讨论他们如何使用技术支持的解决方案来监测和治疗其精神障碍,有可能使突破性进展和对整个社会如何看待这些状况及其所困扰的状况的持久变化。

Imagine, for example, if Mariah Carey or Catherine Zeta-Jones did commercials for Apple Watch or HealthKit discussing how they track their moods and sleep cycles to monitor their bipolar disorders. Or Brad Pitt talked about how he used his Google Pixel to get over his alcohol addiction or Serena Williams discussed how she used her smartphone to voice journal and receive CBT to stave off depression. It’s easy to imagine that this kind of bold campaign could have a trickle down effect into the conversations of everyday people.

例如,想象一下,如果玛丽亚·凯里(Mariah Carey)或凯瑟琳·泽塔·琼斯(Catherine Zeta-Jones)为Apple Watch或HealthKit做广告,讨论他们如何跟踪自己的情绪和睡眠周期以监测其躁郁症。 或是布拉德·皮特(Brad Pitt)谈论了他如何使用Google Pixel来解决酗酒问题,或者瑟琳娜·威廉姆斯(Serena Williams)讨论了她如何使用智能手机为日记本发声并获得CBT来缓解抑郁症。 不难想象,这种大胆的竞选活动可能会在日常的谈话中产生a滴效应。

The concern over data privacy, as an extension of the concern about judgment and stigma, is another towering consideration in the willingness of people to use their smartphones to monitor and treat underlying mental disorders and more routine mental distress. Not so distant scandals involving Facebook and Cambridge Analytica are painful reminders of large-scale misuse of personally identifiable data that were detailed enough to create psychographic profiles of individuals.¹³ Earlier in 2019, a Florida judge’s decision to grant a warrant allowing a law enforcement agency to override customers’ opt-out agreements and search one of the world’s largest online DNA databases brings about another cautionary tale​ to the willingness of individuals to trust technology companies with sensitive health information.¹⁴

对数据隐私的关注是对判断和污名的关注的延伸,这是人们愿意使用智能手机监控和治疗潜在的精神障碍和更多常规精神困扰的另一个高耸的考虑。 涉及Facebook和Cambridge Analytica的丑闻并不是那么遥远,令人痛苦地提醒人们,大规模滥用了个人身份数据,这些数据足够详细地创建了个人的心理特征。¹³在2019年早些时候,佛罗里达州法官决定授予允许执法机构使用的手令。超越客户的选择退出协议并搜索世界上最大的在线DNA数据库之一,这又引发了另一个警示性故事,使个人愿意信任具有敏感健康信息的技术公司.¹⁴

The concern over data privacy is another towering consideration in the willingness of people to use their smartphones to monitor and treat underlying mental disorders.

对数据隐私的关注是人们愿意使用智能手机监控和治疗潜在的精神障碍的另一个重要考虑因素。

Privacy has become increasingly imperative in recent years due to the exponential rate of technology integration in healthcare. Smartphones can track substantially larger amounts of information about a patient than ever before and store vast quantities of sensitive information in an easy-to-access repositories such as a cloud-based service, making the data vulnerable to security breaches.​

近年来,由于医疗保健中技术集成的指数级增长,隐私变得越来越重要。 智能手机可以追踪比以往任何时候都更多的患者信息,并将大量敏感信息存储在易于访问的存储库(例如基于云的服务)中,使数据容易受到安全漏洞的侵害。

Yet another potential impediment to the routine use of smartphones to natively monitor mental health status relates to the putative​ liability to which technology companies may unwittingly expose themselves. Consider the potential liability that a tech company could face if, for example, a user answered question #9 (the question that inquires about suicidal ideations) affirmatively on the PHQ-9 screening instrument and then ended up successfully committing suicide.

常规使用智能手机本地监控心理健康状况的另一个潜在障碍与技术公司可能不知不觉地暴露自己的推定责任有关。 考虑一下,例如,如果用户在PHQ-9筛查工具上肯定地回答了问题9(询问自杀观念的问题),然后最终成功自杀,科技公司可能面临的潜在责任。

This particular quandary also touches upon another matter: response bias in self-reported data. Response bias is a phenomenon when patients respond to questions in ways that do not coincide with actual intent. Thus, response bias can be viewed as a potential threat against having valid and accurate data about an individual’s mood at any given point.

这个特殊的难题也涉及到另一件事:自我报告数据中的响应偏差。 当患者以与实际意图不一致的方式回答问题时,React偏差是一种现象。 因此,React偏见可被视为潜在威胁,即在任何给定时间点都无法获得有关个人情绪的有效和准确数据。

Finally, for smartphone OS leaders, operating systems are not the only technology component in the spotlight. Device manufacturers seem to prefer linking their health kits to hardware that they — or third parties — also manufacture (e.g. wearables such as watches). However, at the time of writing this article, it’s the case, unfortunately, that we still don’t have any consumer-grade wearable devices that accurately gauge mental states.

最后,对于智能手机操作系统的领导者来说,操作系统并不是唯一吸引人们关注的技术组件。 设备制造商似乎更喜欢将其医疗包链接到他们(或第三方)也制造的硬件(例如,手表等可穿戴设备)。 但是,不幸的是,在撰写本文时,情况仍然是我们还没有任何可准确衡量精神状态的消费级可穿戴设备。

Advancements in non-invasive technology such as electroencephalography (EEG), are now just beginning to be used to augment the diagnosis of some mental disorders or, in any case, provide a biosignature, as it were, for various mental disorders. Dr. Amit Etkin, a researcher at Stanford University in the Department of Psychiatry, and colleagues recently published the results of a EEG-based study that examined the likelihood of an individual with Major Depressive Disorder responding to a selective serotonin reuptake inhibitor (SSRI) antidepressant, sertraline (brand name Zoloft) as part of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinic Care (EMBARC) study.¹⁵ In this study, a machine learning algorithm trained on resting state EEG data was able to predict with impressive accuracy which patients with depression would respond to sertraline versus placebo, thus establishing a sertraline response-specific EEG signature in Major Depressive Disorder.

现在,非侵入性技术(例如脑电图(EEG))的进步才刚刚开始用于增强对某些精神障碍的诊断,或者无论如何提供各种精神障碍的生物特征。 斯坦福大学精神病学系研究员Amit Etkin博士及其同事最近发表了一项基于EEG的研究结果,该研究检查了重度抑郁症患者对选择性5-羟色胺再摄取抑制剂(SSRI)抗抑郁药作出React的可能性,舍曲林(商品名Zoloft)作为“临床护理中抗抑郁React的建立者和生物特征的建立”研究(EMBARC)的一部分。¹⁵在这项研究中,以静息状态EEG数据训练的机器学习算法能够准确地预测哪些患者抑郁症患者对舍曲林和安慰剂的React较慢,从而在严重抑郁症患者中建立了舍曲林React特异性的脑电信号。

Dr. Etkin recently established Alto Neuroscience, a startup to develop brain biomarker assays that can be employed in clinical practice to tailor treatment. On the subject of EEG, several companies have developed low-cost, wearable EEG devices, but these consumer-grade devices have failed to generate the type of data resolution that is required to diagnose or monitor mood effectively. In 2020, where wearable devices are a $37 billion industry, companies are hesitant to jump into a market where the consumer grade hardware ecosystem has not evolved enough to keep up with developments in the software realm.¹⁶

Etkin博士最近成立了Alto Neuroscience ,这是一家开发大脑生物标志物测定方法的初创公司,该方法可在临床实践中用于定制治疗方法。 关于EEG,几家公司开发了低成本,可穿戴式EEG设备,但是这些消费级设备未能生成有效诊断或监视情绪所需的数据分辨率类型。 2020年,可穿戴设备的产值达到370亿美元,各公司不愿进入这样一个市场:消费级硬件生态系统的发展不足以跟上软件领域的发展。¹⁶

Today, a hundreds of startups sit squarely in the mental health-tech space (in spite of the aforementioned concerns), hoping to sell the technology-enabled solutions for mental health that they have developed, including smartphone-based solutions such as AI chatbots for mental health and digital cognitive behavioral therapy (CBT) apps.

如今,数百家初创公司正坐在心理健康技术领域(尽管有上述担忧),希望出售他们开发的基于技术的心理健康解决方案,包括基于智能手机的解决方案,例如用于AI聊天机器人的解决方案。心理健康和数字认知行为疗法(CBT)应用程序。

For profit services such as Psychology Today, ZocDoc,Yelp and Google Reviews aim to help treatment-seeking individuals make informed decisions about treatment providers. Other for profit ventures aim to directly connect treatment-seeking individuals with vetted providers. In the Bay Area, digital mental health technology startups catering to the employee mental health space include Lyra Health,Ginger.io and Modern Health.

对于利润的服务,如心理学 ÿ今天 ZocDoc Yelp的谷歌评论旨在帮助寻求治疗的人做出关于治疗提供明智的决定。 其他营利性企业旨在将寻求治疗的个人与经过审查的提供者直接联系起来。 在海湾地区,数字心理健康科技创业迎合员工的心理健康空间包括大号 YRA健康 Ginger.i Ò 现代保健

Yet other digital mental health startups here have taken a different approach, by providing direct-to-consumer solutions. These startups include Two Chairs, Meru Health,​ Reflect, Mood Health, Cerebral Health and Brightside Health,​ each of which provide their customers access to their vetted mental health treatment providers.

通过提供直接面向消费者的解决方案,这里的其他数字心理健康初创公司采取了不同的方法。 这些创业公司包括繁体 Ø主席 中号 ERU健康REFLEC 牛逼 情绪健康脑健康 rightside健康其中的每一个提供给他们的审核心理健康治疗提供他们的客户访问。

While these efforts are to be applauded for their specific contributions in helping improve the mental health delivery apparatus in the country, what’s clear, unfortunately, from the mile high perspective, is that society at large would be much better served were larger players such as Google and Apple, companies that have a disproportionately large market share of smartphone user attention, actively involved in architecting portals of entry for native mental health monitoring, evaluation and treatment.

尽管这些努力在帮助改善该国的精神卫生设施方面做出了具体贡献,这些努力值得称赞,但不幸的是,从英里远的角度来看,很明显,如果像Google这样的大公司,整个社会将得到更好的服务苹果公司(Apple)在智能手机用户关注方面拥有不成比例的巨大市场份额,并积极参与架构入口门户以进行本地心理健康监测,评估和治疗。

Society at large would be much better served were larger players such as Google and Apple, companies that have a disproportionately large market share of smartphone user attention, actively involved in architecting portals of entry for native mental health monitoring, evaluation and treatment.

如果更大的参与者(例如Google和Apple)在智能手机用户关注方面的市场份额过大,并且积极参与构建用于本地心理健康监测,评估和治疗的入口门户,则对整个社会的服务会更好。

Such a step would not only empower individuals with smartphones (i.e. nearly everyone in the U.S.) to take charge of their mental well being, but also enable (and encourage) startups to build products that would reach a much larger segment of the population and, consequently, have a greater impact on society. When these two behemoths of the technology world decide to take this step forward, they will play a crucial role in improving society’s attitude towards digital mental health evaluations and treatment.

这样的步骤不仅可以使拥有智能手机的个人(即美国的几乎每个人)都能掌控自己的心理健康,还可以使(并鼓励)初创公司开发能够覆盖更大范围人群的产品,并且,因此,对社会产生更大的影响。 当科技界的这两个庞然大物决定迈出这一步时,它们将在改善社会对数字心理健康评估和治疗的态度中发挥关键作用。

The question, of course, is just when, and under what circumstances, these giants would be willing to tread that much further into the realm of healthcare and which R&D projects and acquisitions they prioritize.

当然,问题在于这些巨头何时,在什么情况下愿意将其进一步扩展到医疗保健领域,以及他们优先考虑哪些研发项目和收购。

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REFERENCES:

参考资料:

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翻译自: https://medium.com/the-innovation/native-mental-health-monitoring-on-ios-and-android-isnt-it-time-already-4032d3155cf9

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