From prevention to emotional well-being: a study of innovative methods and programs in the field of psychiatry to maintain mental health

Polina M. Androsova, Boris R. Gragyants, Tatyana N. Khmelevska-ya, Maria I. Meshcherina, Uliana A. Lepikhina. From prevention to emotional well-being: a study of innovative methods and programs in the field of psychiatry to maintain mental health. Cardiometry; Issue No. 30; February 2024; p. 80-84; DOI: 10.18137/cardiometry.2024.30.8084; Available from:

In the modern world, despite the widespread efforts of psychiatrists, statistics illustrate an unfavorable trend: more than 20% of USA population suffer from mental disorders, and about 40% of Russia population have signs of mental health disorders, of which about 5% need professional psychiatric care[1]. At the same time, this problem has significantly worsened after the coronavirus pandemic due to a long lockdown in most countries of the world.

Mental health of the population is an extremely important parameter that determines well–being of society. It is difficult to overestimate the importance of mental disorders treatment since they often become not only the cause of conflicts of varying degrees of development but also crimes [2]. In addition, mental well-being of the population determines the degree to which citizens can participate in production activities, in the effective work of companies of various profiles which affect economic and social relations. Accordingly, preventive measures in the field of preventing the development of mental disorders are directly related to the trends in the development of states as a whole. The emotional well-being of citizens is the basis of stable social relations, and for this reason it is important today to adopt innovations that can reduce social tension in society by providing the necessary specialized psychiatric care to those in need.

To date, the issues of prevention of mental disorders in order to ensure the emotional well-being of patients are quite relevant. The particular complexity of the problem of prevention is due to the fact that there are many factors that negatively affect the psyche of patients and can create a favorable background for development of mental disorders [3].

Although the existence and persistence of differences in mental health and psychiatric care are undeniable, serious debate remains about the primary causes of these differences. Historically the focus was put on individual level factors, especially individual behavior (health preferences, mental health literacy, lack of specialists etc.) [4]. While these factors may be relevant and explain some of the differences in inequality outcomes, focusing solely on individual-level factors ignores the crucial role of social and structural factors that contribute to negative mental health outcomes leading to mental health inequalities.

The importance of social determinants of health and discrimination in a wide range of mental health consequences is increasingly recognized. Extensive studies have been conducted confirming the influence of social determinants of health or conditions in which people are born, grow up, live, work, and age, which are formed by the distribution of money, power and resources [5]. Determinants such as food insecurity, adverse childhood experiences, and other negative factors are most often correlated with mental health risk.

Understanding the causes of differences in mental health is complicated by the fact that social determinants of health and many other factors can act together to cause differences in mental health. Research aimed at understanding or intervening to reduce inequality should address these issues. Examples of factors particularly important for mental health include biological vulnerability, family functioning, social environment, accessibility of services, and quality of care. These examples further illustrate the multi-layered, multidimensional approach needed to conceptualize, measure, and address patient differences.

In addition to developing more effective measures that would be culturally and psychometrically relevant there is also a need to develop and study culturally and linguistically relevant interventions aimed at risk and protection mechanisms [6].

MATERIALS AND METHODS

In the process of writing the study literature reflecting current trends in the field of prevention of the development of mental disorders was analyzed. The data obtained was analyzed and systematized by means of analytical and comparative methods. Based on the results of the analysis, the necessary conclusions were drawn and appropriate recommendations were formulated.

RESULTS

Mental disorders are widespread in society, and there is evidence that there has been a significant increase during the recent pandemic. Every year about one in five people experience mental health problems, and about 70% of people with mental disorders do not receive medical treatment [7]. These challenges require improved services and new efforts to improve mental health care. Digital technologies can poten- tially help in providing new digital measures available around the clock and seven days a week.

Technology can be a useful first step for those who have previously avoided treatment for mental illness. Patients today have the opportunity to use mobile devices to access meditation platforms as well as telemedicine technologies.

In the USA an artificial intelligence (AI)-based platform called “Quartet” has been developed which identifies patients who are at risk by evaluating medical records, adjusting mental health pathways and offering professional help if necessary. Moreover, bots for mental health correction have been developed and are being used today, such as Woebot, Moodkits, Moodnotes, etc. Their work is based on the methodology of cognitive behavioral therapy (CBT) and also allows users to implement various strategies to help improve their mental health.

Another new way to use modern technologies is to collect data on social networks to identify trends of self-harm among users using artificial intelligence [8]. In the field of mental health the introduction of AI is not completed yet, and it can be a significant turning point in the twenty-first century when it is done.

Digital applications for mental health assessment and correction have a number of advantages:

– Accessibility. Mental health interventions using mobile devices can be performed anytime, anywhere, making them ideal for those who do not want or do not have the resources to keep up with private sessions.;

– Anonymity. Users can search for treatment options in their comfort zone, without participation of a real person;

– Economic efficiency. Some applications are free or their cost is lower than traditional psychiatric care provided on a paid basis;

– High level of attractiveness to users: some technologies may attract users more than traditional treatment approaches, encouraging them to continue the therapy;

– Equal opportunities. The technology can offer the same treatment program to all users regardless of gender, age and location;

– Collection of quantitative data. The technology can collect information such as location, mobility, phone usage, and other data in quantitative form which can ultimately serve as a valuable resource for further research.

It is worth noting that providers of mental health assessment and correction applications also face certain problems [9]. Application developers should be able to guarantee user privacy since applications tend to deal with very sensitive personal information.

DISCUSSION

Following positive assessment of possible contribution of digital technology achievements to prevention of mental disorders experts introduced the concept of “digital mental health” which involves the use of digital technologies in to improve and prevent mental health and well-being and for early intervention or treatment of specific mental illnesses using, for example, online video communication technologies [10]. Digital technology can help:

• 1)    Optimize current services by using technology to create a better and more flexible user experience;

• 2)    Simplify data collection for medical organizations and therapists that can be used for more “personalized” approach to patients’ problems;

• 3)    provide new digital interventions for prevention of mental health disorders or to provide treatment. However, it is very important that such digital technologies are developed jointly with stakeholders and taking user requirements into account.

The concept of digital mental health can be viewed from different perspectives. For example, it may be the development of digital interventions (or digital preventive measures) such as smartphone applications or virtual reality (VR) while others may be more focused on the application of artificial intelligence (AI) or digital phenotyping [11].

For quite a long time virtual reality (VR) has been progressing in various areas of therapy. International research collaboration between universities in the UK and Canada shows that virtual reality-based programs effectively treat conditions such as fear of public speaking [12]. The Japanese company Jolly Good is working on creating a modern technology called VRDTx which uses VR technology. Moreover, a me-ta-analysis by JMIR Mental Health shows that in most studies VR effectively supports CBT in the treatment of anxiety and depression.

Although it is a relatively new technology to be used in psychology, due to its adaptability VR can be used to treat various mental health problems such as anxiety problems, post-traumatic stress disorder, and 82 | Cardiometry | Issue 30. February 2024

addictions. This is the future of a new type of low- and medium-risk devices.

Virtual reality (VR) and augmented reality (AR) can also be used to alleviate phobias through exposure therapy. For example, a claustrophobic patient may be gradually exposed to scenarios with higher accuracy, for example, they are first exposed to a large elevator, then gradually exposed to a smaller elevator, and then, possibly, an elevator which is full with other people[13]. The advantage of virtual reality is that the environment and variables are completely controlled. VR can also be used to evoke empathy by simulating an understanding of what it means to be in another person’s shoes (so-called “VR empathy machines” are used here). Of course, VR can also be used for simulation-based training to prepare healthcare professionals for meeting real clients in a variety of controlled scenarios.

The obvious advantage of digital interventions (such as apps and chatbots) is that they can be additionally used when providing therapy and they are available around the clock and seven days a week allowing clients to access support between face-to-face therapy sessions and seek help in a shorter time[14]. However, a less discussed advantage which is not sufficiently emphasized is that some users may actually prefer to take advantage of digital support first and use it as a springboard to gain confidence to switch to traditional therapy services (for example, phone consultations). This preference may be due to the level of anonymity that digital support provides allowing clients to avoid any stigma while reducing the risk of feeling judged by the other person’s behavior at the same time.

Another underestimated advantage is that digital transformation of mental health provides confidence in the future for new generations of citizens who are more familiar with improved digital services. Mental health problems and disorders often develop during adolescence, and it is important that there are early interventions (perhaps even digital ones) that will help mitigate further escalation. The younger generation has been called the “mute generation” because they are more likely to use smartphones to send text messages rather than make phone calls, and chat-based CBT or chatbots can take advantage of that[15]. The younger generation may continue to expect that most services will have a digital dimension and will indeed be “primarily digital.”

Another advantage is that a personalized set of different digital interventions can be used together to help improve various aspects of a person’s mental well-being’s needs. This is important, given that mental well-being can be multifactorial and that different symptoms or even the same symptom can be eliminated using a variety of digital tools available around the clock and seven days a week. The term “digital services” can be used here, developing the idea that various digital tools can be assigned depending on a person’s needs, which means that personalized healthcare is used here [16]. For example, a sleep app can be used to improve sleep hygiene while simultaneously using a mindfulness app and a mood logging app to improve a person’s mood.

Although each application may have only a minor impact on a person’s mental well-being, the combination of marginal benefits may be able to influence a person’s overall well-being. Experts point out that when people turn to mental health apps they use multiple apps and create their own sets of digital tools, forming their own multi-digital ecosystem. While it may not be easy to assess the impact of any single application (or part of that application), understanding how people naturally interact with applications opens up new opportunities to better assess their impact and develop more reliable metrics to represent their usefulness. Given the global scale of mental health problems, even a 1% improvement in depression symptoms would be viewed as positive.

An underestimated advantage of digital mental health is the amount of “useful” and “actionable” real-world personal health data that can be obtained from clients through digital interventions [17]. To date, traditional mental health services can only collect data from clients with a very low sampling rate, whereas mental health scales, for example, are used in monthly conversation therapy sessions. Digital applications in particular will allow users to send repeated measurements at different times of the day and on different days from their environment. This extensive data is also known as an instant environmental assessment (EMA) where scales on individual items are usually collected in the form of pop-up questions in the application.

There are also many dilemmas related to “digital ethics” in the field of mental health. A key ethical issue is that digital interventions can be perceived as a substitute for human-centered services (akin to “AI anxi- ety”) and as another digital service that contributes to even more screen time [18]. From both the patient’s and doctors’s perspective, it is clear that digital interventions should not be used to replace high-quality personal services with a computer. Although the relationship between time spent in front of a screen and mental health is complex, one cannot disagree that the most effective use of digital interventions occurs when they are complemented and supported by people.

Although most forms of technology play a certain role, each of them brings its own nuances of ethical issues. For example, chatbots that allow users to communicate with a computer create their own ethical dilemmas. Theoretically a chatbot could conduct psychotherapy but it only provides a kind of “pseudo-empathy” and does not really care about the end user. Another problem is that the advice and recommendations provided by a chatbot can also be unverified and cause excessive trust since consultations are conducted in the form of a “humanized” dialogue. Experts present separate case studies in which chatbots can potentially give harmful medical advice. Perhaps this is different from searching for information on the Internet where users have a certain amount of autonomy and a choice of which website to trust and read. It is also very difficult to ensure the quality and regulate the work of a chatbot with artificial intelligence since all possible conversations are unlikely to be pre-evaluated.

The problem of evaluating the quality of chatbots with artificial intelligence, which quickly generate personalized responses, is due to the fact that the number of dialogue options can be very large and it would be almost impossible to evaluate every possible dialogue. On the positive side, most health-related chatbots actually use a dialog design with a fixed end state (i.e. transparent, pre-defined tree branching logic) [19]. The researchers note that the idea of humanizing technology in the form of a chatbot is unacceptable since anthropomorphism can cause a level of misunderstanding on the part of the patient regarding the need to follow the advice formulated by robotic technologies on a random basis.

Despite these ethical issues, chatbots have become quite relevant in the field of mental health. There are many studies and examples where clients prefer to “communicate” with a digital agent in order to avoid condemnation or embarrassment. The ideal chatbot, as researchers note, must necessarily focus on solving some of these ethical problems, in particular, it should avoid excessive anthropomorphization, it should not have a human name, so that users do not equate the chatbot with human support. It is also important to ensure that dialogue scenarios are developed by health experts and that artificial intelligence capabilities are limited in order to prevent the chatbot from generating malicious statements. Many of ethical issues of digital mental health should be addressed using methods that involve all stakeholders.

CONCLUSIONS

Digital technologies can be used to expand existing mental health services without replacing them, to improve user experience and provide services aimed at future generations. Digital mental health interventions can increase the availability of support (24 hours a day, 7 days a week), and can also be used as the first “anonymous” step to receiving help.

A digital mental health platform can provide a personalized set of applications or functions (creating an individual multi-digital ecosystem) which together can lead to significant benefits for users’s mental well-being.