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Health24.com | Detecting depression: Phone apps could monitor teen angst

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Rising suicide rates and depression in US teens and young adults have prompted researchers to ask a provocative question: Could the same devices that some people blame for contributing to tech-age angst also be used to detect it?

The idea has sparked a race to develop apps that warn of impending mental health crises. Call it smartphone psychiatry or child psychology 2.0.

Studies have linked heavy smartphone use with worsening teen mental health. But as teens scroll through Instagram and Snapchat, tap out texts or watch YouTube videos, they also leave digital footprints that might offer clues to their psychological well-being.

Changes in typing speed, voice tone, word choice and how often kids stay home could signal trouble, according to preliminary studies.

There might be as many as 1 000 smartphone “biomarkers” for depression, said Thomas Insel, former head of the National Institute of Mental Illness and now a leader in the smartphone psychiatry movement.

Privacy concerns

Researchers are testing experimental apps that use artificial intelligence to try to predict depression episodes or potential self-harm.

“We are tracking the equivalent of a heartbeat for the human brain,” said Dr Alex Leow, an app developer and associate professor of psychiatry and bioengineering at the University of Illinois’ Chicago campus.

At least, that’s the goal. There are technical and ethical kinks to work out – including privacy issues and making sure kids grant permission to be monitored so closely. Developers say proven, commercially available mood-detecting apps are likely years – but not decades – away.

“People often feel that these things are creepy,” because of the tech industry’s surreptitious tracking of online habits for commercial purposes, said University of Oregon psychologist Nick Allen.

“Using smartphones as mental illness detectors would require informed consent from users to install an app, “and they could withdraw permission at any time,” said Allen, one of the creators of an app that is being tested on young people who have attempted suicide.

“The biggest hurdle at the moment,” Allen said, “is to learn about what’s the signal and what’s the noise – what is in this enormous amount of data that people accumulate on their phones that is indicative of a mental health crisis.”

Depression affects about 3 million US teens, and rates have climbed in the past decade. Last year, 13% of 12- to 17-year-olds had depression, up from 8 percent in 2010, US government data show. One in 10 college-aged Americans is affected.

Suicide has risen to the second leading cause of death for ages 10 to 34. Rates among teen girls doubled from 2007 to 2015, climbing to 5 per 100 000. And among boys, rates jumped 30%, to 14 in 100 000.

A recent study suggested a parallel rise in smartphone use likely contributed.

Identify early signs

People with mental illness typically get treatment “when they’re in crisis and very late in the course of an illness. We want to have a method to identify the earliest signs,” in an objective way, Insel said.

If smartphones prove to be accurate mood predictors, developers say the ultimate goal would be to use them to offer real-time help, perhaps with automated text messages and links to help lines, or digital alerts to parents, doctors or first responders.

Facebook is already doing just that with what it calls “proactive detection.” Last year, after a live-streamed suicide, Facebook trained its AI systems to flag certain words or phrases in online posts that could indicate imminent self-harm. Friends’ comments expressing concern about the user’s well-being are part of the equation.

“In the last year, we’ve helped first responders quickly reach around 3 500 people globally who needed help,” Facebook CEO Mark Zuckerberg announced in November. Facebook has not disclosed outcomes of those cases.

The ongoing research includes:

– A Stanford University study involving about 200 teens, including kids at risk for depression because of bullying, family circumstances or other life stresses. As part of the research, teens who have been tracked since grade school get an experimental phone app that surveys them three times daily for two weeks with questions about their mood.

Researchers are combining those answers with passive smartphone data, including how active or sedentary kids are, to identify any changes that might be linked with future depression.

Study participant Laurel Foster, 15, acknowledges feeling stress over academics and “the usual” teen friendship pressures and says depression is rampant at her San Francisco high school. She said using the smartphone app felt a bit like being spied on, but with so many online sites already tracking users’ habits “one more isn’t really a big difference.”

“I feel like it’s good to actually find out what is stressing you,” Foster said, endorsing the idea of using smartphones to try to answer that question.

–  At UCLA, as part of a broader effort to battle campus depression launched in 2017, researchers are offering online counseling and an experimental phone app to students who show signs of at least mild depression on a screening test. About 250 freshmen agreed to use the app in the first year. Personal sensing data collected from the app is being analysed to see how it correlates with any worsening or improvement in depression symptoms seen in internet therapy.

Sophomore Alyssa Lizarraga, who had the app on her phone for about six months, said it was “a little like the Big Brother thing. Half of me felt that way. The other half felt like I hope it will be useful.”

Lizarraga, 19, has had depression since high school in Whittier, California. She has worried that she’s “addicted” to her phone and spends a lot of time on social media sites. “People need to see the best side of me” there, she said, and comparing herself with others online sometimes gets her down.

But using smartphones in a positive way for mental health might help nudge people to seek early treatment, if they could see how their phone use showed signs of depression, she said.

–  At the University of Illinois’ Chicago campus, researchers studying depression and mania in bipolar disorder are using crowdsourcing to test their experimental phone app. Anyone can download the free app, and nearly 2 000 have so far, agreeing to let the researchers continuously track things such as typing speed, number of keystrokes and use of spellcheck. Participants include healthy people, and their data will help researchers zero in on changes in phone use that may signal onset of mood problems, said Leow, the psychiatry and bioengineering expert who helped develop it.

The study is for ages 18 and up, but if proven to work, the technology could be used in kids too, Leow said.

–  Mindspring, a Palo Alto, California tech health company co-founded by Insel, the former National Institutes of Health chief, is testing a “digital phenotyping” app in several studies. Insel thinks the technology has promise to transform psychiatry, but that the most important question is whether it can be used to improve patient health.

– Verily, a tech health arm of Google parent company Alphabet, is developing a similar app but declined to elaborate beyond a written statement from its mental health leader, Menachem Fromer. He cited two key goals: making predictions about someone’s mental health and their symptoms and “discovering new subtypes of disease that may inform treatment decisions.”

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Families waiting too long for special needs support in England

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Thousands of children with special educational needs wait more than 20 weeks for help, the BBC finds.

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NHS long-term plan: Non-hospital care to get biggest funding rise

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Health bosses aim to focus on preventing ill-health as part of plan to create NHS fit for 21st century.

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Biomarkers identified to help diagnose heart condition

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Atrial fibrillation is the most common heart rhythm disturbance, affecting 1.6m people in the UK.

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The ‘superwoman’ midwife of the mountains

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After she had to give birth without any help, one Himalayan woman decided to train to become the first midwife in her area.

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‘They took her teeth without telling me’

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Readers tell the BBC of their experiences of dental surgery on people with learning disabilities.

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NHS 10-year plan: May hails historic announcement

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The prime minister promises “world class” treatments, but experts warn it will be tough to deliver.

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Hospital patients who smoke or drink to be helped to quit

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They will be given targeted advice in order to reduce ill health as well as demands on the NHS.

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Cervical cancer screening campaigner Natasha Sale dies aged 31

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Natasha Sale, 31, wanted to lower the cervical screening age from 25 to 18.

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Tiny satellites could be ‘guide stars’ for huge next-generation telescopes

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There are more than 3,900 confirmed planets beyond our solar system. Most of them have been detected because of their “transits” — instances when a planet crosses its star, momentarily blocking its light. These dips in starlight can tell astronomers a bit about a planet’s size and its distance from its star.

But knowing more about the planet, including whether it harbors oxygen, water, and other signs of life, requires far more powerful tools. Ideally, these would be much bigger telescopes in space, with light-gathering mirrors as wide as those of the largest ground observatories. NASA engineers are now developing designs for such next-generation space telescopes, including “segmented” telescopes with multiple small mirrors that could be assembled or unfurled to form one very large telescope once launched into space.

NASA’s upcoming James Webb Space Telescope is an example of a segmented primary mirror, with a diameter of 6.5 meters and 18 hexagonal segments. Next-generation space telescopes are expected to be as large as 15 meters, with over 100 mirror segments.

One challenge for segmented space telescopes is how to keep the mirror segments stable and pointing collectively toward an exoplanetary system. Such telescopes would be equipped with coronagraphs — instruments that are sensitive enough to discern between the light given off by a star and the considerably weaker light emitted by an orbiting planet. But the slightest shift in any of the telescope’s parts could throw off a coronagraph’s measurements and disrupt measurements of oxygen, water, or other planetary features.

Now MIT engineers propose that a second, shoebox-sized spacecraft equipped with a simple laser could fly at a distance from the large space telescope and act as a “guide star,” providing a steady, bright light near the target system that the telescope could use as a reference point in space to keep itself stable.

In a paper published today in the Astronomical Journal, the researchers show that the design of such a laser guide star would be feasible with today’s existing technology. The researchers say that using the laser light from the second spacecraft to stabilize the system relaxes the demand for precision in a large segmented telescope, saving time and money, and allowing for more flexible telescope designs.

“This paper suggests that in the future, we might be able to build a telescope that’s a little floppier, a little less intrinsically stable, but could use a bright source as a reference to maintain its stability,” says Ewan Douglas, a postdoc in MIT’s Department of Aeronautics and Astronautics and a lead author on the paper.

The paper also includes Kerri Cahoy, associate professor of aeronautics and astronautics at MIT, along with graduate students James Clark and Weston Marlow at MIT, and Jared Males, Olivier Guyon, and Jennifer Lumbres from the University of Arizona.

In the crosshairs

For over a century, astronomers have been using actual stars as “guides” to stabilize ground-based telescopes.

“If imperfections in the telescope motor or gears were causing your telescope to track slightly faster or slower, you could watch your guide star on a crosshairs by eye, and slowly keep it centered while you took a long exposure,” Douglas says.

In the 1990s, scientists started using lasers on the ground as artificial guide stars by exciting sodium in the upper atmosphere, pointing the lasers into the sky to create a point of light some 40 miles from the ground. Astronomers could then stabilize a telescope using this light source, which could be generated anywhere the astronomer wanted to point the telescope.

“Now we’re extending that idea, but rather than pointing a laser from the ground into space, we’re shining it from space, onto a telescope in space,” Douglas says. Ground telescopes need guide stars to counter atmospheric effects, but space telescopes for exoplanet imaging have to counter minute changes in the system temperature and any disturbances due to motion.

The space-based laser guide star idea arose out of a project that was funded by NASA. The agency has been considering designs for large, segmented telescopes in space and tasked the researchers with finding ways of bringing down the cost of the massive observatories.

“The reason this is pertinent now is that NASA has to decide in the next couple years whether these large space telescopes will be our priority in the next few decades,” Douglas says. “That decision-making is happening now, just like the decision-making for the Hubble Space Telescope happened in the 1960s, but it didn’t launch until the 1990s.'”

Star fleet

Cahoy’s lab has been developing laser communications for use in CubeSats, which are shoebox-sized satellites that can be built and launched into space at a fraction of the cost of conventional spacecraft.

For this new study, the researchers looked at whether a laser, integrated into a CubeSat or slightly larger SmallSat, could be used to maintain the stability of a large, segmented space telescope modeled after NASA’s LUVOIR (for Large UV Optical Infrared Surveyor), a conceptual design that includes multiple mirrors that would be assembled in space.

Researchers have estimated that such a telescope would have to remain perfectly still, within 10 picometers — about a quarter the diameter of a hydrogen atom — in order for an onboard coronagraph to take accurate measurements of a planet’s light, apart from its star.

“Any disturbance on the spacecraft, like a slight change in the angle of the sun, or a piece of electronics turning on and off and changing the amount of heat dissipated across the spacecraft, will cause slight expansion or contraction of the structure,” Douglas says. “If you get disturbances bigger than around 10 picometers, you start seeing a change in the pattern of starlight inside the telescope, and the changes mean that you can’t perfectly subtract the starlight to see the planet’s reflected light.”

The team came up with a general design for a laser guide star that would be far enough away from a telescope to be seen as a fixed star — about tens of thousands of miles away — and that would point back and send its light toward the telescope’s mirrors, each of which would reflect the laser light toward an onboard camera. That camera would measure the phase of this reflected light over time. Any change of 10 picometers or more would signal a compromise to the telescope’s stability that, onboard actuators could then quickly correct.

To see if such a laser guide star design would be feasible with today’s laser technology, Douglas and Cahoy worked with colleagues at the University of Arizona to come up with different brightness sources, to figure out, for instance, how bright a laser would have to be to provide a certain amount of information about a telescope’s position, or to provide stability using models of segment stability from large space telescopes. They then drew up a set of existing laser transmitters and calculated how stable, strong, and far away each laser would have to be from the telescope to act as a reliable guide star.

In general, they found laser guide star designs are feasible with existing technologies, and that the system could fit entirely within a SmallSat about the size of a cubic foot. Douglas says that a single guide star could conceivably follow a telescope’s “gaze,” traveling from one star to the next as the telescope switches its observation targets. However, this would require the smaller spacecraft to journey hundreds of thousands of miles paired with the telescope at a distance, as the telescope repositions itself to look at different stars.

Instead, Douglas says a small fleet of guide stars could be deployed, affordably, and spaced across the sky, to help stabilize a telescope as it surveys multiple exoplanetary systems. Cahoy points out that the recent success of NASA’s MARCO CubeSats, which supported the Mars Insight lander as a communications relay, demonstrates that CubeSats with propulsion systems can work in interplanetary space, for longer durations and at large distances.

“Now we’re analyzing existing propulsion systems and figuring out the optimal way to do this, and how many spacecraft we’d want leapfrogging each other in space,” Douglas says. “Ultimately, we think this is a way to bring down the cost of these large, segmented space telescopes.”

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