Can smartwatches and fitness trackers augment mental health?
Nov 11, 2021, 7 min read
You’re in the therapy room and the therapist asks you how you’ve been feeling since your last session. If you are anything like me, you may struggle to remember what you had for dinner two days ago, let alone the complexities of your inner life over time.
Smartwatches and fitness trackers can track large amounts of information in a continuous, real-time and convenient fashion. Can these data reflect how we feel and improve our mental health?
Wearables as a sixth sense
We are used to thinking of smartwatches as nifty gadgets for reading messages during meetings or tracking our daily step count. Yet, a large-scale international study at King's College London, University of Amsterdam and Universitat de Barcelona has recently shown that sensor data collected from wearable devices, in conjunction with smartphones, can reliably detect symptoms of depression. Can wearables become our next sixth sense?
Take depression. When someone is depressed, their sleep changes; they sleep less or more, or sleep more poorly. They also exercise less, or experience changes in heart-rate.
Can we use data from wearables to track depression? While research is still ongoing, recent findings from King’s College London have shown that participants' sleep measured with the FitBit over up to three years correlates with their depression scores, as well as heart rate and physical activity.
More time spent at home and a lower distance travelled, as measured by their geolocation data, predicted a higher depression severity. Time spent doing physical activity, measured by the inbuilt accelerometer of a wearable or smartphone, has also been linked to depression symptoms. It can predict not only the course of depression, but also hospital discharge dates. Surprisingly, even the number of Bluetooth connections is among the so-called “digital biomarkers” that could reveal how depressed someone is. Call logs, body temperature, room lighting - the list goes on.
Studies looking at the use of wearables to track mental health are promising - and they go beyond depression. Wearable devices also have the potential to track ADHD and bipolar disorder, among mental and physical health conditions.
How can smartwatches and fitness trackers be used for mental health?
Having access to one’s data can also help one better understand their mental state and communicate it to others: “For the first time, it occurred to me to let my partner know when I could feel an episode was starting… so if you see my behaviour change or I'm unresponsive this is why”, said a participant with depression after two years of wearing a commercial wearable device and completing regular mood questionnaires.
Katie White, who works on the study at King’s College London said:“One of the things that stood out to me most during my experience with participants in the study was their feedback on how remote symptom monitoring helped them to process and understand their depression. Participants told us that seeing their FitBit data alongside completing questionnaires prompted self-reflection, self-awareness, and enhanced their ability to identify patterns in how they were feeling. Many found this empowering. They were able to use this knowledge to communicate with loved ones, or with a medical professional. There is also evidence that symptom monitoring increases emotional self-awareness.“
A memory aid
It can be difficult to remember one's mental journey or day-to-day activities. During a therapy session or to find someone the right support, a mental health professional will readily ask, ‘How have you been feeling over the past few weeks?’, then ‘How often have you felt like this?’ And even if you’re endowed with a sharp memory, studies have shown that recall can be unreliable; we remember things differently depending on factors such as mood. If your appointment is on a ‘bad’ day, you are more likely to filter out positive events. Some keep mood diaries, but with depression, you might lack the motivation to update yours.
Wearable devices can record useful information continuously and passively, which can be used as a prompt to recall mental states, feelings and events. For example, seeing how many hours someone has slept over two weeks could help them understand how or even why one’s mood might have varied. And doctors are open to, or already using wearable data to inform their clinical decisions.
Building healthy habits
Smartwatches and fitness trackers could also remind one of the importance of building exercise or other activities into their routine. People with depression who used a FitBit for up to three years as part of a research study explained that wearing the FitBit reminded them of how important it is to exercise regularly. This increased how much they exercised and improved their mood. Seeing one’s sleep pattern could reveal whether one may benefit from better sleep hygiene. Research has shown that improving sleep hygiene can reduce low mood. Seeing these data and receiving notifications was found to motivate people with mental health struggles to build habits that serve them better.
Enjoyable and convenient
Participants living with depression who used wearables found them easy to fit into their lifestyles and considered them to be a useful addition to their lives, appreciating the comfort and the appearance of different wearables. The fact that the devices were not specifically designed for mental health was also a plus for many participants in the study, as it did not directly invite questions about their mental health from others.
Body data as art
The potential to use wearables in mental health goes beyond tracking and treatment. It could also help loved ones better understand, and even ‘feel’, a sufferer’s experience, and be used as a form of art. A dance performance creatively used wearables to add a new dimension to mental health awareness. While a dancer impersonated experiences of depression, a wearable collected her live data, which was then transposed into music through an algorithm. This has helped audiences get a more visceral understanding of the condition.
Away from academic research, the field is moving even faster. San Francisco-based company Feel Therapeutics are adamant to replace the time spent recalling recent events and feelings with objective data. They recently ran a small study whereby 48 participants took part in a 16-week programme that involved using a wearable device and completing CBT-based exercises informed by the wearable data. 31 people completed the study and showed initial positive results. However, people rarely wish to have their experience reduced to data points or labels, so hopefully this will be taken into account when introducing new interventions.
Are there any risks?
Data accuracy and interpretation
While data from wearables and mobile phones can offer insights into one’s mental health, they are yet to be classed as medical devices, raising accuracy concerns. And research is still examining what combination of biomarkers is necessary to predict one’s clinical state, hence data need to be interpreted with caution.
Also, as per terms and conditions of a lot of commercial devices, algorithms used to calculate the data can be updated at any point. Invariably, this leaves a chance to render some of the research findings inaccurate.
Calorie counting and eating disorder behaviours
Some studies have shown that self-monitoring of one’s calories and exercise levels through fitness trackers and smartwatches can be triggering for those with eating disorders. These findings highlight the importance of being able to personalise how the data is shown, or working with a specialist to interpret one’s data and track progress.
One thing's certain: There is a need to tailor these technologies to individual circumstances, and being mindful of sidelining one's subjective experience in favour of the metric data.
Kit Norman, founder and CEO of Augmentive, says: “I love supporting our specialists in applying cutting-edge technologies that enable them to provide personalised support to their clients. This balance of humans and technology is the future of mental health and the practitioners we work with are perfectly placed to ensure these innovative tools are used both responsibly and effectively. The human side of mental health will always be critical, people want to be heard and to feel an emotional connection. That being said, technologies such as artificial intelligence and automation need to be applied to mental health as they are in medicine to improve the efficiency, efficacy and accessibility.
The automatic collection of personal data through smartwatches is a classic example of this. While there are risks in terms of ethics and privacy, there are huge opportunities to gain a much deeper understanding of the individual and to analyse the efficacy of specific support across similar people.
I use an Apple Watch and love it, primarily for the health and digital wellbeing insights. However, my engagement dropped off pretty quickly and I struggle to use the information in any meaningful way. So I really see the benefit of a professional working alongside it to set both clear and healthy paths forward.”
Even the most basic devices can collect valuable information passively and continuously, and one billion people worldwide already use them to track their sleep and physical activity. Clearly, the abundance and richness of the sensor data will allow a deeper understanding of people’s symptoms and causes, leading to early recognition, more bespoke treatments and opportunities for prevention.
Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments and reviews to broader mental health care: join us today.