Mental Health in a Digital World
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Contents
Contributors xiii
Preface xix
1 Introduction 1
Dan J. Stein, Christine Lochner, Samuel R. Chamberlain,
and Naomi A. Fineberg
Data collection and analysis 2
Communication, psychoeducation, and screening 3
Problematic Internet use 5
Interventions 6
Conclusion 7
Section A Digital Data Collection and Analysis 9
2 Information technology and electronic health record to improve
behavioral health services 11
Donald Hilty, John A. Naslund, Shalini Ahuja, John Torous,
Taishiro Kishimoto, and Allison Crawford
Introduction 11
Setting goals to achieve value and quality in practice and the role
of technology 14
Components and processes of systems used by clinicians 20
AI and big data 28
Clinician, team, system, and institutional/organizational competencies 30
Discussion 33
Conclusions 35
Acknowledgments 35
Conflicts of interest 35
References 35
3 Big data and the goal of personalized health interventions 41
Guy Hindley, Olav B. Smeland, Oleksandr Frei, and Ole A. Andreassen
Introduction/Overview 41
What is big data? 43
Where does big data come from? 44
viContents
Data storage and preprocessing 46
Data analysis 47
Insights from genetics, neuroimaging, and eHealth 49
Key challenges 53
Looking to the future 55
Conclusions 56
References 56
4 Collecting data from Internet (and other platform) users for
mental health research 63
Ashley A. Lahoud, Theresa R. Gladstone, Sydney B. Clark,
and Christopher A. Flessner
Introduction/overview 63
A brief historical overview of the Internet’s use within psychology 63
Are the use of Internet sampling procedures reliable and valid? 64
Benefits to utilizing the Internet to answer research questions 66
Risks/costs of Internet research 68
How to go about collecting data from Internet users 69
Tools to construct surveys and tasks online 73
Conclusion 75
References 75
5 Ecological momentary assessment and other digital technologies
for capturing daily life in mental health 81
Simone Verhagen, Jim van Os, and Philippe Delespaul
Introduction 81
Mental health revolution 82
Precision medicine 83
The importance of context 84
Modern care practices 85
The relevant time window 86
Ecological validity 87
Profiled vs iterative personalized medicine 87
Digital health solutions 88
Ecological momentary assessment 88
Added value to cross-sectional methods 90
Learning from group-level research 90
Toward a paradigm shift in clinical practice 93
Reliable assessment of subjective experiences 93
Individual EMA use in clinical practice 94
Case example 95
Leveraging the full potential of technologies 97
Digital phenotyping 98
Unobtrusive mental health assessments 99
Conclusion 101
References 103
Contentsvii
6 Social media big data analysis for mental health research 109
Akkapon Wongkoblap, Miguel A. Vadillo, and Vasa Curcin
Mental disorders 109
Social media data 111
Social media typology 112
Data collection from social media users 115
User verification and annotation 116
Data collection from social media platforms 117
Natural language processing (NLP) 119
Machine learning 121
Machine learning algorithms 122
Deep learning 124
Evaluating ML models 127
Ethics surrounding profiling social media for mental health 127
A framework for the use of social media for health intervention 128
Ethical considerations and practices 133
Identifying health conditions from social media behavior 134
References 135
Section B Communication, psychoeducation, screening 145
7 Telepsychiatry and video-to-home (including security issues) 147
Samantha L. Connolly, Julianna B. Hogan, Anthony H. Ecker,
Gabrielle F. Gloston, Giselle Day, Jay H. Shore, and Jan A. Lindsay
Introduction 147
Effectiveness 148
Patient satisfaction 150
Provider satisfaction 151
Regulatory and safety issues 152
Licensure portability and reciprocity 152
Security and privacy of patient information 154
Patient safety during TMH encounters 155
Global telemental health 156
Future directions in global TMH 158
Conclusion 160
References 160
8 Social Media and Clinical Practice 169
John Luo and Kevin Ing
Introduction 169
Background 169
Clinical Use 170
Concerns 178
Discussion 184
Conclusion 185
References 186
viiiContents
9 Websites and the validity of mental health care information 191
Nicola Reavley, Luwishennadige M.N. Fernando,
and Anthony Jorm
Quality assessment methods 192
Types of mental disorders 193
Quality of mental disorder information on social media 196
Longitudinal changes in website quality 196
Summary 198
Conclusion 201
References 201
10 Digital phenotyping 207
Lior Carmi, Anzar Abbas, Katharina Schultebraucks,
and Isaac R. Galatzer-Levy
The importance of measurement 207
The challenge of measurement in mental health 207
Virtual care and electronic patient self-report 208
Digital phenotyping of mental health 209
Challenges faced by digital phenotyping 214
Promise and future of digital measurement 215
References 216
11 The digital therapeutic relationship: Retaining humanity
in the digital age 223
Jason Bantjes and Philip Slabbert
Introduction 223
Human factor science and the design of person-centered e-interventions 224
Conceptualizing e-interventions within a relationship-centered paradigm 226
Toward a theoretical conceptualization of relationship-centered
e-interventions 228
Future directions for theory and research 232
Conclusion 234
Funding 234
References 234
Section C Problematic use of the Internet 239
12 Gambling disorder, gaming disorder, cybershopping, and other
addictive/impulsive disorders online 241
Jon E. Grant, Konstantinos Ioannidis, and Samuel R. Chamberlain
Introduction 241
Phenomenology, comorbidity, and clinical assessment tools 243
Psychobiology 248
Treatment: Pharmacotherapy and psychotherapy 250
Discussion and concluding remarks 253
Contentsix
Disclosures 253
References 254
Further reading 259
13 Cyberchondria, cyberhoarding, and other compulsive
online disorders 261
Matteo Vismara, Valentina Caricasole, Alberto Varinelli,
and Naomi A. Fineberg
Introduction 261
Cyberchondria 263
Cyberhoarding 272
Other digital forms of OCRDs 273
Conclusions 277
Declaration statement 277
References 277
14 Internet-use disorders: A theoretical framework for their
conceptualization and diagnosis 285
Elisa Wegmann, Joël Billieux, and Matthias Brand
Introduction 285
Diagnosis 287
Etiology 291
Disordered smartphone use 294
Conclusion 296
Disclosure statements 297
References 297
15 Cybersex (including sex robots) 307
Johannes Fuss and Beáta Bothe
Introduction 307
Epidemiology, definitions, and phenomenology 308
Diagnostic criteria 317
Differential diagnoses 318
Assessment and evaluation 319
Psychobiology 325
Pharmacotherapy 327
Psychotherapy 328
Conclusion 330
References 331
16 Developmental aspects (including cyberbullying) 345
Gemma Mestre-Bach, Fernando Fernández-Aranda,
Susana Jiménez-Murcia, and Marc N. Potenza
Introduction 345
Behavioral development 345
xContents
Neurodevelopment 359
Conclusions 361
Funding 362
Conflict of interest 362
References 362
Section D Interventions 375
17 Internet-based psychotherapies 377
Gerhard Andersson
Background 377
Procedures 378
A typical treatment case 382
Research support 383
Implementation and evidence in clinical settings 385
Future and ongoing developments 386
Conclusion 387
References 387
18 Apps for mental health 395
John Strauss, Jasmine Zhang, Madeleine L. Jarrett, Beth Patterson,
and Michael Van Ameringen
Introduction 395
The potential of MH apps 396
Functions of MH apps 397
Key aspects of mobile apps evaluation 398
Current app evaluation frameworks 418
Conclusions and future directions 423
References 424
Further reading 428
19 Clinical interventions for technology-based problems 435
Daniel L. King, Joël Billieux, Kai Mueller, and Paul H. Delfabbro
Introduction 435
Social perceptions of problems and interventions 437
Types of intervention 438
Primary preventions 440
Secondary prevention 440
Tertiary prevention 441
Prevention and treatment evidence 441
Government responses 444
The role of industry and online content providers 448
Future research directions 449
Discussion 450
Conclusions 451
Conflict of interest 452
References 452
Contentsxi
20 Scaling up of mental health services in the digital age: The rise of
technology and its application to low- and middle-income countries 459
Saher Siddiqui, Pattie P. Gonsalves, and John A. Naslund
Introduction 459
Technology for community outreach, raising awareness,
and challenging stigma 463
Technology for mental health in humanitarian settings 464
Digital Interventions for youth mental health 466
Technology for supporting clinical care and building capacity
of frontline health workers 468
Technology for severe mental disorders 470
Ethical considerations 472
Mental health during pandemics and the need for digital interventions 473
Discussion and conclusion 473
References 474
21 Addiction, autonomy, and the Internet: Some ethical considerations 481
Anna Hartford and Dan J. Stein
Introduction 481
Distinguishing clinical and ethical debates 482
The ethics of persuasive design 484
The nature of the harm 486
Ethical implications 489
Conclusion 492
References 493
Index 497
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Contributors
Anzar Abbas AiCure, New York, NY, United States
Shalini Ahuja Centre for Implementation Science, Health Services and Population
Research Department Institute of Psychiatry, Psychology and Neurosciences King’s
College London, London, United Kingdom
Michael Van Ameringen MacAnxiety Research Centre; Department of Psychiatry
and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
Gerhard Andersson Department of Behavioural Sciences and Learning, Department
of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Ole A. Andreassen NORMENT Centre, Institute of Clinical Medicine, University of
Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo,
Norway
Jason Bantjes Institute for Life Course Health Research, Department of Global Health,
Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch,
South Africa
Joël Billieux Institute of Psychology, University of Lausanne (UNIL); Centre for
Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV),
Lausanne, Switzerland
Sydney B. Clark Department of Psychological Sciences, Kent State University, Kent,
OH, United States
Beáta Bőthe Department of Psychology, Université de Montréal, Montréal, QC,
Canada
Matthias Brand Department of General Psychology: Cognition and Center for
Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg;
Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
Valentina Caricasole University of Milan, Department of Mental Health, Department
of Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy
Lior Carmi Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan, Israel
xivContributors
Samuel R. Chamberlain Department of Psychiatry, Faculty of Medicine, University of
Southampton; Southern Health NHS Foundation Trust, Southampton, United Kingdom
Samantha L. Connolly Center for Healthcare Organization and Implementation
Research, VA Boston Healthcare System; Department of Psychiatry, Harvard Medical
School, Boston, MA, United States
Allison Crawford Virtual Mental Health, Centre for Addiction and Mental Health
Associate Professor, University of Toronto, Toronto, ON, Canada
Vasa Curcin Department of Informatics; School of Population Health and
Environmental Sciences, King’s College London, London, United Kingdom
Giselle Day Houston VA HSR&D Center for Innovations in Quality, Effectiveness
and Safety, Michael E. DeBakey VA Medical Center; VA South Central Mental Illness
Research, Education and Clinical Center, Houston, TX, United States
Philippe Delespaul Department of Psychiatry and Neuropsychology, Faculty of
Health Medicine and Lifesciences, Maastricht University, Maastricht; Mondriaan
Mental Health Trust, Department of Adult Psychiatry, Heerlen, The Netherlands
Paul H. Delfabbro School of Psychology, The University of Adelaide, Adelaide,
Australia
Anthony H. Ecker Houston VA HSR&D Center for Innovations in Quality,
Effectiveness and Safety, Michael E. DeBakey VA Medical Center; Menninger
Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; VA
South Central Mental Illness Research, Education and Clinical Center, Houston, TX,
United States
Fernando Fernández-Aranda Department of Psychiatry, Bellvitge University
Hospital-IDIBELL, Barcelona; Ciber Fisiopatología Obesidad y Nutrición
(CIBERObn), Instituto de Salud Carlos III, Madrid; Department of Clinical Sciences,
School of Medicine, University of Barcelona, Barcelona, Spain
Luwishennadige M.N. Fernando Centre for Mental Health, Melbourne School
of Population and Global Health, University of Melbourne, Melbourne, VIC,
Australia
Naomi A. Fineberg School of Life and Medical Sciences, University of Hertfordshire,
Hatfield; Hertfordshire Partnership University NHS Foundation Trust, Welwyn
Garden City; University of Cambridge School of Clinical Medicine, Cambridge,
United Kingdom
Contributorsxv
Christopher A. Flessner Department of Psychological Sciences, Kent State
University, Kent, OH, United States
Oleksandr Frei NORMENT Centre, Institute of Clinical Medicine, University of Oslo
and Division of Mental Health and Addiction; Department of Research, Innovation
and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo,
Norway
Johannes Fuss Institute of Forensic Psychiatry and Sex Research, University
Duisburg-Essen, Essen, Germany
Isaac R. Galatzer-Levy Reality Labs, Facebook; Psychiatry, New York University
School of Medicine, New York, NY, United States
Theresa R. Gladstone Department of Psychological Sciences, Kent State University,
Kent, OH, United States
Gabrielle F. Gloston Houston VA HSR&D Center for Innovations in Quality,
Effectiveness and Safety, Michael E. DeBakey VA Medical Center; Menninger
Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,
Houston, TX, United States
Pattie P. Gonsalves Sangath, Saket, New Delhi; Sangath, Bardez, Goa, India; School
of Psychology, University of Sussex, Brighton, United Kingdom
Jon E. Grant Department of Psychiatry, University of Chicago, Chicago, IL, United
States
Anna Hartford Brain-Behaviour Unit, Neuroscience Institute, University of Cape
Town, Cape Town, South Africa
Donald Hilty Department of Psychiatry & Behavioral Sciences, Mather, CA, United
States
Guy Hindley NORMENT Centre, Institute of Clinical Medicine, University of
Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo,
Norway; Department of Psychosis Studies, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, United Kingdom
Julianna B. Hogan Houston VA HSR&D Center for Innovations in Quality, Effectiveness
and Safety, Michael E. DeBakey VA Medical Center; Menninger Department of
Psychiatry and Behavioral Sciences, Baylor College of Medicine; VA South Central
Mental Illness Research, Education and Clinical Center, Houston, TX, United States
xviContributors
Kevin Ing University of California Irvine School of Medicine, Department of
Psychiatry & Human Behavior, Orange, CA, United States
Thomas R. Insel Humanest Care, Pleasanton, CA, United States
Konstantinos Ioannidis Department of Psychiatry, University of Cambridge, and
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United
Kingdom
Madeleine L. Jarrett Child, Youth and Emerging Adult Program, Cundill Centre for
Child and Youth Depression, Centre for Addiction and Mental Health; Human Biology
Program, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
Susana Jiménez-Murcia Department of Psychiatry, Bellvitge University Hospital-
IDIBELL, Barcelona; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn),
Instituto de Salud Carlos III, Madrid; Department of Clinical Sciences, School of
Medicine, University of Barcelona, Barcelona, Spain
Anthony Jorm Centre for Mental Health, Melbourne School of Population and Global
Health, University of Melbourne, Melbourne, VIC, Australia
Daniel L. King College of Education, Psychology, & Social Work, Flinders University,
Adelaide, Australia
Taishiro Kishimoto Department of Neuropsychiatry, Keio University School of
Medicine, Tokyo, Japan
Ashley A. Lahoud Department of Psychological Sciences, Kent State University,
Kent, OH, United States
Jan A. Lindsay Houston VA HSR&D Center for Innovations in Quality,
Effectiveness and Safety, Michael E. DeBakey VA Medical Center; Menninger
Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine;
VA South Central Mental Illness Research, Education and Clinical Center, Houston,
TX, United States
Christine Lochner SA MRC Unit on Risk & Resilience in Mental Disorders,
Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
John Luo University of California at Irvine School of Medicine, Director of Emergency
and Consultation-Liaison Psychiatry, UCI Medical Center, Health Sciences Clinical
Department of Psychiatry & Human Behavior, Orange, CA, United States
Gemma Mestre-Bach Universidad Internacional de La Rioja, Logroño, La Rioja,
Spain
Contributorsxvii
Kai Mueller Outpatient Clinic for Behavioral Addictions, Department of
Psychosomatic Medicine and Psychotherapy at the University Medical Center, Mainz,
Germany
John A. Naslund Department of Global Health and Social Medicine, Harvard Medical
School, Boston, MA, United States
Jim van Os Department of Psychiatry and Neuropsychology, Faculty of Health
Medicine and Lifesciences, Maastricht University, Maastricht; Department of
Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands; Department of Psychosis Studies, Institute of
Psychiatry, King's College London, King's Health Partners, London, United Kingdom
Beth Patterson MacAnxiety Research Centre; Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
Marc N. Potenza Department of Psychiatry; Department of Neuroscience; Yale Child
Study Center, Yale University School of Medicine; Connecticut Mental Health Center,
New Haven; Connecticut Council on Problem Gambling, Wethersfield; Wu Tsai
Institute, Yale University, New Haven, CT, United States
Nicola Reavley Centre for Mental Health, Melbourne School of Population and
Global Health, University of Melbourne, Melbourne, VIC, Australia
Katharina Schultebraucks Emergency Medicine, Columbia University, New York,
NY, United States
Jay H. Shore Department of Psychiatry and Family Medicine, University of Colorado
Anschutz Medical Campus; Centers for American Indian and Alaska Native Health,
Colorado School of Public Health, Anschutz Medical Campus, University of Colorado,
Aurora, CO, United States
Saher Siddiqui Harvard College, Harvard University, Cambridge, MA, United States
Philip Slabbert Institute for Life Course Health Research, Department of Global
Health, Faculty of Medicine and Health Sciences, University of Stellenbosch,
Stellenbosch, South Africa
Olav B. Smeland NORMENT Centre, Institute of Clinical Medicine, University of
Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo,
Norway
Dan J. Stein SA MRC Unit on Risk & Resilience in Mental Disorders, Department
of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South
Africa
xviiiContributors
John Strauss Child, Youth and Emerging Adult Program, Cundill Centre for Child
and Youth Depression; Shannon Centennial Informatics Lab, Centre for Addiction and
Mental Health; Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, ON, Canada
John Torous Department of Psychiatry and Director, Division of Digital Psychiatry,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
Miguel A. Vadillo Department of Psychology, Autonomous University of Madrid,
Madrid, Spain; School of Population Health and Environmental Sciences, King’s
College London, London, United Kingdom
Alberto Varinelli University of Milan, Department of Mental Health, Department of
Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy
Simone Verhagen Department of Psychiatry and Neuropsychology, Faculty of Health
Medicine and Lifesciences, Maastricht University, Maastricht; Department of Lifespan
Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
Matteo Vismara University of Milan, Department of Mental Health, Department of
Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy
Elisa Wegmann Department of General Psychology: Cognition and Center for
Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg,
Germany
Akkapon Wongkoblap Department of Informatics, King’s College London, London,
United Kingdom; School of Information Technology; DIGITECH, Suranaree
University of Technology, Nakhon Ratchasima, Thailand
Jasmine Zhang MacAnxiety Research Centre; Department of Psychiatry and
Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
Preface
Digital mental health is exploding as a discipline for innovation, research, and in-
vestment. It is no longer possible to track all of the new companies innovating in
mental health, but at least 1000 start-ups have been launched in the past decade, with
$1.8B (USD) invested in 2020 alone, nearly a threefold increase over 2019 (https://
[Link]/reports/2020-market-insights-report-chasing-a-new-equilibrium/;
[Link]
2020-d344c822f757). By early 2021, PubMed listed over 2500 references for “dig-
ital mental health,” a term that was scarcely reported in the literature a decade ago
([Link] And for the first time there are venture funds and
investment vehicles organized specifically to support innovation in this space (https://
[Link]/).
Why all of this interest in digital mental health? There was no technological break-
through, like CRISPR, that can explain this new fascination. There was no particular
discovery or research finding of effectiveness that would shift mental health to this
new discipline. Although during the Covid-19 pandemic the focus of the field was
on remote care with a rapid transition to telehealth, there was no clear global change
in the prevalence or incidence of mental illness, as there was for the virus, which ap-
peared to be a driver of this intense interest.
One explanation for the explosion of digital mental health is more prosaic. In spite
of the progress in neuroscience and genomics, the emergence of new interventions,
and the increasing awareness of the importance of mental health for overall health, the
field has largely stalled in terms of outcomes. Measures of morbidity and mortality
for the major mental illnesses have changed little over the past 4 decades, even while
outcomes for many chronic noncommunicable diseases are improving globally. As a
result, mental health has become a crisis in many parts of the world.
Our failure to bend the curve for mental health outcomes is not due to lack of means
or lack of knowledge. Psychiatry and psychology have developed powerful treatments
that compare favorably to treatments in the rest of medicine. Rather the crisis in men-
tal health is a crisis of care. We simply have failed to deliver the medical and psycho-
logical treatments that we know are effective. Or we deliver them so late in the course
of illness or with so little fidelity that they are no longer effective.
To solve this crisis of care we need to address three critical gaps: engagement,
quality, and accountability. That’s where digital mental health comes in. The nearly
ubiquitous tools of modernity—smartphones, sensors, and data science—may be able
to bend the curve for mental health by solving for the gaps in engagement, quality, and
accountability. This volume describes much of the empirical data to support this po-
tential. These are early days in this new world for mental health, a world that includes
