The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

John Torous; Sandra Bucci; Imogen H Bell; Lars V Kessing; Maria Faurholt-Jepsen; Pauline Whelan; Andre F Carvalho; Matcheri Keshavan; Jake Linardon; Joseph Firth

doi:10.1002/wps.20883

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

World Psychiatry. 2021 Oct;20(3):318-335. doi: 10.1002/wps.20883.

Authors

John Torous^{1

2}, Sandra Bucci^{3

4}, Imogen H Bell^{5

6}, Lars V Kessing^{7

8}, Maria Faurholt-Jepsen^{7

8}, Pauline Whelan^{3

4}, Andre F Carvalho^{9

10

11}, Matcheri Keshavan^{1

2}, Jake Linardon¹², Joseph Firth^{13

14}

Affiliations

¹ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
³ Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
⁴ Centre for Health Informatics, University of Manchester, Manchester, UK.
⁵ Orygen, Melbourne, VIC, Australia.
⁶ Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
⁷ Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark.
⁸ Copenhagen Affective Disorder Research Center, Copenhagen, Denmark.
⁹ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹⁰ Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
¹¹ IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia.
¹² Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia.
¹³ Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
¹⁴ NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia.

Abstract

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

Keywords: chatbots; digital health; digital phenotyping; implementation; mHealth; mental health; psychiatry; smartphone apps; social media; virtual reality.

Abstract

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