By Joseph S. Alipio, RN
St. Paul University Philippines – Graduate School

Maria Claire Bautista, RN
St. Paul University Philippines – Graduate School

Gold Mendoza RN
St. Paul University Philippines – Graduate School

*Roison Andro Narvaez MSN RN
St. Paul University Philippines – Graduate School
University of Makati

Marieta Sudaypan, RN
St. Paul University Philippines – Graduate School

Ralph Antonio Peco, MSN RN
University of Makati

Citation: Alipio, J. S., Bautista, M.C., Mendoza, G., Narvaez, R. A.,  Sudaypan, M. & Peco, R. A. (2022). Impact of Wearable Devices in Mental Health and Quality of Life. Canadian Journal of Nursing Informatics, 17(3-4).  https://cjni.net/journal/?p=10472

Abstract

Background: One of the main facets of a healthy individual is having a stable mental health condition.  The past two years have been a global fiasco of unprecedented events that triggered the general population’s mental status. The use of digital technology, particularly wearable devices, brings forth hope in reaching people seeking mental wellness and aid.

Objective: This study aims to provide clarity and complexity on the influence of wearable devices and their efficacy in the promotion, surveillance, execution, and improvement of mental healthcare delivery.

Design: An integrative review of the literature. The consolidated compiled articles were manually screened by researchers to obtain the ranking system of Melnyk and Fineout-Overholt (2015) in categorizing the levels of evidence (LOE) for each study.

Data Source: The literature review piloted the utilization of a systematic search through different online databases based on the inclusion and exclusion criteria. Ten studies were included in this integrative review.

Result: 10 articles met the criteria set forth for this review which showed that the usage of wearable devices in mental health significantly improves the real-time cognitive assessment of mental health conditions, supports clinicians in the detection or mode of treatment, and promotes mental wellness. The overall result of users’ acceptability and intention of integrating wearable devices has an affirmative effect on promoting mental health and improving medical modalities in mentally ill patients. The results show that using innovative devices has an essential role in the continuous development of the healthcare system, particularly in mental healthcare. 

Contributions of the paper

1. What is known about the topic?

1. Uses of technology significantly influence healthcare delivery and improve the quality of service that is provided to patients.
2. Mental health dramatically impacts and influences individual development and societal stability.
3. With the growing demand for mental health treatment, portable intelligent gadgets and wearables promote better mental health promotion, monitoring, and management. 

2. What does this paper add?

1. Wearable devices are used in other aspects of mental health aside from stress level detection, vital signs, and primary sensor algorithms.
2. The new technologies/ applications used in mental health could promote quality of life.

Background

In recent years, the emerging area of smart wearable devices has shown rapid development due to the increasing prevalence of personalized health applications. Technological development such as smart sensors, increased use of computers, and wearable gadgets in the medical field paved the way for wearable health technology to emerge as one of the most exciting new frontiers in personalized medicine and self-care. Big data from these wearable devices help our patients by predicting individual treatment responses or risks, understanding how a condition manifests in particular individuals, and designing interventions tailored to patients’ specific needs (Chivilgina, 2021). These wearable sensors or devices are already influencing healthcare and medicine since they make it possible to monitor one’s health outside of a clinical setting and to forecast medical occurrences (Dunn et al., 2018). These modern intelligent devices help people pursue healthier lifestyles and provide continuous surveillance of healthcare information that can be used for disease prevention, diagnosis, and promotion of health through actively recording physiological parameters and tracking metabolic status.

As a result, wearable medical devices have the potential to become a pillar in the future market for mobile medical technologies. In addition, the possible economic value of the wearable market is predicted to expand considerably, amounting to US $70 billion by 2025 (Bayoumy et al., 2021). This projected market growth forecasts significant promise and movement in the healthcare domain aside from consumer, industrial, and medical applications. To align with the holistic meaning of health provided by the World Health Organization (2022), mental health cannot be ignored or neglected. Technology must also serve as a boon to mental health detection, management, and promotion (Narvaez et al., 2022).

With more individuals needing mental health treatment, portable smart gadgets and mental health apps for monitoring mental health have gained popularity (Torous, 2018; Tandon, 2020). A previous systematic review looked at how wearable sensors are used to monitor depression, anxiety, and stress. Still, there are few on mental health, and even though some of the research included extensive information, the categorization of observed signals that indicated stress, and so on was not detailed in-depth in these evaluations (Hickey et al., 2021). As a result, the availability of these technologies can both enhance mental diseases’ diagnostic capabilities and expand access to mental health care. Therefore, this integrative review aims to acknowledge the impact of wearable devices on the quality of life in mental health by reviewing the available qualitative literature and to suggest directions for future research.

Aim/Objective

The aim of this review was to explore the different uses of wearable devices in mental health care, its’ impact on quality of life, and implications for healthcare and nursing.

Method

Design

This research study used an integrative review of the literature design. The integrative review is an approach that permits for the combination of varied methodologies. It can play a potential role in the contribution of evidence-based practice, especially in nursing (Whittemore & Knafl, 2005). The authors utilized standard steps to conduct the integrative review including identification of the topic of interest, evaluation and analysis of data, consolidation of findings, and implication in nursing (Toronto, 2020).

Search Strategy

An integrative search of all available literature was utilized using online databases: Google Scholar, National Library of Medicine, PubMed, ScienceDirect, Elsevier, SCOPUS, and Wiley Online Library. The inclusion criteria defined in the selection of articles were in English and translated into English, and peer-reviewed articles centered on the uses of wearable devices with impact on quality of life in mental health. The researchers excluded studies from abstract-only articles, duplicates, opinions, and editorials not centered on mental health and not directly related to wearable devices. The main keywords used for this review were: wearable technology OR wearable devices OR mental wellness device AND quality of life AND mental health.

Quality Assessment

The authors reviewed the publications for each study by utilizing the Hierarchy of Evidence for Intervention and Treatment Questions to categorize Level of evidence (LOE) (Melnyk & Fineout-Overholt, 2015). The researchers evaluated the article manually from the online database and considered the inclusion and non-inclusion criteria in the integrative review (Figure 1).

Figure 1: Search strategy and selection of literature

Data abstraction and analysis

The data collected from the studies’ roster were evaluated. Melnyk and Fineout-Overholt’s (2015) guidelines were used as the appraisal tool to determine the article selection. The authors assessed the articles and categorized them into the following: year and country it was published, author, method, data sample, setting, platform used, and stages of evidence (Figure 1).

Results

Article / Sample Characteristics

As shown in Table 1, a total of ten studies published between 2016 to 2020 were included in the study sample. The study designs differed, including descriptive quantitative, ethnographic, exploratory, and correlational studies. The studies originated from the United Kingdom, Australia, Ireland, and Taiwan with Australia ranking first in terms of numbers. The study settings depended on which location the study was conducted. The methods and instruments used included various data collection tools such as questionnaires, surveys, and semi-structured interviews. All studies belonged to level of evidence (LOE) VI, which is descriptive or qualitative in nature. With regards to wearable devices, the researchers were able to identify a variety of sampling sizes across the studies included in the sample. The total number of participants was 7,198 across studies, age groups ranged between 18 and 69 years old and included a mix of adults, young adults, and senior citizens.

Table 1. Summary of Included Studies on Wearable Devices and their characteristics

Discussion

The ten (10) articles that were selected for this integrative review share the same general objective: to determine the possible acceptability and efficiency of wearable devices in assessing and promoting mental health and treating mental health disorders. Table 2 shows that most of the devices used in the studies were watches (Apple and Fitbit), wearable biosensors, smart headbands, mobile phone applications, and a pendant Sensor. While other studies did not specify the devices they have used since there are many available on the market, they only get data based on the user’s acceptability and how they perceive the wearable device to be used in mental health. Based on the presented data and results, there is a strong predictor of interest and perceived effectiveness on the use of wearable devices. This statement can be further supported by the findings as follows.

Table 2. Wearable Devices

Three studies used similar platforms in the form of smartwatches or wristbands to assess their relevance in the care of mental health. Using Fitbit wearable devices to measure daily step count promoted physical activity to address weight loss and promote better physical health among patients with serious mental illness (Nasland et al., 2016). The device used was feasible and could be a potential strategy for reinforcing behavioral weight loss in mental health facilities. Moreover, it was known that in major depressive disorders, cognitive symptoms are common, and it can be difficult to identify individuals who need treatment or are not adequately experiencing treatment responses. To address this issue, one study used Apple watches that provided real-time data to support the feasibility and validity of the high-frequency assessment of cognition and mood over an extended period of time in patients with major depressive disorders (Cormack et al., 2019). Another study showed with reasonable accuracy, that a patient’s general and mental health measures could be predicted through Heart Rate Variability (HRV) data collected from wearing a wrist wearable device (Coutts et al., 2020).

Other studies found that wearable devices can be an effective solution to help in preventing stress-related mental disorders. Two studies used the Ecological Momentary Assessment (EMA) to merge with a portable electronic device that integrates sensors for Ecological Physiological Assessments (EPA) (Coutts et al., 2020; Tutunji et al). (2021). Environmental stressors such as the examination period could result in physiological arousal which can be detected by the sensors. Thus, using wearable wristband devices can detect stress using machine learning models. The findings can then attest that those wearable biosensors bear the potential to monitor stress-related mental health problems.

However, two studies in this integrative review had similarities based on the purpose of their surveys to gauge the effectiveness of combined medical management of professional care along with the application of wearable devices and the adaptability of wearable devices in clinical or non-clinical settings. In these modern times where everything is fast paced, how well does an older adult adapt and use technological advancements? Using a smart bracelet and a questionnaire revealed that older adult users with higher technology readiness and interaction with technology have higher perceived ease of use and perceived usefulness in using wearable devices (Jeng et al., 2022). On the other hand, wearables can be significantly effective as an alternative to talking therapies or self-help options (Hunkin et al., 2020). Devices such as smartphone applications were more appealing to patients who were not in favor of psychological therapy. With these presented findings, the study claims that clinicians are practically using popular applications and wearable apparatus to aid them in expanding clinical management through the pool of information stored in the device across common mental disorders and for the mental wellness of individuals.

Despite continuous improvements in medical and mental health innovations, discretion is still imperative among clinicians and consumers alike regarding digital health technology. Implications of the complete application of wearable devices in mental health care must be considered because it is still relatively new, and its algorithms are still under development (Joseph et al., 2019). No wonder, with continuous technological advancement, it is expected that wearable devices that are more reliable and enabling will no longer be available only in centralized health care settings but will also be accessible to all individual users. 

Early identification of warning signs from digital footprints could facilitate adaptive and dynamic just-in-time monitoring and care for individuals with common mental disorders (Knight & Bidargaddi, 2018). However, they added that continuous monitoring using commercial apps and wearables would make it more viable to help clinicians augment medical management for common mental disorders. Furthermore, cognitive impairment has also been noted in adult patients undergoing hemodialysis (Zhou et al., 2020). However, it has been poorly diagnosed due to the unavailability of proper devices and tools. To address this issue, they confirmed that utilizing a locket sensor on a non-hemodialysis day has served as a basis for digital biomarkers via detection of mobility performance metrics, precisely measuring the accumulated posture duration and postural transition in any cognitive impairment among patients on dialysis. Based on their study results, patients with cognitive impairment prefer sitting, lying down, and taking fewer daily steps than cognitively intact patients.

Regrettably, the mental state of everyone has been greatly affected due to the unexpected situation brought about by the pandemic. Many have suffered from pandemic anxiety, depression, or even burnout. These signs and symptoms then resulted in sleep pattern alterations among individuals. One of the wearable devices tested was WHOOP, a commercial sleep digital wearable device. Utilizing WHOOP has shown that people with short sleep durations of fewer than six hours and inconsistent sleep timing before and during the onset of the pandemic have higher odds of suffering from burnout, anxiety, and depression, relating to new or higher cases of substance use, especially in the United States (Czeisler et al., 2022).

In general, the purposes and outcomes of applying wearable devices in health care practice include health promotion and safety monitoring, prediagnosis and treatment, chronic illness management, and rehabilitation (Lu et al., 2020). Some researchers found that the application of different wearable devices transformed the healthcare delivery system and reduced healthcare costs (Zheng et al., 2014). Finally, through this integrative review, the researchers recognized the efficacy of wearables, especially its advantages in replacing psychotherapy and as a self-help option. However, the patients showed more interest when the devices were technologically effective through first-hand experience. With higher efficiency, they become more responsive to wearable devices as a directive treatment approach compared to conventional therapies.

Limitations

The results presented claim that portable medical devices or wearables, without a doubt, present high potential for supporting individuals needing mental health support and care. While necessary and in demand, the technology requires patience and knowledge to use. Many factors should be considered towards the implementation, including the shortage of health care personnel and facilities. Uneven distribution of mental health professionals abounds, especially in the provinces and slum areas with no coverage, financial resources, or maintenance of wearable devices (Paluch and Tuzovic, 2019; Aroganam et al., 2019). Another thing to consider is the privacy of the patient data and the storage of all the data gathered using the adaptation of wearable devices in a clinical setting (Thierer, 2015; Pericleous & van Staa, 2019). Wearable technology remains at its development and growth stage. Still, wearables continue to grow exponentially and are being implemented in many more ways, transforming our lives to be much more convenient, safe, and automated.

Conclusion

Wearable technologies undoubtedly can provide enormous benefits to healthcare providers and patients, as supported by the findings we have presented above. Studies show that the longer a device was used to monitor a patient, the easier health care providers could understand the patient’s case and needs. Through all the data collected from the wearable device, clinicians can reach a more accurate diagnosis than they would have without the device. Finally, these wearable devices are still in their discovery stages. Further research on the use of wearable devices and their issues should be addressed, such as user acceptance, security, ethics, and data concerns, to enhance the usability and functions of these devices for practical use, especially for mental health.

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Corresponding Author

Correspondence concerning this article should be addressed to Roison Andro Narvaez, St. Paul University Philippines, Mabini Street, Tuguegarao, Cagayan, 3500 Philippines.