Samantha Laine Perfas
Harvard University, Massachusetts, August 17, 2023
You can already track your steps, your sleep, so why not track your mood?
Apple’s latest software updates for its iPhone, iPad, and Apple Watch will now allow users to log and track their moods.
They are far from the first tech company to offer this, but with the rising concerns over mental health across the nation, it raises the question of whether mood-tracking apps are effective.
Jukka-Pekka Onnela is an Associate Professor of Biostatistics and Co-Director of the Master of Science in Health Data Science programme at the Harvard T H Chan School of Public Health. He studies how data collected from digital devices can help us understand our social interactions, behaviour, and moods.
The Harvard Gazette spoke with Onnela to better understand how mood tracking works.
This interview has been edited for length and clarity.
Questions and Answers
GAZETTE: What do you think about Apple offering mood tracking on its devices?
ONNELA: In general, I think that it is a very positive development that a company like Apple is thinking about mental health. When you have a big company stepping into this space, it serves as an important signal that mental health really matters. From my impression, the App relies on self-reporting, and there are many companies that do this already. But the devil is always in the details; if Apple has found out a good way for people really adhere to the self-reports over the long term, that could be a game changer.
Mood tracking limitations
Gazette: What are some of the limitations of mood tracking?
Onnela: Most approaches to mental health have relied heavily on self-reporting, and one of the limitations of this approach is that it’s very difficult to get people to do it over long periods of time. If it is a more acute setting, where you ask users to self-report daily for a week or a month, I think that is doable. But if we are thinking about a chronic condition, which would require self-reporting for years and years, I do not think it is feasible, and the data will be spotty.
Also, certain types of serious mental illness are characterised by the fact that a person lacks insight into their own behaviour or moods; so if we think about serious mental illness — like bipolar disorder, schizophrenia, and so on — it may be of limited utility to ask people about their own behaviours because they do not have that awareness compared to somebody who has mild to moderate depression. And as a statistician, I must mention bias. You might have one day when you are feeling so good that you do not feel like doing a survey on psychological symptoms. But in contrast, it could also be that you feel so bad that you do not want to be thinking about these topics.
Gazette: Tracking one’s mood seems like a first step. But what do users do with the information? Is the purpose of these apps simply to record data or provide actionable steps?
Onnela: Currently there are thousands of Apps for tracking moods, broadly speaking. My sense is that there are two sets of things that can be done: We can measure, and we can manage. Measurement is important if it can be done accurately because we cannot manage what we cannot measure. For example, think of something like your weight. We have weight scales — most of us have them in our bathrooms. If we are going to have any intervention on weight, we need a way to assess if what we are doing is working or not.
Measurement and Management
My sense is that smartphones are really a game-changer when it comes to the measurement piece of mental health. Anecdotally, I am aware of Apps that provide tips for managing mental health; I am also aware of some applications that give terrible tips. I would really stress the importance of keeping these two things apart, the measurement component and the management component. But overall better measurement is going to be helpful both at the clinic and outside of the clinic.
Gazette: It sounds like as a user, it could be helpful to use Apple’s mood tracking or other Apps to measure what is going on in my life. But in terms of management, I should seek help elsewhere?
Onnela: Yes, seek clinical help. One aspect of this measurement piece, which is sometimes overlooked, is that being able to see your own past mood could potentially act as an informational intervention. For example, imagine a person looking at their self-reported data; they could be shocked to see that for the last two months, consistently, they have reported anxiety, depression, and so forth. We have to be careful when we feed this information back to users.
Gazette: I was actually thinking about that. Let us say that I am tracking my mood and for two months, I find out that I am unhappy 75% of the time, might that make me more unhappy to realise how unhappy I am?
Onnela: I think that is right. That could happen. Especially if the results are out of the norm. But of course, when those measurements are out of the norm, that is when they are potentially the most useful. But again, it just underlines the fact that one has to think very carefully about how this information is fed back to the participant.
Gazette: Does this feel like encroachment from tech companies, to be entering these areas of mental health and mood tracking? Where do you see that line between companies helping people and when they might be taking it too far?
Health and Wellness
Onnela: That is a tough question, and probably a contentious one. It is clear that there is an unmet need for mental health resources. We have millions of people in the US who do not have health insurance, and millions more who are underinsured. I think it helps explain why we have so many smartphone applications that specifically target mental health and wellness.
But there is a difference between health and wellness; if we are thinking about wellness, that is a fairly unregulated space. If we are talking about health, then we do have regulations there, with the (US) Food and Drug Administration (FDA) playing a hugely important role. So, I am sure that clinicians are worried to some extent, and so am I. But it is also concerning that we have millions of people who are not getting the help that they need. I think that it is important to continue to explore and innovate and experiment. But that has to be done with some guardrails in place, and if we had a perfectly functioning mental health system, I do not think there would be a need for these types of approaches.
Gazette: Do you think we can trust companies to use this data and technology ethically and responsibly?
Onnela: I think it depends on the company. There are some companies who seem to be very responsible about the way they use data. For example, they may only collect the data that is absolutely needed. They do not sell their data, and they do not sell your data to third parties. But there are also bad apples out there. I am not sure this is any different from any other field, but when we talk about health, the risks are probably more significant than in almost any other area. I think that calls for regulation and establishing best practices.
Complicated Relationship
Gazette: Technology and mental health have a complicated relationship. So what are some of the limitations of using technology to help our mental and emotional well-being individually and collectively as a society? Or where do you see the potential?
Onnela: I always think about the role of adherence. We may have the best drug, but if people don’t take the drug, it’s pointless. And with many of these new technologies, especially wearables and tracking, we know that most people will wear the device for three to four months, and then stop wearing it and it ends up in some drawer somewhere. Wearables cannot work on people who don’t wear them.
I think that the great potential of smartphones is the ubiquity of the device. When thinking about health inequities, if we can leverage devices that people already have, then we can potentially reduce those inequities. In contrast, if you have to buy a dedicated wearable, that is expensive. And the people who are most able to afford that are probably the people who are least likely to truly benefit.
The downside of this very technology is that there are studies showing the negative impact of spending too much time on your smartphone. We know that screen time, especially among adolescents, has been on the rise. People are practically glued to their devices, that cannot be a good thing. It is no panacea; the same technology that I think has the most potential for addressing mental health, if not used with caution, can also deteriorate your mental health. It is a balancing act.
Samantha Laine Perfas is a Staff Writer at Harvard Gazette, published by Harvard University, Cambridge, Massachusetts. The above article appeared in the Harvard Gazette Health.
