Mobile Tracking for Mental Health and Wellbeing

Introduction

In western countries, up to 30% of young people experience mild, moderate or more severe depressive symptoms by 18 years of age (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993; Rushton, Forcier, & Schectman, 2002). Mild symptoms can progress to moderate and then severe symptoms (Rushton et al., 2002), resulting in diagnosable mental health disorders. Therefore, there is a substantial need for prevention programs that are simple and low-cost. These programs are fundamental to reducing the economic and personal burden of depression (Andrews, Sanderson, Corry, & Lapsley, 2000). Using a stepped care model may reduce the disease burden of mental illness, beginning with simple and inexpensive prevention programs (that occur before the onset of diagnosed disorders) and ‘stepping up’ to higher intensity programs as needed (Geisner, 2006; Jorm & Griffiths, 2006; van Straten, Seekles, Beekman, & Cuijpers, 2010). The stepped-care model has the advantage of providing low intensity early intervention programs with reduced length and cost of the treatment to young people experiencing mild mental health symptoms (Kuehner, Huffziger, & Liebsch, 2009; Lynch et al., 2005; Spence et al., 2005). van Straten et al. (2010) advocate the use of ‘watchful waiting’ with young people experiencing mild mental health problems as a first step in the stepped care model. Current universal prevention programs that focus on intensive computerised or school-based cognitive behavioural therapy-based programs, such as the beyondblue Schools Research Initiative (Spence, Sheffield, & Donovan, 2003) are costly, time-consuming, have high attrition rates and therefore may be better suited to second-step early intervention targeting young people with elevated symptomatology. Third-step interventions should involve individualised face-to-face therapy with young people experiencing diagnosed disorders. Fourth-step interventions could then involve the use of anti-depressant medication combined with face-to-face therapy for use with severe chronic episodes of depression, anxiety or severe mental illness in combination with CBT and regular monitoring for suicidal ideation and behaviour (van Straten et al., 2010).

As a first step intervention, the ‘watchful waiting’ approach has two limitations. First, as general practitioners (GPs) are often the first point of contact for people with mild mental health symptoms (Council of Australian Governments, 2006), the onus of watchful waiting would be placed upon GPs. Nonetheless, GPs are under pressure to treat many people within a day and to keep appointment times brief. In Australia, for example, the current average appointment time for GPs is approximately 15 minutes per patient (Britt, Valenti, & Miller, 2002). Second, GPs are more likely to identify mental health problems in young people who are aware of emotion distress (Haller, Sanci, Sawyer, & Patton, 2009); therefore, watchful waiting may not be useful with young people who are unaware of emotional distress until more severe symptoms are developed.