From data to diagnosis – digital help for depression

Few diseases are as difficult to diagnose as depression. What's more, outsiders often don't perceive it as a disease. The reason for this are symptoms that are not directly visible. Sufferers of the disease tend to experience fear, worry, and despair in everyday life, when no doctor is present. This is the starting point for telemedicine tools such as online programs or smartphone apps.

According to the World Health Organization (WHO), more than 320 million people worldwide suffer from depression. Compared to men, women are twice as likely to develop depression. One reason for this might be that depression is less often detected in men because they tend to not show any weaknesses or to seek help. This is what makes a diagnosis so difficult: we can't look inside the mind of another person. Sometimes this tremendous mental anguish can even lead to suicide – and rates are increasing. That's why it is especially important to continuously optimize care for people with depression to detect the disease early and treat it.

If depression is invisible, how can it be diagnosed and treated – and ideally at an early stage? Only the patient can shed light on his/her own mental state. This requires for patients to both realize that they suffer from depression and to subsequently visit a physician.

Having said that, there are also several measurable physical parameters that could indicate depression or an impending depressive episode. "Some patients might exhibit a slightly increased heartrate in the days leading up to and during an episode. Meanwhile, other sufferers might take longer to fall asleep or their voice becomes hoarser and softer," explains Professor Ulrich Hegerl, Executive Chairman of the German Foundation for Depression Relief (Stiftung Deutsche Depressionshilfe).

Both mental and physical symptoms are usually noticeable in everyday life. To enable a quick diagnosis and treatment, it is crucial for patients to make their own observations about their health. "If patients systematically and consistently collect data over months and years, many changes will become apparent that signal an impending depressive episode, which in turns allows sufferers to take countermeasures," adds Hegerl.

One tool to accommodate these types of data acquisition and documentation of observations are smartphone apps, online treatment programs or wearables. Since there are shortfalls in the care of patients with depression – sufferers often have to wait several months for an appointment with a psychologist –, these applications are frequently aimed at getting patients to self-manage their depression.

"With the app as their digital companion, patients are meant to structure their everyday life to identify depressive episodes at an early stage and get help or alerts when their situation worsens," explains data protection expert Professor Andre Döring.

One of these apps is Arya. Sufferers are especially aware of their fears and worries in everyday life. This is the starting point for the app since smartphones have become our constant companions and can help us manage daily life. Arya enables patients to monitor their emotions and behavior patterns and encourages activities to boost mental well-being. It stores moments of happiness so that they can be accessed during depressive episodes. The treatment is integrated into everyday life.

The STEADY project of the German Foundation for Depression Relief (Stiftung Deutsche Depressionshilfe), primarily targets bottlenecks in healthcare. "The STEADY project aims to encourage affected patients to self-manage their disease. The goal is to set up a system that enables people with depression to manage and better utilize the existing data about their bodily functions, behavior, and environment," Hegerl sums up the platform’s objectives. This data is collected with the help of sensors in smartphones or wearables. "Our basic concept is to systematically self-collect data about sleep patterns, exercise and movement patterns, speech tempo and volume, heart rate, skin conductance and cell phone use and then edit the data to make it available to STEADY users. The idea is for individuals to learn how to use this data and learn how to better cope with their depression."

Thanks to the common daily use of online services and apps, data protection concerns are more pressing than ever. Health apps, online treatment programs and digital platforms collect vast amounts of data – and very sensitive data at that. This is especially the case when it comes to depression. That's also why data protection expert Döring says, "it's crucial for patients to choose the right app from a reputable and reliable provider. The findings that are disseminated as part of the app must also be medically verified at all times."

Yet it's not just the developers who should protect data and provide transparency about how this data is used and who mines this data. Users should also be discerning when it comes to smartphone and online applications. "You are dealing with very sensitive data and every user should be very mindful of the specific data he/she has to provide. Another issue is whether patients have to give details about their diagnosis and emotional state. Needless to say, things become very personal very quickly. Patients provide information they would potentially only entrust to a physician," adds Döring.

Both patients and physicians benefit from eHealth and mHealth. On the one hand, patients can record their mental state and understand their disease and learn how to cope with it. On the other hand, physicians benefit from the collected data – not just when it comes to an individual diagnosis and treatment of patients but also as it pertains to recognizing behavioral patterns of different patients.

Having said that, there is still room for improvement when it comes to the digitization of care for people with depression. Hegerl confirms that we are moving in the right direction: "I am sure that it will become increasingly important in the future to take advantage of all the data we constantly produce and the possibilities of digital technologies to improve our health. There will be more and more sufferers who want to utilize this option to better manage their disease."