Remote measurement technologies for depression in young people: A realist review with meaningful lived experience involvement and recommendations for future research and practice
Authors: Walsh Annabel E L , Naughton Georgia , Sharpe Thomas , Zajkowska Zuzanna , Malys Mantas , van Heerden Alastair , Mondelli Valeria 
Published: June 2022

Background

Remote measurement technologies (RMT), such as smartphones and wearables, allow data collection from an individual in real-time during their day-to-day life, from which their mood, physiology, behaviour, and environment can be inferred. As such, RMT could monitor and detect changes relevant to depression for objective screening, symptom management, relapse-prevention, and personalised interventions. Whilst RMT for depression in young people has been previously reviewed, technological capability and digital mental health literature steeply increase each year but with limited scrutiny of the realist and ethical considerations likely to impact the benefits, implementation, and overall potential of RMT in the real-world.

Methods

A realist review of RMT for depression in young people aged 14 – 24 years was conducted in collaboration with two young, lived experience co-researchers from The McPin Foundation Young People’s Network (YPN) and in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) for quality and publication. Iterative searches across 10 electronic databases and 7 sources of grey literature, fine-tuning of selection-criteria, data extraction and evidence synthesis with insights from the wider YPN members allowed gradual refinement of an initial framework into a realist intervention theory.

Results

Of 6118 records identified, 104 were included in evidence synthesis. What does and does not work? Smartphones were most preferred, with both passive and active data collection for a holistic approach but a balance between data quality, intrusiveness, and data privacy. From the evidence currently available, depression was best detected by changes in sleep, mobility, smartphone use, social communication, and self- or- parent-reported mood. This had some uses in screening, self-monitoring, and feedback to the healthcare professional but not in relapse-prevention and personalised interventions, where significantly more research is required. How and why? The impact of RMT as an intervention itself on depression outcomes remained unclear but self-monitoring and feedback improved emotional self-awareness, therapeutic relationship, and help-seeking behaviours. For whom? With limited standardisation and investigation of the impact of depression on adherence rates, there may be an overestimation of how much young people are likely to use RMT in the real-world. However, they were most likely to benefit those interested in and motivated by the data-driven nature, who have lower depression severity, no co-morbidities where self-monitoring could cause harm, and the presence of changeable behaviours. In what contexts? RMT facilitated monitoring during transition to university, known to be associated with worsening depression in young people; however, there were significant challenges in health care and school settings. Adaptability was important, such that RMT were culturally compelling and accurate for the local context. Overall, there were many gaps in the evidence and common methodological issues across the literature.

Conclusions

From the evidence base and lived experience insights, realist and ethical considerations were highlighted, as well as the remaining gaps in evidence and methodological issues common across the literature. For RMT to be the scalable solution for depression in young people rather than a case of overplayed potential, several important recommendations for future research and practice were made.