- mHealth wearables, long seen as a tool for helping patients manage their health, are now being tested as a care management tool for their doctors.
Researchers at the University of Michigan, who have been analyzing stress levels of medical school interns for more than a decade, recently added Fitbits to their study. They’re hoping to move beyond the traditional patient survey and explore how daily routines, environmental factors, activity and sleep factor into the stress levels of a typically stressed population.
“There’s a lot of potential for wearables and mHealth in helping us understand how and why stress happens,” says Srijan Sen, MD, PhD, a member of the UM Medical School Department of Psychiatry and the university’s Molecular and Behavioral Neuroscience Institute. “Now we can go everywhere that (the intern) goes.”
In a recent study, titled “Effects of Sleep, Physical Activity, and Shift Work on Daily Mood: a Prospective Mobile Monitoring Study of Medical Interns” and published in the Journal of General Internal Medicine, Sen and his team of researchers used digital health tools, including Fitbits and mHealth apps, to discover that interns, in general, were losing nearly three hours of sleep per week, and that substantial changes to their sleep schedules (three hours earlier or later than pre-residency patterns) led to both less sleep and worse moods.
This, in turn, affected their activity levels, and had a negatives effect on their work performance.
“Though past studies have explored the consequences of problematic sleep, physical inactivity, and mood in this population, this investigation is the first to measure the association between changes in objectively measured sleep timing and duration and physical activity on daily mood during internship,” they reported. “Critically, our findings add to prior studies suggesting that long work hours, insufficient sleep, and circadian challenging shift schedules may create an insalubrious environment for intern mental health.”
Sen says the addition of mHealth tools over the past few years gives researchers a better idea not only of what happens to interns throughout the day and night, but also a database from which providers can develop methods for identifying and treating stress and depression.
“We’re just now being able to turn the day-to-day experiences of these doctors under stress into meaningful data,” he says.
Typically, Sen says, mHealth interventions are introduced late in the game, when patients are severely stressed or depressed and treatments are designed to address what has become a serious health issue. With an mHealth platform, he says, researchers are hoping to identify triggers much earlier, so that they can design interventions that guide patients away from stressful situations and perhaps introduce health and wellness habits.
The project may already be helpful. According to Sen, researchers are finding that the introduction of an mHealth platform, which enables the interns to measure their own activity and sleep levels and fill out daily “mood scores” on an app, is itself reducing depression.
“It’s still early days, but the data might help us find a way to protect people from depression,” he says.
For now, researchers are increasing the number of interns involved in the ongoing study, and they’re working on specific recommendations, such as improved shift designs, to improve sleep and activity patterns and, essentially, make the nation’s future doctors less stressed.
Sen and his colleagues are tackling a population with a strong connection to stress. A recent survey found that roughly 10 percent of medical school students have thought about killing themselves within the previous year, and their suicide rate is as much as 30 percent higher than that of the general population.
Sen sees this research being expanded to other populations that suffer from stress and depression, including police, fire and EMS workers, the military and pregnant women.
He also anticipates adding more mHealth and telehealth technology to the study. This includes a recent partnership with Mindstrong Health, which is gaining notice for its research into how moods and mental state can be measured through a user’s smartphone activity.
“I’m sure that what we’re doing in two years is going to be completely different from what we’re doing now,” he says.