Asian Journal of Psychiatry 10 (2014) 1–2
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Digital psychiatry in Asia
With today’s 6.8 billion global mobile phone subscriptions rapidly approaching the world population ﬁgure (Sanou, 2013), the preponderance of digital technologies can no longer be ignored by the global mental health community. Asia’s interest in digital psychiatry tools such as internet based therapies and mobile phone monitoring has been previously hampered by lower availability of internet access and mobile phones. However this situation is at a tipping point with analysts projecting that Asia will now fuel nearly 50% of global mobile phone growth between 2013 and 2017 and soon represent 50% of the global mobile market (GSMA, 2013). China’s growth in mobile phone ownership from 50% in 2002 to currently 95% exempliﬁes the potential rapid rate of technology growth in Asia (Pew, 2014). In light of the burgeoning opportunity for digital psychiatry in Asia, this special edition of The Asian Journal of Psychiatry aims to explore the current efforts and future trends that underscore the growing role of digital tools for global psychiatry. Asia has already begun to utilize digital psychiatry tools and in their article Drs. Ben-Zeev and Brian review the current progress and promise of mobile technologies in Asia. Their discussion of already existing unique text message and mobile phone based interventions in Asia underscores current efforts while their description of the smartphone application FOCUS highlights the potential of new advances in digital psychiatry. Dr. Li and colleagues’ article examines how these new digital psychiatry tools can be implemented at a national level as she reviews the potential for smartphones to further expand and advance China’s mental health care services. She notes that China is the ideal setting for such a digital transformation and argues that the country is poised to embrace digital psychiatry for its nearly 1.35 billion citizens. Sharing these latest advances in digital psychiatry with the global mental health community is now only a mouse click away as Drs. Andrews and Watts outline in their article. They note that while Western countries may have more experience with digital psychiatry, the Internet creates a medium for fast and free exchange of digital psychiatry tools. Using Cognitive Behavioral Therapy (CBT) as an example, the authors explore the ability to easily share validated and evidence based treatments with both patients and clinicians around the world. The clinical demand for such collaboration is corroborated in the brief article by Dr. Srivastava who also outlines the potential of digital CBT but from an Indian perspective. However, sharing of digital psychiatry tools also requires adapting such resources to the many local languages and cultures of Asia. Dr. Karim and colleagues, in this issue, explore http://dx.doi.org/10.1016/j.ajp.2014.06.005 1876-2018/ß 2014 Elsevier B.V. All rights reserved.
the process and product of adapting the Internet Addition Test to the Bengali language and Bangladeshi culture. Their paper also portends the negative impacts of digital media on patients and reminds us that digital psychiatry tools also have both beneﬁts and risks. The negative impact of excessive mobile technology on mental health is a new but concerning issue and Dr. Pourrazavi and colleagues, in this issue, report on social cognitive constructs in predicting excessive mobile phone use in Iranian university students. The risks of using digital tools, such as text messaging or blogs, can also impact psychiatrists and create ethical, professional, and legal liability. To better explore the potential pitfalls in using these tools, Dr. Gutheil and colleagues provide an educational review regarding psychiatrists’ utilization of various digital mediums including telepsychiatry. When used properly, the potential of digital psychiatry offers the ﬁeld the ability to reach new patients and treat them with new resources. In this issue, Dr. Chandra and colleagues explore the feasibility of using a text messaging intervention to deliver mental healthcare outreach to a population of underserved young women in India. Their results suggest that digital interventions may have the power to engage previously untreated populations in psychiatric care. In addition to creating access for patients, digital psychiatry tool also have the potential to offer novel clinical information for patient care. In their paper, Dr. Kimhy and colleagues examine the ability of mobile devices to add new dimensions of social context, space, and time to patient treatment on locked inpatient units. With such new data, the authors argue it may soon be necessary to rethink how we evaluate psychiatric illnesses. Digital psychiatry is still nascent but the time for its expansion in Asia is now. Previous tangible barriers such as limited Internet access and scarce mobile phone ownership are now replaced with clinical need and academic opportunities for global collaboration. Each article in this special edition extols the myriad of clinical and research beneﬁts of digital psychiatry and discusses concrete examples and next steps to realize this potential. The need to share knowledge on this topic is so great that recently a new journal, Internet Interventions, has been created to highlight current advances combining digital technologies and mental health. While digital psychiatry may sound like science ﬁction, the scientiﬁc evidence base for using these tools is already growing and now ready to blossom in Asia. We hope that this special edition of The Asian Journal of Psychiatry will educate, excite, and inspire the ﬁeld to continue to expand upon the avenues of research presented in the following pages.
Editorial / Asian Journal of Psychiatry 10 (2014) 1–2
References Brian, R.M., Ben-Zeev, D., 2014. Mobile health (mHealth) for mental health in Asia: objectives, strategies, and limitations. Asian J. Psychiatry, XXX. Chandra, P.S., Sowmya, H.R., Mehrotra, S., Duggal, M., 2014. ‘SMS’ for mental health – feasibility and acceptability of using text messages for mental health promotion among young women from urban low income settings in India. Asian J. Psychiatry, XXX. GSMA, 2013. The Mobile Economy. http://www.gsmamobileeconomy.com/ GSMA%20Mobile%20Economy%202013.pdf [accessed 15.05.14] Karim, A.R., Nigar, N., 2014. The Internet Addiction Test: assessing its psychometric properties in Bangladeshi culture. Asian J. Psychiatry, XXX. Kimhy, D., Vakhrusheva, J., Liu, Y., Wang, Y., 2014. Use of mobile assessment technologies in inpatient psychiatric settings. Asian J. Psychiatry, XXX. Li, H., Zhang, T., Chen, Y., Wang, J., 2014. Mobile health in China: current status and future development. Asian J. Psychiatry, XXX. Pew Research Global Attitudes Project, 2014. Emergency Nations Embrace Internet, Mobile Technology. http://www.pewglobal.org/2014/02/13/emerging-nationsembrace-internet-mobile-technology/ [accessed 15.05.14] Pourrazavi, S., Allahverdipour, H., Jafarabadi, M.A., Matlabi, H., 2014. A sociocognitive inquiry of excessive mobile phone use. Asian J. Psychiatry, XXX.
Sanou, B., 2013. The World in 2013: ICT Facts and Figures. http://www.itu.int/en/ITUD/Statistics/Documents/facts/ICTFactsFigures2013-e.pdf [accessed 15.05.14] Srivastava, P., Mehta, M., 2014. Computerized cognitive behavior therapies in psychiatry: a viable option in India? Asian J. Psychiatry, XXX. Torous, J., Keshavan, M., Gutheil, T.G., 2014. Promise and Perils of digital psychiatry. Asian J. Psychiatry, XXX. Watts, S.E., Andrews, G., 2014. Internet access is NOT restricted globally to high income countries: so why are evidenced based prevention and treatment programs for mental disorders? Asian J. Psychiatry, XXX.
John Torous MD* Harvard Longwood Psychiatry Residency Training Program, Boston, MA, United States *Correspondence to: Harvard Longwood Psychiatry Residency Training Program, 330 Brookline Avenue, Boston, MA 02215, United States. Tel.: +1 617 667 4630; fax: +1 617 667 5575 E-mail address: [email protected]