Aristotle was a firm believer in the law of non contradiction, which says that an idea and its opposite cannot be both true at the same time. But Aristotle never had a smartphone. Research has increasingly shown that smartphone use can contribute to depression, especially in teenagers. At the same time, smartphones are offering many virtual ways to help prevent and treat depression and other mental illnesses successfully.
“There are interesting studies that point to both [possibilities],” says Dr. John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center, which is affiliated with Harvard Medical School, where he serves as a staff psychiatrist and clinical informatics fellow. “For some people, connectivity is beneficial and protective. For others, the isolation may be harmful. I think we will learn there is no one rule for this,” says Torous, who also chairs the American Psychiatric Association’s work group on the evaluation of smartphone apps.
To date, the research has not been able to keep up with the technology. “A lot of things are happening, some exciting, frightening, concerning, wonderful things,” he says. “These are huge issues that many people aren’t aware of. The discussion is being driven more by PR and hype, and not as much by facts. We need to shift the conversation. We have to think about this transformation and how to do it the right way.”
[Read: Why Teen Girls Are at Such a High Risk for Depression.]
The Harm in Smartphones
When we talk about smartphones, we are talking about social media; any parent of a teenager knows that the actual telephone is least-used application on the device. And there are considerable data that suggest social media use can be a mental health risk. One study from 2016 states unequivocally that social media use is “significantly associated with increased depression.” And a quick Google search will uncover many more like it.
There are a couple of theories as to why smartphone use is harmful to teens— and, it should be added, to adults at risk for depression as well. “There seems to be a tendency for young people who spend hours on screens to be lacking in the development of interpersonal social skills and connections that we believe are essential for depression prevention,” says Ellen Frank, professor emeritus of psychiatry and psychology at the University of Pittsburgh School of Medicine. Conversely, developing those connections can help lift someone out of depression.
There may in fact be a biological component of social connection. “We know which hormonal systems influence social connections, and they seem to require the physical presence of another person,” Frank says. In other words, the number of people who “like” you on Instagram don’t count. “So electronic media may not serve young people well in general, whether they have depression or not, but kids with depression are especially vulnerable.”
Another factor is the extent to which regular social routines — wake time, bedtime, mealtime, activity and rest — impact brain health and mental health. Frank and her colleagues studied adolescents at risk for bipolar disorder, and those who had their phones by their bed had terribly disturbed sleep. “They had sleep patterns like an 80-year-old person,” she says. “That can’t be good for any kid, especially one at risk for mood disorders.”
[See: Am I Just Sad — or Actually Depressed?]
The Help From Smartphones
Four years ago, the World Health Organization released its Mental Health Action Plan 2013-2020, and one of its recommendations was: “The promotion of self-care, for instance, through the use of electronic and mobile health technologies.” That goal is well on its way to being realized.
“We think there are about 10,000 commercial [mental health] apps available, and that is always growing,” Torous says. In fact, both Torous and Frank, along with many of their colleagues, are involved in developing electronic options for those with mental health disorders. Torous and his team at Beth Israel Deaconess are developing an app to assess cognition for clinical research studies. And Frank is the chief scientific officer for HealthRhythms, an app that collects smartphone data to help medical professionals learn about behavioral health.
Many of these apps purport to alleviate stress, depression and anxiety, while also promoting mindfulness and cognitive behavioral improvement strategies. Torous co-authored a just-released study, to be published in the October 2017 issue of World Psychiatry, that suggests they really work. This is the first meta-analysis of smartphone apps used to treat depressive symptoms. Researchers reviewed randomized controlled trials of 22 apps used by 3,414 participants and found that symptoms were reduced significantly more from the smartphone than in control groups, leading to the conclusion that “smartphone devices are a promising self-management tool for depression.”
Another study, released in 2016, followed users of the popular meditation and mindfulness app Headspace. The study found that healthy adults showed a 28.6 percent decrease in depressive symptoms and a 7.2 percent increase in positive emotions after using the app.
[Read: Is Depression a Disease?]
There are many more studies like these, and mental health experts are increasingly excited about these and still-to-be-invented apps’ potential, including as a way to supply real-time data on a person’s location, activity level, biomarkers and other clues to his or her current mood. “Increasingly today, everyone in the world owns a smartphone or will soon, and we can collect new types of data we could never collect before,” Torous says. And many apps can be “enormously helpful, especially to the socially isolated person who is not comfortable seeing a mental health provider,” Frank says.
So, are smartphones good or bad? Yes. “Phones have changed all our lives, and like everything else, any tool can be of great benefit or can do a lot of harm if used inappropriately,” Frank says. Sorry, Aristotle.
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