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CloseCAN A WATCH HELP PREVENT TEEN SUICIDE?
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⚠ Content Warning: The following article contains discussions of suicidality and depression. |
Suicidality in teenagers has become the new pandemic.
The American Psychological Association defines suicidality as “the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan.” It can also be defined to include suicidal thoughts, plans, gestures, or attempts.
However it’s defined, there is a clear and present danger occurring among our teenage children. Whether the rise in suicidality in this demographic is due to the isolation from the COVID-19 pandemic and its lockdowns, the omnipresence of harmful social media, or some other societal or familial causality, the time for mental health technology solutions is now.
One such solution is occurring in the partnership between researchers at Oregon Health & Science University School of Medicine (OHSU) and digital healthcare technologists at Analog Devices.
In a study together, OHSU and ADI have teamed up to develop evidence-based technology to help address the rising mental health crisis in teens with a wearable smartwatch using vital signs monitoring (VSM). The hope is that, ultimately, the watch will act as an early detection system for individuals suffering from depression and suicidality.
OHSU strives for excellence in education, research and scholarship, clinical practice, and community service. OHSU’s Biomedical Innovation Program (BIP) helps accelerate the delivery of healthcare technologies to improve human health. BIP is a collaboration of the Oregon Clinical & Translational Research Institute (OCTRI), OHSU Technology Transfer, and OHSU Collaborations & Entrepreneurship. This program cultivates, evaluates, and funds promising translational projects with the objective of moving innovative technologies to clinical application through commercialization.
“Adolescents with suicidality are presenting to emergency departments in unprecedented numbers across the country,” says Dr. David Sheridan, M.D., associate professor of emergency medicine at OHSU.
With this knowledge, Sheridan knew he had to act fast. So, he decided to build upon his research identifying physiological signs of suicidality and partnered with ADI to develop smartwatch technology, which could sense problems immediately.
ADI + OHSU: A RESEARCH PARTNERSHIP FOR LIFE
This collaboration between academia (OHSU) and industry (ADI) addresses an urgent and unmet need for helping avoid depression and suicide, and it could not have come at a more opportune time.
Due to the enormous demand for mental health beds throughout the country, there is an extremely limited supply for adolescents.4 This taxes the healthcare system since the emergency department often does not have the ability to make beds available for these new emergencies.
Almost half of adolescent patients who previously have been seen in the emergency department for depression or suicidality will have multiple visits for these crises. Real-time monitoring of these patients leveraging the ADI Study Watch is another major reason to develop out-of-the-box and remote healthcare solutions.
“This important research with OHSU leverages ADI’s novel, sensor technology, and data capture solutions to develop new insights into mental health and empower healthcare professionals with new tools in the future to better manage their at-risk patients.”Adrian Fox
Managing Director, Digital Healthcare Systems | Analog Devices
SIGNS OF HELP: THE ADI STUDY WATCH
Consumer smartwatches with their large faces and algorithms that measure everything from footsteps and heart rate to body temperature, are common the world over. ADI’s device, on the other hand, dives deeper to detect heartbeats and delivers clinical-grade data, while also calculating HRV in real-time. This smartwatch measures heart rate with light reflectivity rather than standard electrocardiogram (ECG), so it could help eliminate a chest patch with adhesive ECG electrodes.
Patients can sign off on wearing the watch and share their data with a clinician or researcher where it’s anonymized. ADI’s watch provides both precise measurements as well as all the raw data that can be used by researchers to develop advanced analytic methods—giving it a distinct advantage over out-of-the-box, consumer watches.
What’s more, a signal quality index for heartbeats, developed by David Xue, ADI Staff Machine Learning Engineer, provides researchers a quick and efficient way to filter down to the critical data.
The team in this mental health technology initiative is collaborating with Bonnie Nagel, Ph.D., Professor of Psychiatry in the OHSU School of Medicine and Associate Vice President for Research, and aims to enroll adolescents with acute suicidality to understand these signals better and know how to improve mental health.
Objective data and clinical research are top priorities for this collaboration. If scalable, this OHSU-ADI smartwatch will be one of the first, evidence-based wearable technologies to monitor suicidality.
“It’s a paradigm shift. We aren’t requiring suicidal patients to reach out to us, but instead we are coming to them.”Dr. David Sheridan, M.D.
Associate Professor of Emergency Medicine | OHSU
DIFFICULTIES IN IDENTIFYING WHEN SOMETHING IS WRONG
It can be hard for a parent or guardian to know whether a difficult phase is teen angst or something more serious like depression or suicidality. In fact, a national poll conducted by the Mott Children’s Hospital (a pediatric acute care hospital in Ann Arbor, Michigan) found that 40% of parents have a hard time distinguishing between mood swings and teen depression.5
A big part of this problem is that teenagers often don’t recognize their worsening suicidal symptoms—or don’t want to address them—until it becomes a challenge to implement preventive measures.
This problem created an “a-ha” moment for Sheridan: What if there was a way to alert adolescents and their families about increasing physiological signs of suicidality before a crisis point so teenagers and parents could address the issue and determine whether a trip to the emergency department is warranted?
“Parents and guardians many times say they didn’t know about their child’s mental state and feel so helpless,” Sheridan says. “This technology has the potential for parents, guardians, and patients to take control back. Part of why we chose smartwatches is they are very common, and there is potential to link a parent or loved one to it. Therefore, a parent could get a notification as well to check in with their child.”
CONNECTING THE DOTS: NERVOUS SYSTEM, HEART RATE VARIABILITY, DEPRESSION, AND SUICIDALITY
Heart rate variability (HRV) is the variation in heart rate from beat to beat and has a direct relationship to the parts of the nervous system that regulate the ability to calm oneself down (parasympathetic nervous system) and increase adrenaline when needed (sympathetic nervous system).
When viewed from a holistic perspective, taking into account certain physiological data points like HRV and nervous system reactions helps technologists and healthcare providers form some basis for scientific analysis and potential causal relationships.
Sheridan found as much in his recent study, which discovered a correlation between HRV and suicidality in teenagers.6 “This study offers an insight into potential physiologic metrics that can be used to help adolescents potentially early on,” Sheridan says.
Heart Rate Variability (HRV)
- The amount of time between heartbeats fluctuates slightly
- Variations are very small, plus or minus a fraction of a second between beats
- Fluctuations are undetectable except with specialized devices
- HRV may be present in healthy individuals and indicate the presence of health problems, including heart conditions, anxiety, and depression
Parasympathetic Nervous System
- Inhibits the body from overworking and restores the body to a calm and composed state
- Controls slowing heart rate and blood pressure, especially when relaxing
Sympathetic Nervous System
- Prepares the body for the fight or flight response during any potential danger
- Manages increases in heart rate and blood pressure in emergency situations
COLLABORATING TO DELIVER SIGNS OF HOPE
Ultimately, the long-term goal of this collaboration between ADI and OHSU is to develop a monitoring system that will alert an individual and their family members to increasing signs of suicidality and the need for preventive measures earlier.
Ongoing research is aimed at measuring these physiologic signals and applying advanced machine learning analytics to process the signals into clinically relevant information.
In the fight to help at-risk teens with mental health issues, this is just the beginning. Once this study is completed, this smartwatch may go into broader use with the hope of helping others in high risk groups who need mental health care, including veterans with PTSD, new mothers with postpartum depression, and more.
By leveraging wearables like smartwatches with clinical-grade data, patients can enhance their understanding of the signs of depression and suicide.
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Funding for this project is provided by the National Institute of Mental Health K12: Oregon Emergency Care Training Program grant # 5K12HL133115, the OHSU Foundation, and the OCTRI Biomedical Innovation Program (BIP). The BIP is a collaboration of the Oregon Clinical & Translational Research Institute (OCTRI), OHSU Technology Transfer, and OHSU Collaborations & Entrepreneurship. OCTRI is supported by (UL1TR002369) from the National Center for Advancing Translational Science (NCATS) at the National Institutes of Health (NIH). |
References
1 CDC: “Leading causes of death by age group United States, 2021.”
2 NIH.gov: “State Suicide Rates Among Adolescents and Young Adults Aged 10-24: United States, 2000-2018.”
3CD.gov: “Suicidal Ideation and Behaviors Among High School Students—Youth Risk Behavior Survey, United States, 2019.”
4 NIMH.gov: “Youth emergency department visits for mental health increased during pandemic, 2023”
5 Newport Academy: “Is it teenage angst or depression?, 2022”
6 NIH.gov: “Heart Rate Variability and Its Ability to Detect Worsening Suicidality in Adolescents: A Pilot Trial of Wearable Technology, 2021”
