The statistics are disturbing.
In Canada, the suicide rate for 2015 was 11.5 per 100,000 people, according to Statistics Canada. This is comparable to the annual global age-standardized suicide rate of 10.5 per 100,000, as reported in 2016 by the World Health Organization.
Moreover, while suicide ranked among the top 10 causes of death overall in this country in 2011, for those aged 25 to 44, it was the third-leading cause of death, Statistics Canada reports.
Dr. Eric Chan Tai Kong, a fourth-year Resident in the University of Alberta's Department of Psychiatry and a Master's student in the Psychiatry Graduate Program, believes mobile technology could play a key role in helping to identify and address suicide-related mental health issues more efficiently and effectively.
As part of his Master's research project, Dr. Chan Tai Kong, who earned an undergraduate degree in biochemistry at the University of Saskatchewan and completed medical school at the University of Alberta, is developing mobile applications to track the symptoms of mental illness.
The key mobile app Chan Tai Kong is working on now employs the self-report parts of a new questionnaire developed by Dr. Larry Alphs - known as the Suicide Ideation and Behavior Assessment Tool (SIBAT) - to record and monitor changes in thoughts and behaviour in order to track factors that may be associated with risk of self-harm or suicide.
The scale is being administered to students at the University of Alberta who are participating in the more broadly based AddGenes (Genes for Sexual Addiction and Related Conditions) study. Dr. Katherine Aitchison, a Professor in the Department of Psychiatry and Adjunct Professor in the Department of Medical Genetics, is the Principal Investigator for AddGenes. Dr. Chan Tai Kong won a fellowship from Janssen Inc. Canada to support the work.
"The primary outcome I am observing in my research is whether SIBAT data obtained from the smartphone application is consistent with data obtained using another collection method and a different questionnaire. In order to do this, data from the app is compared both with the SIBAT administered via another tool (Qualtrics), as well as data collected using the Mini International Neuropsychiatric Interview (MINI)," says Dr. Chan Tai Kong.
If his research confirms that data collected with the mobile app is reliable and accurate, it could help pave the way for smartphone apps to be used more extensively to assess the status of participants in clinical trials as well as mental health patients in clinical settings.
"This will give us the opportunity to better track and monitor symptoms of mental illness with minimal intrusion on the participant. We can then use this data potentially in both the restructuring of psychiatric disease classification as well as to better understand the effects of medications on different populations," he explains.
Although many researchers are eager to use mobile apps to collect mental health data, relatively little research has been done thus far to validate the accuracy of any data that's collected.
"One could argue that using a voluntary self-assessment tool like this from home and doing it on a mobile device can affect the results. So the key is to actually compare the data we obtain using this mobile app to another method, so we can determine whether the app is able to accurately capture an individual's state," he says.
If the app proves to be a viable tool, the advantages of using it to gather patient information are obvious.
"It can allow us to check in with an individual more frequently, among other things. For example, if you need a patient to come into a clinic just to see how they are doing, that's hard to track. Few people want to visit a clinic every day or even once a week, so this app would allow for more frequent assessment without being so intrusive."
As Dr. Chan Tai Kong puts it, a mobile app that tracks an individual's fluctuating moods over time and in different settings is akin to creating a "flip book series of pictures" of an individual's mental health rather than a single snapshot gleaned from a visit to a clinician's office. "It can allow you to get a sense of trajectory, and that can be very helpful with an evaluation," he says.
At the same time, he stresses that a mobile app is only a tool, and is intended to complement face-to-face therapeutic interactions with trained mental health professionals.
Dr. Chan Tai Kong has already collected preliminary data from more than 200 research subjects, and presented his related analysis.
"Once we have enough data then we'll continue to process results. Hopefully we'll have some more tangible findings to report by next spring, but until then, I'd rather not comment further."
Dr. Chan Tai Kong says he developed his mobile app with assistance from Dr. Andrius Baskys, a Riverside, Calif.-based clinical psychiatrist and Adjunct Professor in the Department of Psychiatry. The two met thanks to an introduction by Dr. Aitchison.
"Dr. Baskys introduced me to a platform for the development of mobile applications, and from there I essentially put the framework together, working together with the AddGenes team on issues relating to research ethics committee approval, privacy office concerns, and appropriate thresholds for sending alerts to the team," he says.
"Not all of the apps I'm working on are complete at this point because they're not all imminently needed. But I also put together a framework for others such as the PHQ-9 Depression Scale, the ACE (Adverse Childhood Experiences) questionnaire, the AUDIT (Alcohol Use Disorders Identification Test), and for monitoring medication side effects."
While he works toward his Master's degree in the Graduate Program, Dr. Chan Tai Kong is also currently completing a rotation in forensic rehabilitation psychiatry, where he is working largely with psychiatric patients at Alberta Hospital Edmonton who have been found NCR (Not Criminally Responsible) by the justice system.
"The unit I'm on is more focused on getting them rehabilitated to return to the community. So it's about ensuring that the risk is relatively low, and ensuring that they have the resources and capabilities to function and hopefully succeed in life once they're out," he explains.
Dr. Chan Tai Kong is on track to complete his Residency training in mid-2020. He has yet to formulate any long-term career plans, although he knows he will continue to work in psychiatry.
"It's quite open right now. There are a lot of different areas that I have strongly considered, but right now I'm not going to lock myself in. When I was in medical school I looked at everything from cardiology to emergency medicine to pathology to radiology, and I seriously considered all of them. And if you asked me to make the same choice 100 times I'd pick psychiatry 100 times," he says.
In Canada, the suicide rate for 2015 was 11.5 per 100,000 people, according to Statistics Canada. This is comparable to the annual global age-standardized suicide rate of 10.5 per 100,000, as reported in 2016 by the World Health Organization.
Moreover, while suicide ranked among the top 10 causes of death overall in this country in 2011, for those aged 25 to 44, it was the third-leading cause of death, Statistics Canada reports.
Dr. Eric Chan Tai Kong, a fourth-year Resident in the University of Alberta's Department of Psychiatry and a Master's student in the Psychiatry Graduate Program, believes mobile technology could play a key role in helping to identify and address suicide-related mental health issues more efficiently and effectively.
As part of his Master's research project, Dr. Chan Tai Kong, who earned an undergraduate degree in biochemistry at the University of Saskatchewan and completed medical school at the University of Alberta, is developing mobile applications to track the symptoms of mental illness.
The key mobile app Chan Tai Kong is working on now employs the self-report parts of a new questionnaire developed by Dr. Larry Alphs - known as the Suicide Ideation and Behavior Assessment Tool (SIBAT) - to record and monitor changes in thoughts and behaviour in order to track factors that may be associated with risk of self-harm or suicide.
The scale is being administered to students at the University of Alberta who are participating in the more broadly based AddGenes (Genes for Sexual Addiction and Related Conditions) study. Dr. Katherine Aitchison, a Professor in the Department of Psychiatry and Adjunct Professor in the Department of Medical Genetics, is the Principal Investigator for AddGenes. Dr. Chan Tai Kong won a fellowship from Janssen Inc. Canada to support the work.
"The primary outcome I am observing in my research is whether SIBAT data obtained from the smartphone application is consistent with data obtained using another collection method and a different questionnaire. In order to do this, data from the app is compared both with the SIBAT administered via another tool (Qualtrics), as well as data collected using the Mini International Neuropsychiatric Interview (MINI)," says Dr. Chan Tai Kong.
If his research confirms that data collected with the mobile app is reliable and accurate, it could help pave the way for smartphone apps to be used more extensively to assess the status of participants in clinical trials as well as mental health patients in clinical settings.
"This will give us the opportunity to better track and monitor symptoms of mental illness with minimal intrusion on the participant. We can then use this data potentially in both the restructuring of psychiatric disease classification as well as to better understand the effects of medications on different populations," he explains.
Although many researchers are eager to use mobile apps to collect mental health data, relatively little research has been done thus far to validate the accuracy of any data that's collected.
"One could argue that using a voluntary self-assessment tool like this from home and doing it on a mobile device can affect the results. So the key is to actually compare the data we obtain using this mobile app to another method, so we can determine whether the app is able to accurately capture an individual's state," he says.
If the app proves to be a viable tool, the advantages of using it to gather patient information are obvious.
"It can allow us to check in with an individual more frequently, among other things. For example, if you need a patient to come into a clinic just to see how they are doing, that's hard to track. Few people want to visit a clinic every day or even once a week, so this app would allow for more frequent assessment without being so intrusive."
As Dr. Chan Tai Kong puts it, a mobile app that tracks an individual's fluctuating moods over time and in different settings is akin to creating a "flip book series of pictures" of an individual's mental health rather than a single snapshot gleaned from a visit to a clinician's office. "It can allow you to get a sense of trajectory, and that can be very helpful with an evaluation," he says.
At the same time, he stresses that a mobile app is only a tool, and is intended to complement face-to-face therapeutic interactions with trained mental health professionals.
Dr. Chan Tai Kong has already collected preliminary data from more than 200 research subjects, and presented his related analysis.
"Once we have enough data then we'll continue to process results. Hopefully we'll have some more tangible findings to report by next spring, but until then, I'd rather not comment further."
Dr. Chan Tai Kong says he developed his mobile app with assistance from Dr. Andrius Baskys, a Riverside, Calif.-based clinical psychiatrist and Adjunct Professor in the Department of Psychiatry. The two met thanks to an introduction by Dr. Aitchison.
"Dr. Baskys introduced me to a platform for the development of mobile applications, and from there I essentially put the framework together, working together with the AddGenes team on issues relating to research ethics committee approval, privacy office concerns, and appropriate thresholds for sending alerts to the team," he says.
"Not all of the apps I'm working on are complete at this point because they're not all imminently needed. But I also put together a framework for others such as the PHQ-9 Depression Scale, the ACE (Adverse Childhood Experiences) questionnaire, the AUDIT (Alcohol Use Disorders Identification Test), and for monitoring medication side effects."
While he works toward his Master's degree in the Graduate Program, Dr. Chan Tai Kong is also currently completing a rotation in forensic rehabilitation psychiatry, where he is working largely with psychiatric patients at Alberta Hospital Edmonton who have been found NCR (Not Criminally Responsible) by the justice system.
"The unit I'm on is more focused on getting them rehabilitated to return to the community. So it's about ensuring that the risk is relatively low, and ensuring that they have the resources and capabilities to function and hopefully succeed in life once they're out," he explains.
Dr. Chan Tai Kong is on track to complete his Residency training in mid-2020. He has yet to formulate any long-term career plans, although he knows he will continue to work in psychiatry.
"It's quite open right now. There are a lot of different areas that I have strongly considered, but right now I'm not going to lock myself in. When I was in medical school I looked at everything from cardiology to emergency medicine to pathology to radiology, and I seriously considered all of them. And if you asked me to make the same choice 100 times I'd pick psychiatry 100 times," he says.