30. Mental Health

In today’s fast-paced world, stress has become a growing health concern. While more automatic stress tracking technologies have recently become available on wearable or mobile devices, there is still a limited understanding of how they are actually used in everyday life. This paper presents an empirical study of automatic stress-tracking technologies in use in China, based on semi-structured interviews with 17 users. The study highlights three challenges of stress-tracking data engagement that prevent effective technology usage: the lack of immediate awareness, the lack of pre- required knowledge, and the lack of corresponding communal support. Drawing on the stress-tracking practices uncovered in the study, we bring these issues to the fore, and unpack assumptions embedded in related works on self-tracking and how data engagement is approached. We end by calling for a reconsideration of data engagement as part of self-tracking practices with technologies rather than simply looking at the user interface.

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リンク: https://doi.org/10.1145/3411764.3445446

Online mental health communities (OMHCs) are prominent resources for improving people's mental wellbeing. An immediate cue of such improvement is support-seekers' satisfaction expressed in their replies to the received comments. However, the comments that seekers find satisfying may change with their community knowledge, e.g., measured by tenure and posting experience in that community. In this paper, we first model the amount of satisfaction conveyed in the support-seekers' replies to the received comments. Then we quantitatively examine how seekers' expressed satisfaction is affected by their community knowledge, sought and received support in an OMHC. Results show that support-seekers with more posting experience generally display less contentment to the received comments. Compared to newcomers, higher tenured members express less satisfaction when receiving informational support. We also found that support matching positively predicts seekers' satisfaction regardless of their community knowledge. Our findings have implications for OMHCs to satisfy support-seekers through their community knowledge.

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リンク: https://doi.org/10.1145/3411764.3445523

The recent growth of digital interventions for mental well-being prompts a call-to-arms to explore the delivery of personalised recommendations from a user's perspective. In a randomised placebo study with a two-way factorial design, we analysed the difference between an autonomous user experience as opposed to personalised guidance, with respect to both users’ preference and their actual usage of a mental well-being app. Furthermore, we explored users’ preference in sharing their data for receiving personalised recommendations, by juxtaposing questionnaires and mobile sensor data. Interestingly, self-reported results indicate the preference for personalised guidance, whereas behavioural data suggests that a blend of autonomous choice and recommended activities results in higher engagement. Additionally, although users reported a strong preference of filling out questionnaires instead of sharing their mobile data, the data source did not have any impact on the actual app use. We discuss the implications of our findings and provide takeaways for designers of mental well-being applications.

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リンク: https://doi.org/10.1145/3411764.3445076

While Digital Self-Control Tools (DSCTs) mainly target smartphones, more effort should be put into evaluating multi-device ecosystems to enhance digital wellbeing as users typically use multiple devices at a time. In this paper, we first review more than 300 DSCTs by demonstrating that the majority of them implements a single-device conceptualization that poorly adapts to multi-device settings. Then, we report on the results from an interview and a sketching exercise (N=20) exploring how users make sense of their multi-device digital wellbeing. Findings show that digital wellbeing issues extend beyond smartphones, with the most problematic behaviors deriving from the simultaneous usage of different devices to perform uncorrelated tasks. While this suggests the need of DSCTs that can adapt to different and multiple devices, our work also highlights the importance of learning how to properly behave with technology, e.g., through educational courses, which may be more effective than any lock-out mechanism.

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リンク: https://doi.org/10.1145/3411764.3446865

The increasing number of mental disorders worldwide calls for novel types of prevention measures. Given the number of commuters who spend a substantial amount of time on the road, the car offers an opportune environment. This paper presents the first in-vehicle intervention study affecting mental health and well-being on public roads. We designed and implemented two in-vehicle interventions based on proven psychotherapy interventions. Whereas the first intervention uses mindfulness exercises while driving, the second intervention induces positive emotions through music. Ten ordinary and healthy commuters completed 313 of these interventions on their daily drives over two months. We collected drivers' immediate and post-driving feedback for each intervention and conducted interviews with the drivers after the end of the study. The results show that both interventions have improved drivers' well-being. While the participants rated the music intervention very positively, the reception of the mindfulness intervention was more ambivalent.

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リンク: https://doi.org/10.1145/3411764.3445119

Although children’s behavioral and mental problems are generally diagnosed in clinical settings, the prediction and awareness of children’s mental wellness in daily settings are getting increased attention. Toy blocks are both accessible in most children’s daily lives and provide physicality as a unique non-verbal channel to express their inner world. In this paper, we propose a toy block approach for predicting a range of behavior problems in young children (4-6 years old) measured by the Child Behavior Checklist (CBCL). We defined and classified a set of quantitative play actions from IMU-embedded toy blocks. Play data collected from 78 preschoolers revealed that specific play actions and patterns indicate total problems, internalizing problems, and aggressive behavior in children. The results align with our qualitative observations, and suggest the potential of predicting the clinical behavior problems of children based on short free-play sessions with sensor-embedded toy blocks.

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リンク: https://doi.org/10.1145/3411764.3445470

Research increasingly shows that technology can improve access to mental health interventions. However, unaccompanied migrant youth (UMY) still struggle in accessing appropriate mental health resources in spite of their high need for mental health support. Through co-design workshops, and using the lens of the social-ecological model of resilience, we explored the social-ecological factors that support or hinder UMY's use of mental health apps as resources. We identified the strong influence of the macro-system (i.e. resettlement policies) on the bio-and micro-systems, which in turn limits participants' abilities to use the apps. Our findings highlight the factors specific to each social-ecological system - including personal experiences, technological infrastructure and social environment - that need to be accounted for when designing technological mental health resources for UMY. This contributes: a rich description of the interplay of mental health apps with social-ecological systems in which UMY are embedded; and the corresponding design considerations.

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リンク: https://doi.org/10.1145/3411764.3445771

A growing body of work has emphasized the need for customizability and flexibility in mobile health technologies to increase user autonomy. However, customization may be burdensome for people with motivational and cognitive challenges, such as those with mental illnesses, and the optimal level and type of customizability are unclear. Based on 32 interviews with people who experience symptoms of depression and anxiety, we examine how individuals use and customize mental health apps to manage their symptoms. Our findings suggest that participants’ engagement with the apps is largely affected by their level of energy and motivation, depending on the severity of symptoms. Customization is deemed desirable when the required user effort does not exceed users’ mental and motivational capacity and when ample resources are available. App suggestions also need to take into account users’ self-efficacy. We discuss how customizable systems can increase autonomy without overburdening users in the context of mental health.

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リンク: https://doi.org/10.1145/3411764.3445331

Pregnancy loss is a common yet stigmatized experience. We investigate (non)disclosure of pregnancy loss among LGBTQ people to known ties on identified social media as well as what constitutes ideal socio-technical disclosure environments. LGBTQ persons experiencing loss face intersectional stigma for holding a marginalized sexual and/or gender identity and experiencing pregnancy loss. We interviewed 17 LGBTQ people in the U.S. who used social media and had recently experienced pregnancy loss. We demonstrate how the Disclosure Decision-Making (DDM) framework explains LGBTQ pregnancy loss (non)disclosure decisions, thereby asserting the framework's ability to explain (non)disclosure decisions for those facing intersectional stigma. We illustrate how one's LGBTQ identity shapes (non)disclosure decisions of loss. We argue that social media platforms can better facilitate disclosures about silenced topics by enabling selective disclosure, enabling proxy content moderation, providing education about silenced experiences, and prioritizing such disclosures in news feeds. CAUTION: This paper includes quotes about pregnancy loss.

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リンク: https://doi.org/10.1145/3411764.3445238

Digital biomarkers of mental health issues offer many advantages, including timely identification for early intervention, ongoing assessment during treatment, and reducing barriers to assessment stemming from geography, age, fear, or disparities in access to systems of care. Embedding digital biomarkers into games may further increase the reach of digital assessment. In this study, we explore game-based digital biomarkers for social anxiety, based on interaction with a non-player character (NPC). We show that social anxiety affects a player’s accuracy and their movement path in a gaming task involving an NPC. Further, we compared first versus third-person camera perspectives and the use of customized versus predefined avatars to explore the influence of common game interface factors on the expression of social anxiety through in-game movements. Our findings provide new insights about how game-based digital biomarkers can be effectively used for social anxiety, affording the benefits of early and ongoing digital assessment.

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リンク: https://doi.org/10.1145/3411764.3445410

Individuals in distress adopt varied pathways in pursuit of care that aligns with their individual needs. Prior work has established that the first resource an individual leverages can influence later care and recovery, but less is understood about how the design of a point of care might interact with subsequent pathways to care. We investigate how the design of the Indian mental health helpline system interacts with complex sociocultural factors to marginalize caller needs. We draw on interviews with 18 helpline stakeholders, including individuals who have engaged with helplines in the past, shedding light on how they navigate both technological and structural barriers in pursuit of relief. Finally, we use a design justice framework rooted in Amartya Sen’s conceptualization of realization-focused justice to discuss implications and present recommendations towards the design of technology-mediated points of mental health support.

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リンク: https://doi.org/10.1145/3411764.3445336

Prolong Grief Disorder (PGD) is a condition in which mourners are stuck in the grief process for a prolonged period and continue to suffer from an intense, mal-adaptive level of grief. Despite the increased popularity of virtual mourning practices, and subsequently the emergence of HCI research in this area, there is little research looking into how continuing bonds maintained digitally promote or impede bereavement adjustment. Through a one-month diary study and in-depth interviews with 17 participants who recently lost their loved ones, we identified four broad mechanisms of how grievers engage in what we called "backstage" grieving (as opposed to bereavement through digital public space like social media). We further discuss how this personal and private grieving is important in maintaining emotional well-being hence avoiding developing PGD, as well as possible design opportunities and challenges for future digital tools to support grieving.

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リンク: https://doi.org/10.1145/3411764.3445670

Eating disorders (EDs) constitute a mental illness with the highest mortality. Today, mobile health apps provide promising means to ED patients for managing their condition. Apps enable users to monitor their eating habits, thoughts, and feelings, and offer analytic insights for behavior change. However, not only have scholars critiqued the clinical validity of these apps, their underlying design principles are not well understood. \edit{Through a review of 34 ED apps, we uncovered 11 different data types ED apps collect, and 9 strategies they employ to support collection and reflection}. Drawing upon personal health informatics and visualization frameworks, we found that most apps did not adhere to best practices on what and how data should be collected from and reflected to users, or how data-driven insights should be communicated. Our review offers suggestions for improving the design of ED apps such that they can be useful and meaningful in ED recovery.

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リンク: https://doi.org/10.1145/3411764.3445289

A growing body of research in HCI focuses on understanding how social media and other social technologies impact a given user’s mental health, including eating disorders. In this paper, we review the results of an interview study with 10 clinicians spanning various specialties who treat people with eating disorders, in order to understand the clinical contexts of eating disorders and social media use. We found various tensions related to clinician comfort and education into the (mis)use of technologies and balancing the positive and negative aspects of social media use within active disease states as well as in recovery. Understanding these tensions as well as the variation in the current process of diagnosing patients is a critical component in connecting HCI research focused on eating disorders to clinical practice and ultimately assessing how digital self-harm could be addressed clinically in the future.

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