DNP 711 - Week 11:

INTRODUCTION/OVERVIEW: The Impacts of Technology Innovations for Data & Privacy

Recent major health events such as our current COVID-19 pandemic added to the past events of severe acute respiratory syndrome coronavirus (SARS-CoV) in Asia (2002-2003), pandemic H1N1/09 influenza virus worldwide (2009), and the massive outbreak of Escherichia coli O104:H4 in Germany (2011) prompt epidemiologists, public health officials, and infectious disease scientists at government agencies, university centers, and international health agencies to substantially upscale our collective national and international investment in improving methods for conducting infectious disease and public health threat surveillance (Heymann, 2004; Chan et al., 2010; Velasco et l., 2014; WHO, 2017). This exponential upscaling in investment into surveillance efforts should include a multitude of public health threats of which suicide prevention and mental health burden reduction. Furthermore, the once-famous adage of "geography is destiny" is rapidly becoming obsolete and replaced by a new adage or maxim that directs that "connectivity is destiny" (Khanna, 2016). Supported by systems of global infrastructure that morph our divisions into connections, nations to nodal endpoints, and shifts our perspective of the world through the lens of connectivity to an encompassing creation of new ways that we self-organize as a human species (Khanna, 2016). The primary remaining question is whether connectivity continues to be the path of our collective salvation or the next inflection point of human history that we ignore at our peril while also surrendering the future to forces far beyond our control (Wallach, 2015; Khanna, 2016).

It is easy to recognize the prevalence and ever-increasing influence of technological advances in multiple facets and domains of contemporary daily life for individuals on a global scale, which includes all age demographics. What remains challenging to understand is the magnitude and scale of effects on the various demographical age groups and the dichotomy between the intended-use of innovators and the actual-use behaviors or end-user experiences of these technological advancements. Particularly challenging to comprehend or predict is how technological advances interact with both mental health and human behaviors, specifically regarding suicide prevention efforts and suicidal behavior harm-reduction strategies for adolescents and young adults.

Some of my peers and colleagues also identified some of the positive potential aspects that might result from the connection between technology use and suicide-related behaviors, such as advances in telemedicine interventions (Morris, 2020), mobile application development for suicide prevention (Freeman, 2020; NotOK, 2020), medication compliance tracking medical devices (Hartman, 2020). However, all of these suggested connectivity elements are also susceptible to potential compromise or maligned use by bad actors. For instance, telemedicine interventions might provide patient access to quality, but they also provide distinct opportunities for the compromise or breach in personal health information and health records data because of its conduction over internet-based resources (Morris, 2020). The idea of mobile application development for suicide prevention could result positively with the reduction of suicidal events because of the new connection to helpful resources (Freeman, 2020; NotOK, 2020). However, it also leaves individual users vulnerable to data privacy breaches and unwitting targets of third-party marketing campaigns or data repackaging for sale to other unidentified third-parties. Practices that happen as a byproduct of application development and operational funding when venture capital or lack of unicorn-status within the Silicon Valley communities is unachievable. Finally, the idea of medication compliance tracking medical devices is quite dystopian in its distinct ability to both enhance treatment adherence and simultaneously undermine patient autonomy and the right to or expectation of privacy (Hartman, 2020). Thus, while there are possible benefits derived from technological advancements, it is crucial that we also recognize and acknowledge that simultaneously adverse harms also potentially accompany those advances on both the individual and societal levels. We would be remiss in not addressing the potentially detrimental associations that technology use has with overall mental health and suicidal behaviors.

Other more extensive screening studies with nationally representative samples of adolescents and young adults are beginning to make the connection between technology use and increases in depression, self-harm, and suicide (Twenge, 2020a). Other studies since 2010 are making connections between technology use and increases in loneliness (Twenge et al., 2019a), anxiety (Duffy et al., 2019), depressive symptoms (Twenge et al., 2018; Duffy et al., 2019; Keyes et al., 2019), major depressive episodes in the past year (Mojtabai et al., 2016; Twenge et al., 2019b), hospital admissions for self-harm behaviors (or other related nonsuicidal self-injuries)(Mercado et al., 2017), suicidal ideation (Plemmons et al., 2018), self-harm or suicide attempts via poisoning methods (Spiller et al., 2019), suicide attempts (Plemmons et al., 2018; Burstein et al., 2019), self-reported suicidal ideation (Twenge et al., 2019b), and in the overall suicide rate (Twenge et al., 2018; Twenge et al., 2019b; Ruch et al., 2019; Twenge, 2020a). The consensus is growing where the noticeable decline in mental health outcomes is attributable or probably linked to the increasing popularity of and usage-dependence smartphones and social media contemporaneously (Twenge et al., 2018; Keyes et al., 2019; Luby & Kertz, 2019; Spiller et al., 2019; Twenge, 2020a). Excessive technology use, specifically mobile digital and social media, among adolescents may prove particularly costly from a mental health outcomes perspective (Uhls et al., 2017). However, as in the previous examples, there are both positive benefits and adverse harms that accompany technological advancements in society. For instance, recent research and replicative verification studies on the topic of usage amount shows that the best outcomes for mental health occur with little use of mobile digital and social media rather than abstinence or lack of usage (Przybylski & Weinstein, 2017; Twenge et al., 2018; Twenge & Campbell, 2018)

In summary, the duality between potential benefits and adverse harms does not cause us to call for a limitation of technological advancements usage in suicide prevention. Instead, we are offering or advocating for a more deliberative, responsible, and careful approach in the development, deployment, and application of innovative or emerging technologies to our collective efforts of suicide prevention.

References:

Burstein, B., Agostino, H., & Greenfield, B. (2019). Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015. JAMA pediatrics, 173(6), 598-600.

Chan, E. H., Brewer, T. F., Madoff, L. C., Pollack, M. P., Sonricker, A. L., Keller, M., ... & Brownstein, J. S. (2010). Global capacity for emerging infectious disease detection. Proceedings of the National Academy of Sciences, 107(50), 21701-21706.

Duffy, M. E., Twenge, J. M., & Joiner, T. E. (2019). Trends in mood and anxiety symptoms and suicide-related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590-598.

Freeman, L. (2020). Help at your fingertips. Retrieved from https://childsuicideawareness.family.blog/2020/04/05/help-at-your-fingertips/

Hartman, M. (2020). Blog 6: Technology innovations and implications. Retrieved from https://childsuicideinaz.family.blog/2020/04/06/blog-6-technology-innovations-and-implications/

Heymann, D. L. (2004). The international response to the outbreak of SARS in 2003. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 359(1447), 1127-1129.

Keyes, K. M., Gary, D., O’Malley, P. M., Hamilton, A., & Schulenberg, J. (2019). Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018. Social psychiatry and psychiatric epidemiology, 54(8), 987-996.

Khanna, P. (2016). Connectography: Mapping the future of global civilization. New York: Random House.

Luby, J., & Kertz, S. (2019). Increasing suicide rates in early adolescent girls in the United States and the equalization of sex disparity in suicide: the need to investigate the role of social media. JAMA network open, 2(5), e193916-e193916.

Mercado, M. C., Holland, K., Leemis, R. W., Stone, D. M., & Wang, J. (2017). Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2001-2015. Jama, 318(19), 1931-1933.

Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6), e20161878.

Morris, P. (2020). Technology for preventing suicide in Arizona youth. Retrieved from https://suicideawarenessprevention.wordpress.com/2020/04/04/week-11/

NotOK. (2020). Retrieved from https://www.notokapp.com/

Plemmons, G., Hall, M., Doupnik, S., Gay, J., Brown, C., Browning, W., ... & Rehm, K. (2018). Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics, 141(6), e20172426.

Przybylski, A. K., & Weinstein, N. (2017). A large-scale test of the Goldilocks hypothesis: Quantifying the relations between digital-screen use and the mental well-being of adolescents. Psychological Science, 28, 204–215.

Ruch, D. A., Sheftall, A. H., Schlagbaum, P., Rausch, J., Campo, J. V., & Bridge, J. A. (2019). Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016. JAMA network open, 2(5), e193886-e193886.

Spiller, H. A., Ackerman, J. P., Spiller, N. E., & Casavant, M. J. (2019). Sex-and age-specific increases in suicide attempts by self-poisoning in the United States among youth and young adults from 2000 to 2018. The Journal of pediatrics, 210, 201-208.

Twenge, J. M., & Campbell, W. K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventative Medicine Reports, 12, 271–283.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17.

Twenge, J. M., Spitzberg, B. H., & Campbell, W. K. (2019a). Less in-person social interaction with peers among US adolescents in the 21st century and links to loneliness. Journal of Social and Personal Relationships, 36(6), 1892-1913.

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019b). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology.

Twenge, J. M. (2020a). Increases in Depression, Self-Harm, and Suicide Among US Adolescents After 2012 and Links to Technology Use: Possible Mechanisms. Psychiatric Research and Clinical Practice, appi-prcp.

Twenge, J. M., & Martin, G. N. (2020b). Gender differences in associations between digital media use and psychological well-being: evidence from three large datasets. Journal of Adolescence, 79, 91-102.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2020c). Considering All of the Data on Digital-Media Use and Depressive Symptoms: Response to Ophir et al. Clinical Psychological Science, 2167702619898179.

Uhls, Y. T., Ellison, N. B., & Subrahmanyam, K. (2017). Benefits and costs of social media in adolescence. Pediatrics, 140(Supplement 2), S67-S70.

Velasco, E., Agheneza, T., Denecke, K., Kirchner, G., & Eckmanns, T. (2014). Social media and internet‐based data in global systems for public health surveillance: a systematic review. The Milbank Quarterly, 92(1), 7-33.

Wallach, W. (2015). A dangerous master: How to keep technology from slipping beyond our control. Philadelphia, PA: Basic Books/Perseus Books Group.

World Health Organization (WHO). (2017). WHO guidelines on ethical issues in public health surveillance. Geneva: World Health Organization.