New Digital Tool Brings Medical, Mental Health History to Life
Neuroscientists from the Laureate Institute for Brain Research (LIBR) have created a mobile health application for visualizing the social, medical and mental health history of individual patients.
The tool, called the ‘Tulsa Life Chart’ or ‘TLC’ for short, uses information provided during a survey to create a web-based graphic representation of an individual’s life. The result is a one-page interactive image that visually communicates meaningful events occurring across the life span.
The tool makes it easier for clinicians to process the life history of a patient, which is important for the diagnosis and treatment of medical and mental health conditions.
For example, the TLC can help clinicians determine onset and time course of key symptoms, guide the focus of psychotherapy interventions, and give patients and family members greater insight into the impact of life events on medical or mental health symptoms.
In a recent study published in the journal JMIR Mental Health, the researchers used the TLC to examine the life histories of 500 individuals diagnosed with a spectrum of mental health conditions, including mood, anxiety, eating, and substance use disorders and their healthy counterparts.
Participants completed the TLC with an interviewer, who asked a series of structured questions about their life experiences at different ages. This included questions about positive and negative experiences, schools they had attended, jobs they had held, important friendships and family members, hobbies, and mental health treatments they had received, among others. Their information was transformed into a one-page electronic and interactive graphic that conveyed the unique aspects of their lives. Afterward, participants were asked to describe their experience using the TLC and whether they would recommend it to others.
The researchers found that negative early life events were more commonly reported by individuals with psychiatric disorders. In particular, individuals with depression and anxiety disorders reported experiencing decreased mood starting as early as elementary school, which is much earlier than the young adult age when these disorders are usually diagnosed. However, for individuals with substance use disorders, decreased mood was not observed until young adulthood when such disorders are often diagnosed. Surprisingly, individuals with eating disorders reported greater social support despite an increased incidence of negative events as early as middle school.
Study author and clinical psychologist Dr. Robin Aupperle said, “Our results are not only important for providing insight into these mental health conditions, but they also provide a way to help make sense of what individual patients have experienced. For example, if a patient has experienced comparatively more negative life events than their peers, but reports greater social support, this may enhance insight into their current symptoms as well as their strengths that may support resilience.”
Participants reported favorable user feedback with the TLC, with most finding the experience to be pleasant and helpful for understanding their mental health. Several participants specifically noted that the TLC helped them to change their life perspective by reflecting on how resilient they have been in the face of challenges. There were also some negative aspects reported, mostly relating to how much time the process took, and some discomfort with sharing sensitive information with a stranger.
“The TLC provides a quick and easily reviewable ‘fingerprint’ of a patient’s relevant psychosocial experiences that could be useful for mental health clinicians, patients and family members during diagnosis and treatment,” said Dr. Sahib Khalsa, psychiatrist and co-author of the study. “This fingerprint could be used to establish a clear record that travels with the patient and be used to help providers better understand their unique history. It remains to be seen whether it can improve clinical utility, perhaps by saving a clinician’s time or by improving the quality of care.”
To address these questions, he says, future studies are needed. An additional challenge is integrating the tool into electronic health records and obtaining buy-in from health systems to deploy it.
In the meantime, the researchers continue to improve the TLC. Most recently, they have created a self-guided version that has dramatically reduced the completion time, from an average of 2.5 hours down to about 50 minutes. The team is looking into ways of further reducing this time by incorporating information from publicly available databases and optimizing user experience by obtaining feedback from patients and practitioners.