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A team, led by Dr. Farzan Sasangohar, is seeking to develop technological solutions to improve the mental health of veterans, college students, health care workers and more. Listen to SoundBytes to learn more. | Image: Texas A&M Engineering

Highlights

A team, led by Dr. Farzan Sasangohar of the Wm Michael Barnes ‘64 Department of Industrial and Systems Engineering, seeks to develop technological solutions to improve the mental health of veterans, college students, health care workers and moreThe Mental Health Evaluation and Lookout pilot program — also known as mHELP — combines commercial smartwatches with advanced machine learning and a wide range of sensors to detect signs and symptoms of high anxiety and direct the user to mental health and self-care resources.

"mHELP enables that," Sasangohar said. "It's a self-management suite of tools. It does everything from detection to closing the loop at some therapeutic activities to connecting them to the right people, to support."

Plans to move forward with a home study in early 2020 were interrupted due to measures against the COVID-19 pandemic. 

"That was the bad news. The good news is we unleashed this user-center inquiry," Sasangohar said. "We talked to as many students as we could. We interviewed 200 students, surveyed more than 2,000 TAMU students, kind of in lieu of that home study."

The results gave researchers new insights into how students were dealing with the pandemic and what barriers they faced in managing their mental health.

This information was part of a larger conversation found in the SoundBytes episode. A full transcript of the episode is located below.

Transcript

Steve Kuhlmann: 

Hannah Conrad: A team, led by Dr. Farzan Sasangohar of the Wm Michael Barnes '64 Department of Industrial and Systems Engineering, is seeking to develop technological solutions to improve the mental health of veterans, college students, health care workers and more — all through mobile apps that can be easily downloaded onto a smartwatch or phone. I'm Hannah Conrad and my co-host, Steve Kulhmann, and I are joined by Dr. Sasangohar to discuss the Mental Health Evaluation and Lookout pilot program, also known as mHELP, which combines commercial smartwatches with advanced machine learning and a wide range of sensors to detect signs and symptoms of high anxiety and direct the user to mental health and self-care resources. Portions of this episode were recorded in person before the COVID-19 pandemic.

Dr. Farzan Sasangohar: So first thing we did actually was to review what's out there. Lots of apps; we found hundreds of apps that do anything related to PTSD or stress or anxiety. We found that very little though does anything beyond things that are happening actively, such as mindfulness, such as you know, education. You have to actively want to do them. Very little integration with health care, things that actually could be used in therapy sessions with providers, and almost none remote monitoring, which is, I think, the real gap. What happens is most issues happen in between sessions. And guess, you know, what information we have from those in between session periods. None. So we started looking at all the utilities they provided. Education is great. Self-assessment is great. But guess what, self-assessment for somebody who has PTSD could not be reliable, because for the very nature of the disease, for the condition, people are emotionally numb, which means they don't care. And that's just not reliance on one source of information. I'm not kind of putting it in the garbage can. I think it's extremely important to have those. But where I was going with this was to add some objectivity into that. If you can continuously monitor with some objective data combined with subjectively reported self-assessments, then you have something to work with. Then when you go to that session with the patient, you don't have to spend half an hour to elicit you know, how was your sleep? What happened in the past couple weeks? You have that right in front of you, maybe visualized. So you have the entire big picture, which helps providers to prepare and actually provide care in that one hour period. Think about, you know, what kind of good things could happen with this, not only are you saving millions of dollars in health care costs, but you're improving health care.

Hannah Conrad: What areas of mental health are you looking at with mHELP? Is it more like anxiety, depression, PTSD, or is there a larger thing?

Dr. Farzan Sasangohar: So we started with PTSD, you know, you might hear veterans suffering from it, definitely in the news, but it's not just limited to veterans. It's anybody who are exposed to trauma. This could be kids; this could be anybody who get into an accident; this could be anybody who views trauma. So it's more of an anxiety type of family. But then what happens is the signs and symptoms, the physiology and physiological changes, are sometimes very similar to other things like depression, like stress, and stress is this, you know, vague compound thing that involves, you know, anxiety and everything else. But once you get into one of these, you see a lot of similarities. And that's where defining these become different and more difficult, and there are lots of commonality between them, at least as it's reflected in physiology, like heart rate. So most of my research is to enable that end-to-end by making sure we sense the right information, make sure we analyze it properly. So a lot of machine learning and artificial intelligence is involved. And then we show the right things to right people. So that's an end-to-end because we want to make sure patients have a smooth interaction with these systems. They're adopted properly; they're used sustainably. So these are all the issues as a human factors engineer I'm interested in. And I'm also interested in how this big data is being formed into something that helps decision making in health care. And then I want to make sure providers get the right information, that we don't add to their workload. We actually integrate these technologies smoothly with whatever they're doing right now.

Steve Kuhlmann: So what made you passionate about this research?

Dr. Farzan Sasangohar: So when I joined Texas A&M, well, I had no idea I'm going to do this. I had different things in mind, you know, just wanted to continue my doctoral research. I was invited into a meeting to discuss veterans' mental health. That was really touching, discussing issues of veterans and mental health and PTSD. And so when I went back to my office and started thinking about this, that motivated me. I did some research, and it was very unfortunate to see lack of support, not really understanding them. The system is there and is very well funded, but you know, it doesn't really support. So I really wanted to do something about that. I wanted people to maybe use technologies to self-care, at least, and that really changed my career path. And that, you know, diverged into all sorts of things. College student mental health, nurses, you know, shift workers, you know, a lot of people under a lot of pressure and you know, we have these issues with health care almost everywhere in these complex systems.

Jenn Reiley: Howdy, it's your producer Jenn Reiley here with a quick note. From here, we switch to a recording that happened after COVID measures were put in place, so the audio quality may be a bit different. Also, Steve has a brief message for us. Take it away, Steve.

Steve Kuhlmann: Be sure to check back in for the next episode of Engineer This for part two of this discussion, where we'll take a deeper look at how Dr. Sasangohar and his team adapted their mobile health tools to the COVID-19 pandemic and the well being of health care professionals. Now, back to the conversation.

Dr. Farzan Sasangohar: So unfortunately, we were about to go on with a pilot study, a home study with about 60 participants, and that was interrupted by COVID. That was the bad news. The good news is we unleashed this user-center inquiry. We talked to as many students as we could. We interviewed 200 students, surveyed more than 2,000 TAMU students, kind of in lieu of that home study. And that gave us a lot more ammo to really understand their needs and expectations and get some face validity at the ideas we have. Obviously, we need to adapt to this new situation. We'd like to minimize face-to-face contact as much as possible, which means you know, the study is a little bit more complex now. So we have to ship devices to participants and do things virtually. So it's a little bit more complicated, but we're on the track; we're on the right track. We're going to do a pilot this fall, and then hopefully the campus-wide pilots going to happen fall of 2021.

Steve Kuhlmann: That's great.

Hannah Conrad: What are some ways that you're getting around the face-to-face contact.

Dr. Farzan Sasangohar: So a lot of our face-to-face contact was study onboarding type of activity, kind of explaining the type of study, explaining data collection methods, collecting some initial data, demographic data, and that's the main one we're going to lose with moving to virtual, because usually, when we do measurements of biometrics, things like heart rate, blood pressure, we tend to do some baseline measurements at the beginning of study to make sure we understand any changes and put them in context. We'll still try to do those virtually, so once these devices are shipped, we're going to do the same exact activities via Zoom, and we have to coach them on doing some of these on their own. With students, we tend to be successful, but with some of the other studies like with older adults, those are interrupted in a different way because it's a little bit harder to coach people to do self-measurements. But with students, we hopefully think it's going to go well.

Steve Kuhlmann: Excellent. So you know, as you indicated, COVID-19 kind of changed a lot, especially for researchers in the work that they were doing. How has your research shifted due to COVID-19, not just with the mHELP project, but in general?

Dr. Farzan Sasangohar: So we knew mental health is a big systemic issue, which motivated my entire line of research on mental health. COVID-19 added this extra pressure and stress on top of everything that was existing before we even started this research. To give you an example, in the interviews we've conducted with students, we found that now suddenly there's a lot of stress about academic issues. Majority think people might have difficulty with these courses that are going to be purely online or half online or, you know, a hybrid model. People are really stressed about transition. You know, any sort of change is stressful and general uncertainty about what's going to happen with the pandemic, that introduced this massive amount of stress, which, you know, made this idea of mental health an issue even more. We can now get a little bit more resources to look into something that we knew is a systemic problem. Unfortunately, it's really sad to see this amount of stress and anxiety and depression because of COVID. And our interviews and surveys clearly communicate that to us.

Steve Kuhlmann: Among the projects that you've been working on, we did see that you were working I think, as you just mentioned, on some student interviews that you had a survey set up for. How has that project been going?

Dr. Farzan Sasangohar: So I also teach an Aggie Challenge course. It's set up to give exposure to engineering students from a wide range of backgrounds. So students from all engineering programs get together in teams, get exposed to research on important matters. What I chose in the past three years for the Aggie Challenge course was mental health. We started with veterans, but then last year, we switch gear to students. So that gave us a lot of resources, because these students who signed up for the course are passionate about mental health. So the team became interviewers trained in qualitative data collection. So we ended up conducting 200 interviews in one semester. That was a massive success for us because doing interviews in this day and age is very difficult. And they're very, very rich. They talked to us about their issues about anxiety, depression firsthand. How COVID-19 changed things, for better or worse. They talked to us about barriers in seeking help, even though we have so much help available, you know, people are still shy about asking for those. We had a very rich amount of data coming our way, which prompted another study, once we knew people have this much interest in the topic. Then we designed a survey and we want it to be campus wide. At the end of last spring semester, we unleashed this survey to all students asking for their opinion on anxiety, depression, related to COVID. So we made it very focused to COVID-19, to flesh out some of the things we found about those barriers and how people use or not use resources available to them. What are the major barriers, and then this idea of self-management because the more I do this research, the more I'm convinced this is an issue. This is a disorder that needs to be supported very differently than other disorders. It kind of put this validation mark on our approaches in coming up with technologies that enable people to take care of themselves. Because even though we have excellent services, excellent support system, very little of that is used, if you ask me. mHELP enables that. It's a self-management suite of tools. It does everything from detection to closing the loop at some therapeutic activities to connecting them to the right people to support. So it really gave us hope that this idea is actually working. And it shows a huge amount of need for it. And a lot of positive feedback on future adoption and utilization of the students really, really support the idea of having something like this, as long as it's usable. And as long as it's integrated with everything else they're using. You know, we found a lot of things that are eye opening. It's mental health, but you know, they also need a lot of other things in it. They don't want to shop around for tools to do time management and calendaring and all that. They want everything in one place. So if it needs to have a tool to support mental health and self-manage, and then swap to go to another app and then swap to go to another. That wouldn't do. It's all about integration. It's all about interoperability right now.

Steve Kuhlmann: Were there any other unexpected items that came up in the course of these interviews?

Dr. Farzan Sasangohar: Yes. So a small percentage of students mentioned that COVID-19 actually decreased their stress and anxiety. But let's put this in context. With COVID, people are a little bit more efficient if they can manage their time properly. You're saving time. You're saving commute time; you're saving, you know, some reduced schoolwork. It has disadvantages, but you know, it gives a lot more flexibility. Plus, you know, staying with family was mentioned. And you know, once you're with family at home, you know, that takes off some stress. The other side of the spectrum is, you know, we were thinking people would be really stressed about the pandemic itself. But what we found out was the major stressor was not being able to interact with people, participate in social activities, which usually are the balancers. Given the very course, a very high course load and you know, the distress associated with the semester, the balance there was that social interaction. And that's suddenly gone. Major issues and changes in sleeping habits, major changes in eating habits. There's this major fear and worry about their own health and family and loved ones' health. But then the major thing that was really eye catching for me was that students felt changes to their social relations and social isolation was a major stressor.

Steve Kuhlmann: So when you look at the general scope of the mHELP project, and even with some of these interviews, how is your team trying to approach moving forward in trying to take this information that you've gathered in and apply it further into the projects?

Dr. Farzan Sasangohar: Our lab is big in taking user feedback and stakeholder feedback and turning them into concise engineering requirements. Given the depth and the level of detail we've seen, the data we received, we came up with a very wide range of information requirements, and these are things that need to show up in any sort of interactive tool we're going to put in front of users, in this case students. So that gave us a lot of ammo to expand mHELP into something that's kind of a one-shot, one-stop to self-manage mental health, but also do a lot more. It has direct links into all sorts of services on campus. It has a much wider range of therapeutic activities and relaxation features and mindfulness features. This would ensure sustainability of any sort of adoption with this tool. So our plan is to put this in front of students, do a pilot study on campus, do iterative usability testing and see if our ideas, given to us by users and translated into engineering requirements and developed into this tool, actually, is meeting expectations, I really believe by going through that process of starting with users and then keeping them in the loop and inject their feedback systematically into this entire process, we're going to have a tool that's going to be adopted well, and people are going to use it more sustainably so that they're not going to, they're not going to drop it in a week or a month.

Hannah Conrad: The feedback loop that you're sort of creating is very interpersonal. And in a way, it's a very kind of one-on-one research project with the users, which I think is a really unique setup for a research project. What's it like to be working so closely with the people who are testing your system?

Dr. Farzan Sasangohar: This is what I was trained in, this is what I believe in. I think that connection to your intended users not only is giving you the data you need to make sure things you do are going to be sustainably used. But I really enjoy showing my users my own enthusiasm, showing them my passion about this. Once they see that, they tend to be a lot more efficient in what they do, which is providing feedback. You know, your users open up; they give you a lot more than what you expect. It's just amazing. You know, that's probably the secret sauce for a lot of these successful interactions. So I'm very happy that we are going to get this data out. We're going to disseminate these findings. I'm super excited that it's going to come out of Texas A&M. It's going to make us the leader in doing this kind of research showing, showing that we care, showing that you know, showing our excellence in research, showing our commitment to our students. And my my hope is really to have this tool as a research tool available to everyone in the world. I really hope that happens.

Hannah Conrad: We hope you enjoyed this episode of Engineering Soundbytes. Make sure to subscribe to stay up to date with what's happening within Texas A&M Engineering. Until next time, stay safe and Gig 'em.

Steve Kuhlmann: Thanks for listening to the Texas A&M Engineering Soundbytes podcast. The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the official policy or position of The Texas A&M University System. Soundbytes is a part of the Texas A&M Podcast Network. To find more official Texas A&M podcasts, go to podcast.tamu.edu. Thanks and Gig 'em.