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Depression is a global health concern, with more than 300 million people worldwide suffering from depression (“Depression,” 2018). Poor mental health can have a negative impact on a patient’s social, emotional, physical, and cognitive functioning. Given the prevalence of depressive disorders, depression is now recognized as a leading cause of disability.

Therefore, depression measurements become essential in healthcare. With the effective implementation of technology in research and practice, digital assessments and interventions reveal numerous positive effects. Journaling, in particular, can improve patient outcomes and quality of life. Depression journals can help patients express negative thoughts, analyze risk factors, and manage symptoms. Journals can even act as an alternative to therapy and foster positive behavioral changes. Electronic depression journals with their engaging interfaces can provide accurate information in real time, facilitate doctor-patient communication, guarantee confidentiality, and boost patient outcomes and mental health.

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Depression and Journaling

Depression is a global health concern, with more than 300 million people worldwide suffering from depression (“Depression,” 2018). Poor mental health can have a negative impact on a patient’s social, emotional, physical, and cognitive functioning. Given the prevalence of depressive disorders, depression is now recognized as a leading cause of disability.

Therefore, depression measurements become essential in healthcare. With the effective implementation of technology in research and practice, digital assessments and interventions reveal numerous positive effects. Journaling, in particular, can improve patient outcomes and quality of life. Depression journals can help patients express negative thoughts, analyze risk factors, and manage symptoms. Journals can even act as an alternative to therapy and foster positive behavioral changes. Electronic depression journals with their engaging interfaces can provide accurate information in real time, facilitate doctor-patient communication, guarantee confidentiality, and boost patient outcomes and mental health.

Depression and Journaling: Application & Benefits

Journaling acts as an outlet of negative thoughts, stress, pain, and intense emotions. Thus, depression journals can be applied to a wide range of conditions and populations. Digital journals can help patients find a healthy way to express negative feelings, control symptoms of depression, and manage a healthy lifestyle. Some of the main applications of depression journals spread across multiple domains

Symptoms, duration, and forms of depression: Depression journals can be beneficial to determine symptoms, triggers, duration, and types of depression. Depression is a complex phenomenon, so it’s not surprising there are different types and subtypes of depression. Major depressive disorder, for instance, is one of the most common forms of depression, characterized by severely low mood, which has been persistent for at least two weeks. Dysthymia or persistent depressive disorder, on the other hand, is a term used to describe a depressed mood lasting for at least two years. Depression journals can help patients indicate the duration of episodes and frequency of mood changes and allow experts to differentiate the nature of the specific condition. Interestingly, psychotic depression is another severe form of depression, or when a person suffers from both depression and psychosis (including delusions and hallucinations). Depression journals can be beneficial in psychotic depression to help patients list and analyze negative thoughts and irrational fears. Depression is also common in bipolar disorder (followed by manic episodes) and seasonal affective disorder. Note that usually, depression peaks during the winter months when there’s less sunlight. In fact, depression journaling can be used to assess risks, triggers, and connections between events. Last but not least, experts should focus on postpartum depression, which is a serious condition that affects many women after birth. Depression journals can help new parents and families cope with suicidal thoughts and decrease the effect depression may have on their parenting (“Depression,” 2018). Note that some patients may need medication to manage their depression, so journals can help experts track drug compliance.

Demographic factors and history of depression: Depression is a complex phenomenon which affects a wide variety of populations. There are various risks factors for depression, such as family history of depression, social factors (e.g., poverty), trauma, and physical illnesses. Depression affects many people, including children and adolescents. In fact, journaling can be applied to pediatric populations. Journals, which are close to the diaries some children use, can help young people report depression and its debilitating effects. Interestingly, a recent study, based on data stored in the Media Behavior and Influence Study (MBIS) database (N = 19,776 subjects), analyzed the effects of media on depression and behavior. The research team used self-reports of depression and found a connection between depression and media use (e.g., television and social media) (Block et al., 2014). We should mention that another study found a link between depression and Internet addiction, which is now classified as a psychiatric disorder. Hence, depression journals become beneficial tools to report factors, such as demographics (e.g., age) and risk factors (e.g., media consumption) in young adults. When it comes to age differences, journals also become effective geropsychiatric measures. In fact, depression in later life is a global health concern. Note that other common tools utilized to assess depression in older people include the Geriatric Depression Scale, the Geriatric Depression Scale-15 currently, the Beck Depression Inventory-II, and the Center for Epidemiological Studies Depression Scale (Balsamo et al., 2018).

Psychosomatic and behavioral aspects of depression: Depression affects a patient’s physical, emotional, cognitive, and social functioning. For that reason, depression journals can be utilized to track changes in appetite, sleep, mood, reasoning, and social interactions. Interestingly, depression can affect even a patient’s vision. A recent study revealed that depression correlates with poor vision (assessed by the NEI VFQ-25) (Paz et al., 2013). Since depression affects all aspects of a patient’s life, depression leads to poor quality of life. In fact, research reveals a strong association between depression and poor quality of life (as well as low functioning scores), especially in patients with a chronic disease (e.g., cardiovascular disease). Note that medication use can lead to depression, so journals can be used to track drug administration and compliance.

Depression journals with their various applications have numerous benefits. As explained above, journaling can improve patient outcomes and act as an alternative to treatment. Depression journals can help patients explore and manage their condition and its adverse effects

Understand their condition: Journaling can help patients express their negative thoughts, track triggers of depression, and explore interventions. In fact, although expressive journaling may not reduce the occurrence of negative thoughts, it can limit their impact and improve symptoms (Lepore, 1997). Journaling can also help people increase their tolerance of unpredictable events and reduce any unrealistic feelings of guilt and shame (“Benefits of journaling for depression, anxiety and stress management,” 2018).

Change their lifestyle: By helping patients gain a rational understanding of their condition, journaling can help patients set realistic goals (e.g., exercising or attending social events) in order to improve their mood. Interestingly, a study showed that walking in nature is a practical step, which is beneficial for individuals diagnosed with major depressive disorder. Berman and colleagues recruited 20 people with major depression to test if nature walks can benefit depressed patients. After a 50-min natural walk, participants showed an increase in memory span (assessed via backward digit span (BDS) task) and mood (assessed via PANAS) (Berman et al., 2012). In addition, journals can track sleep patterns and food intake.

Reduce major depression and symptoms: One of the main benefits of depression journals is their capability to reduce symptoms. A study revealed that people diagnosed with major depressive disorder showed lower depression scores after three days of expressive writing (20 minutes per day). To be more precise, 40 participants completed a series of assessments; after which, they were randomly assigned to an expressive writing condition (about feelings and emotional events) or a control condition (neutral daily activities). The participants assigned to the expressive writing condition revealed a decrease in depression (assessed via Beck Depression Inventory and Patient Health Questionnaire-9 scores) – a positive effect which persisted at the follow-up period as well (Krpan et al., 2013).

Substitute cognitive behavioral therapy:  Journals can even substitute cognitive behavioral therapy (CBT). A study showed that writing in a journal may be as beneficial as cognitive behavioral therapy, especially in high-risk adolescents. The study recruited high-risk and depressed adolescents (N = 225, M age = 18) who were randomized to the following conditions: cognitive behavioral therapy, supportive-expressive group intervention, bibliotherapy, expressive writing, and journaling. The results showed that all five interventions had a positive effect on depression, and journaling was as effective as therapy (Stice et al., 2007). Talking about young adults, college students can also benefit from expressive writing. A study showed that journaling could reduce brooding and rumination, which are among the major risk factors for depression (Gortner et al., 2006).

Overcome trauma: A major benefit of depression journals is to help patients overcome trauma and prevent fatal outcomes. In fact, expressive writing can reduce symptoms of depression in women who suffered intimate partner violence. Koopman and colleagues conducted a study to explore the effects of expressive writing on depression, posttraumatic stress disorder and pain symptoms in women who survived violence. In depressed victims, findings showed that expressive writing might lead to a decrease in depression symptoms and improvement in lifestyle (Koopman et al., 2005).

Digital Depression Logs

While depression journals have numerous applications and benefits, pen-and-paper methods are slowly being replaced by digital journals. With their impressive capabilities, mobile devices, digital journals, and apps can:

Facilitate data collection and reports: Digital solutions facilitate data collection. Adding a journal entry into a mobile device is easy and achievable 24/7. In addition, search options can help patients and experts trace a patient’s history of depression. Data export options across devices and formats (e.g., PDF) are also available.

Reminders: Automatic reminders are perhaps one of the most beneficial options digital tools integrate: they can help patients keep a depression journal thoughtfully. What’s more, reminders and notifications can benefit drug compliance.

Engaging interface and social features: Digital solutions and mental health apps offer engaging interfaces. Journaling prompts, geotags, visualizations, and pictures can make journaling an enjoyable experience. In addition, Help buttons can allow patients and their families to connect with support groups and professionals.

Privacy: As explained above, digital depression journals allow patients to enter detailed data, which can be automatically visualized in charts and graphs. Most of all, with their impressive data collection and storage capabilities, digital tools comply with the safety and ethical regulations required in research.

PROMIS & Pain Assessments

Depression is a complex construct, so are the standard depression measurements implemented in medical care. Although journals have numerous benefits, we should also mention some of the most common assessments in practice. Some of the popular depression-rating scales are the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale (MADRS), which are clinician-rated assessments. Self-reports, on the other hand, are more cost-effective and able to measure subjective constructs. As stated above, an effective self-report instrument is the Beck Depression Inventory (BDI). Interestingly, this scale was developed based on statements given by depressive patients during therapy. It includes 21 items, which assess all DSM-IV symptoms, numerous cognitive aspects (e.g., guilt), and other relevant symptoms. Note that another popular self-report tool is the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) (Uher et al., 2012).

When it comes to subjective measures, though, PROMIS has become an integrated part of the research. The 29-item PROMIS profile contains four-item depression and anxiety scales, which can be highly beneficial in patients with chronic pain (Kroenke et al., 2014). Note that the PROMIS Depression bank focuses more on affective and cognitive symptoms instead of somatic problems (e.g., insomnia) (Schalt et al., 2016).

Summary

Depression is a complex health condition. Due to the prevalence of the disorder, it’s not surprising that there are numerous tools to assess depression and mood. Journaling, in particular, can be an effective method to monitor depression and improve patient outcomes. Depression journals can help patients and doctors manage negative thoughts, stress, pain, drug compliance, and lifestyle. What’s more, journals are applicable to a wide range of populations and conditions.

Most of all, digital journals and apps can engage participants, facilitate data collection, benefit doctor-patient communication, and improve patient outcomes. Qolty can help experts create an effective digital tool to explore the phenomenon of depression and improve patients’ quality of life.

References

Balsamo, M., Cataldi, F., Carlucci, L., Padulo, C., & Fairfield, B. (2018). Assessment of late-life depression via self-report measures: a review. Retrieved from https://www.dovepress.com/assessment-of-late-life-depression-via-self-report-measures-a-review-peer-reviewed-article-CIA#

Benefits of journaling for depression, anxiety and stress management (2018, May 14). Retrieved from https://positivepsychologyprogram.com/benefits-of-journaling/

Berman, M., Kross, E., Krpan, K., Askren, M., Burson, A., Deldin, P., Kaplan, S., Sherdell, L., Gotlib, I., & Jonides, J. (2012). Interacting with nature improves cognition and affect for individuals with depression. Journal of Affective Disorders, 140(3).

Block, M., Stern, D., Raman, K., Lee, S., Carey, J., Humphreys, A., Mulhern, F., Calder, B., Schultz, D., Rudick, C., Blood, A., & Breiter, H. (2014). The relationship between self-report of depression and media usage. Frontiers in Human Neuroscience.

Depression (2018, February) Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Depression (2018, March 22). http://www.who.int/news-room/fact-sheets/detail/depression

Gortner, E., Rude, S., & Pennebaker, J. (2006). Benefits of expressive writing in lowering rumination and depressive symptoms. Behavior Therapy, 37(3), p. 292-303.

Koopman, C., Ismaikji, T., Holmes, D., Classen, C., Palesh, O., & Wales, T. (2005). The effects of expressive writing on pain, depression and posttraumatic stress disorder symptoms in survivors of intimate partner violence. Journal of Health Psychology, 10(2), p. 211-221.

Kroenke, K., Yu, Z., Wu, J., Kean, J., & Monahan, P. (2014). Operating Characteristics of PROMIS Four-Item Depression and Anxiety Scales in Primary Care Patients with Chronic Pain. Pain Medicine.

Krpan, K., Kross, E., Berman, M., Deldin, P., Askren, M., & Jonides, J. (2013). An everyday activity as a treatment for depression: The benefits of expressive writing for people diagnosed with major depressive disorder. Journal of Affective Disorders, 150(3), p. 1148-1151.

Paz, S., Globe, D., Wu, J., et al. (2003). Relationship Between Self-reported Depression and Self-reported Visual Function in Latinos.

Schalet, S., Pilkonis, P., Yu, L., Dodds, N., Johnston, K., Yount, S., Riley, W., & Cella, D. (2016). Clinical Validity of PROMIS® Depression, Anxiety, and Anger across Diverse Clinical Samples. Journal of Clinical Epidemiology, 73, p. 119-127.

Stice, E., Burton, E., Bearman, S., & Rohde, P. (2007). Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition. Behaviour Research and Therapy, 45(5), p. 863-876.

Uher, R., Perlis, R., Placentino, A., Dernovsek, M., Henigsberg, N., Mors, O., Maier, W., McGuffin, P., & Farmer, A. (2012). Self-report and clinician-rated measures of depression severity: Can one replace the other? Depress Anxiety, 29(12), p. 1043-1049.