Evaluating the Modified Patient Health Questionnaire-2 and Insomnia Severity Index-2 for Daily Digital Screening of Depression and Insomnia: Validation Study

Background: The Patient Health Questionnaire-2 (PHQ-2) and Insomnia Severity Index-2 (ISI-2) are screening assessments that reflect the past 2-week experience of depression and insomnia, respectively. Retrospective assessment has been associated with reduced accuracy owing to recall bias. Objective: This study aimed to increase the reliability of responses by validating the use of the PHQ-2 and ISI-2 for daily screening. Methods: A total of 167 outpatients from the psychiatric department at the Yongin Severance Hospital participated in this study, of which 63 (37.7%) were male and 104 (62.3%) were female with a mean age of 35.1 (SD 12.1) years. Participants used a mobile app ("Mental Protector") for 4 weeks and rated their depressive and insomnia symptoms daily on the modified PHQ-2 and ISI-2 scales. The validation assessments were conducted in 2 blocks, each with a fortnight response from the participants. The modified version of the PHQ-2 was evaluated against the conventional scales of the Patient Health Questionnaire-9 and the Korean version of the Center for Epidemiologic Studies Depression Scale-Revised. Results: According to the sensitivity and specificity analyses, an average score of 3.29 on the modified PHQ-2 was considered valid for screening for depressive symptoms. Similarly, the ISI-2 was evaluated against the conventional scale, Insomnia Severity Index, and a mean score of 3.50 was determined to be a valid threshold for insomnia symptoms when rated daily. Conclusions: This study is one of the first to propose a daily digital screening measure for depression and insomnia delivered through a mobile app. The modified PHQ-2 and ISI-2 were strong candidates for daily screening of depression and insomnia, respectively.ope

Associations between Heart Rate Variability and Brain Activity during a Working Memory Task: A Preliminary Electroencephalogram Study on Depression and Anxiety Disorder

Heart rate variability (HRV) has been suggested to reflect executive function and related neural activity. Executive dysfunction has been suggested to play an important role in the pathophysiology of emotional disorders. The purpose of this study was to investigate whether HRV showed a significant correlation with electroencephalogram (EEG) during a working memory performance in patients with depressive or anxiety disorder. A retrospective analysis was conducted with data from 61 patients with depressive disorder (43 women and 18 men) and 59 patients with anxiety disorder (35 women and 24 men). HRV was measured in the resting state, and EEG was recorded in the resting state and during the execution of a working memory task. It was performed in patients with depressive and anxiety disorder, and the paired sample t-test between resting state and task performance, as well as the partial correlation analysis between HRV and EEG, was conducted. Both depressed and anxious patients showed weaker beta relative power during the working memory task compared to the rest period. The resting-state EEG did not correlate with HRV parameters in both groups. In depressed patients, HRV showed a positive correlation with delta power during the task and a negative correlation with beta relative power during the task. In patients with anxiety disorder, HRV showed a significant positive correlation with theta power of the right frontal region during the task. Our results suggest that HRV would be related to executive-function-related neural activity in patients with depressive or anxiety disorder. Future studies with more subjects, including healthy controls, are needed to verify the correlation between HRV and EEG and to come up with a more comprehensive picture of neurobiological changes in emotional disorders.ope

Altered Functional Connectivity of the Salience Network in Problematic Smartphone Users

Smartphones provide convenience in everyday life. Smartphones, however, can elicit adverse effects when used excessively. The purpose of this study was to examine the underlying neurobiological alterations that arise from problematic smartphone use. We performed resting state seed-based functional connectivity (FC) analysis of 44 problematic smartphone users and 54 healthy controls. This analysis assessed the salience, central executive, default mode, and affective networks. Compared to controls, problematic smartphone users showed enhanced FC within the salience network and between the salience and default mode network. Moreover, we observed decreased FC between the salience and central executive network in problematic smartphone users, compared to controls. These results imply that problematic smartphone use is associated with aberrant FC in key brain networks. Our results suggest that changes in FC of key networks centered around the salience network might be associated with problematic smartphone use.ope

Depressive Symptoms Feature-Based Machine Learning Approach to Predicting Depression Using Smartphone

With the impact of the COVID-19 pandemic, the number of patients suffering from depression is rising around the world. It is important to diagnose depression early so that it may be treated as soon as possible. The self-response questionnaire, which has been used to diagnose depression in hospitals, is impractical since it requires active patient engagement. Therefore, it is vital to have a system that predicts depression automatically and recommends treatment. In this paper, we propose a smartphone-based depression prediction system. In addition, we propose depressive features based on multimodal sensor data for predicting depressive mood. The multimodal depressive features were designed based on depression symptoms defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The proposed system comprises a "Mental Health Protector" application that collects data from smartphones and a big data-based cloud platform that processes large amounts of data. We recruited 106 mental patients and collected smartphone sensor data and self-reported questionnaires from their smartphones using the proposed system. Finally, we evaluated the performance of the proposed system's prediction of depression. As the test dataset, 27 out of 106 participants were selected randomly. The proposed system showed 76.92% on an f1-score for 16 patients with depression disease, and in particular, 15 patients, 93.75%, were successfully predicted. Unlike previous studies, the proposed method has high adaptability in that it uses only smartphones and has a distinction of evaluating prediction accuracy based on the diagnosis.ope

Lateral orbitofrontal gray matter abnormalities in subjects with problematic smartphone use

BACKGROUND AND AIMS: Smartphone use is becoming commonplace and exerting adequate control over smartphone use has become an important mental health issue. Little is known about the neurobiology underlying problematic smartphone use. We hypothesized that structural abnormalities in the fronto-cingulate brain region could be implicated in problematic smartphone use, similar to that has been reported for Internet gaming disorder and Internet addiction. This study investigated fronto-cingulate gray matter abnormalities in problematic smartphone users, particularly those who spend time on social networking platforms. METHODS: The study included 39 problematic smartphone users with excessive use of social networking platforms via smartphone and 49 normal control male and female smartphone users. We conducted voxel-based morphometric analysis with diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm. Region of interest analysis was performed on the fronto-cingulate region to identify whether gray matter volume (GMV) differed between the two groups. RESULTS: Problematic smartphone users had significantly smaller GMV in the right lateral orbitofrontal cortex (OFC) than healthy controls, and there were significant negative correlations between GMV in the right lateral OFC and the Smartphone Addiction Proneness Scale (SAPS) score, including the SAPS tolerance subscale. CONCLUSIONS: These results suggest that lateral orbitofrontal gray matter abnormalities are implicated in problematic smartphone use, especially in social networking platform overuse. Small GMV in the lateral OFC was correlated with an increasing tendency to be immersed in smartphone use. Our results suggest that orbitofrontal gray matter abnormalities affect regulatory control over previously reinforced behaviors and may underlie problematic smartphone use.ope

Altered resting-state functional connectivity of the dorsal anterior cingulate cortex with intrinsic brain networks in male problematic smartphone users

The excessive use of smartphones is associated with various medical complications and mental health problems. However, existing research findings on neurobiological mechanisms behind problematic smartphone use are limited. In this study, we investigated functional connectivity in problematic smartphone users, focusing on the default mode network (DMN) and attentional networks. We hypothesized that problematic smartphone users would have alterations in functional connectivity between the DMN and attentional networks and that such alterations would correlate with the severity of problematic smartphone use. This study included 30 problematic smartphone users and 35 non-problematic smartphone users. We carried out group independent component analysis (group ICA) to decompose resting-state functional magnetic resonance imaging (fMRI) data into distinct networks. We examined functional connectivity using seed-to-seed analysis and identified the nodes of networks in group ICA, which we used as region of interest. We identified greater functional connectivity of the dorsal anterior cingulate cortex (dACC) with the ventral attention network (VAN) and with the DMN in problematic smartphone users. In seed-to-seed analysis, problematic smartphone users showed atypical dACC-VAN functional connectivity which correlated with the smartphone addiction proneness scale total scores. Our resting-state fMRI study found greater functional connectivity between the dACC and attentional networks in problematic smartphone users. Our findings suggest that increased bottom-up and interoceptive attentional processing might play an important role in problematic smartphone use.ope

The Relationship Between Smartphone Addiction, Mindfulness and Impulsivity

Objectives: To comparatively analyze mindfulness between young adults with smartphone addiction and healthy smartphone users and to explore whether mindfulness could affect smartphone addiction and whether impulsivity could mediate their association. Methods: Forty young adults with smartphone addiction (17 male, 23 female; mean age: 26.8±6.7 years) and 44 healthy smartphone users (21 male, 23 female; mean age: 27.8±5.1 years) were included in this study. Mindfulness was evaluated through the Mindful Attention Awareness Scale and the Five Facet Mindfulness Questionnaire-Short Form (FFMQ-SF). Subjects were also evaluated for impulsivity via the self-reported Barratt Impulsiveness Scale (BIS). Relationships of smartphone addiction with mindfulness and impulsivity were analyzed using linear regression through mediation. Results: Subjects with smartphone addiction had a lower level of mindfulness and but higher impulsivity than healthy users. The awareness subscale of FFMQ-SF had a significant effect on smartphone addiction scale. The attentional impulsiveness subscale of BIS showed a significant mediating effect. Conclusion: Smartphone addicts showed a low level of mindfulness. In particular, low awareness had a significant effect on smartphone addiction through mediation of high attentional impulsiveness. This finding suggests that mindfulness-based interventions might enhance executive control over their excessive smartphone use.ope

Association between childhood and adult attention deficit hyperactivity disorder symptoms in Korean young adults with Internet addiction

Background and aims Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric comorbidities of Internet addiction (IA); however, the possible mechanisms that contribute to this high comorbidity are still under debate. This study aims to analyze these possible mechanisms by comparing the effect of IA severity and childhood ADHD on inattention, hyperactivity, and impulsivity in young adults with IA. We hypothesized that IA might have associations with ADHD-like cognitive and behavior symptoms aside from childhood ADHD. Methods Study participants consisted of 61 young male adults. Participants were administered a structured interview. The severity of IA, childhood and current ADHD symptoms, and psychiatry comorbid symptoms were assessed through self-rating scales. The associations between the severity of IA and ADHD symptoms were examined through hierarchical regression analyses. Results Hierarchical regression analyses showed that the severity of IA significantly predicted most dimensions of ADHD symptoms. By contrast, childhood ADHD predicted only one dimension. Discussion The high comorbidity of inattention and hyperactivity symptoms in IA should not solely be accounted by an independent ADHD disorder but should consider the possibility of cognitive symptoms related to IA. Functional and structural brain abnormalities associated with excessive and pathologic Internet usage might be related to these ADHD-like symptoms. Conclusion Inattention and hyperactivity in young adults with IA are more significantly associated with the severity of IA than that of childhood ADHD.ope

Structural and functional brain alterations associated with cancer-associated cognitive decline in gastric cancer patients: A preliminary longitudinal neuroimaging study

Objective: Despite the clinical significance of cancer-associated cognitive decline (CACD), no longitudinal study has evaluated CACD in gastric cancer patients. This preliminary study explored structural and functional neural changes of CACD in gastric cancer patients focusing on the effects of chemotherapy. Methods: 13 gastric cancer patients who received adjuvant chemotherapy (CTx+ group), 9 gastric cancer patients who did not receive adjuvant chemotherapy (CTx- group), and 10 healthy controls (HCs) were enrolled in this study. We performed self-report questionnaires, neurocognitive tests, voxel-based morphometry (VBM), and resting-state functional magnetic resonance imaging (rsfMRI) analyses before and 3 months after chemotherapy. Results: Compared to the CTx- group, the CTx+ group exhibited statistically significant decrease in attention and executive function over time and dysfunction in delayed recognition performance. The results of the rsfMRI analysis showed a significant group-by-time interaction in the left hippocampus-anterior thalamus. However, no significant structural change was observed in the VBM analysis. Conclusion: To the best of our knowledge, this is the first longitudinal neuroimaging study on CACD in gastric cancer patients. Based on the results of our preliminary study, we suggest that the neuropathological processes and clinical presentation of CACD in gastric cancer patients is similar to those of patients associated with age-related neurodegenerative disorders.ope

Insular activation and functional connectivity in firefighters with post-traumatic stress disorder

Background: Firefighters are frequently exposed to stressful situations and are at high risk of developing post-traumatic stress disorder (PTSD). Hyperresponsiveness to threatening and emotional stimuli and diminishment of executive control have been suggested as manifestations of PTSD. Aims: To examine brain activation in firefighters with PTSD by conducting an executive control-related behavioural task with trauma-related interferences. Method: Twelve firefighters with PTSD and 14 healthy firefighters underwent functional magnetic resonance imaging (fMRI) while performing a Stroop match-to-sample task using trauma-related photographic stimuli. Seed-based functional connectivity analysis was conducted using regions identified in fMRI contrast analysis. Results: Compared with the controls, the participants with PTSD had longer reaction times when the trauma-related interferences were presented. They showed significantly stronger brain activation to interfering trauma-related stimuli in the left insula, and had weaker insular functional connectivity in the supplementary motor area and the anterior cingulate cortex than the controls. They also showed a significant correlation between left insula-supplementary motor area connectivity strength and the hyperarousal subscale of the Clinician-Administered PTSD Scale. Conclusions: Our findings indicate that trauma-related stimuli elicit excessive brain activation in the left insula among firefighters with PTSD. Firefighters with PTSD also appear to have weak left insular functional connectivity with executive control-related brain regions. This aberrant insular activation and functional connectivity could be related to the development and maintenance of PTSD symptoms in firefighters.ope