6 research outputs found
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Predicting depressive symptom severity through individuals' nearby bluetooth device count data collected by mobile phones: preliminary longitudinal study
Background:Research in mental health has found associations between depression and individuals' behaviors and statuses, such as social connections and interactions, working status, mobility, and social isolation and loneliness. These behaviors and statuses can be approximated by the nearby Bluetooth device count (NBDC) detected by Bluetooth sensors in mobile phones. Objective: This study aimed to explore the value of the NBDC data in predicting depressive symptom severity as measured via the 8-item Patient Health Questionnaire (PHQ-8). Methods: The data used in this paper included 2886 biweekly PHQ-8 records collected from 316 participants recruited from three study sites in the Netherlands, Spain, and the United Kingdom as part of the EU Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) study. From the NBDC data 2 weeks prior to each PHQ-8 score, we extracted 49 Bluetooth features, including statistical features and nonlinear features for measuring the periodicity and regularity of individuals' life rhythms. Linear mixed-effect models were used to explore associations between Bluetooth features and the PHQ-8 score. We then applied hierarchical Bayesian linear regression models to predict the PHQ-8 score from the extracted Bluetooth features. Results: A number of significant associations were found between Bluetooth features and depressive symptom severity. Generally speaking, along with depressive symptom worsening, one or more of the following changes were found in the preceding 2 weeks of the NBDC data: (1) the amount decreased, (2) the variance decreased, (3) the periodicity (especially the circadian rhythm) decreased, and (4) the NBDC sequence became more irregular. Compared with commonly used machine learning models, the proposed hierarchical Bayesian linear regression model achieved the best prediction metrics (R2=0.526) and a root mean squared error (RMSE) of 3.891. Bluetooth features can explain an extra 18.8% of the variance in the PHQ-8 score relative to the baseline model without Bluetooth features (R2=0.338, RMSE=4.547). Conclusions: Our statistical results indicate that the NBDC data have the potential to reflect changes in individuals' behaviors and statuses concurrent with the changes in the depressive state. The prediction results demonstrate that the NBDC data have a significant value in predicting depressive symptom severity. These findings may have utility for the mental health monitoring practice in real-world settings.</p
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Engagement with a remote symptom-tracking platform among participants with major depressive disorder (RADAR-Engage): a randomized controlled trial
Background:Multi-parametric remote measurement technologies (RMTs), comprising smartphones and wearable devices, have the potential to revolutionise understanding of the etiology and trajectory of major depressive disorder (MDD). Engagement with RMTs in MDD research is of the upmost importance for validity of predictive analytical methods and long-term use, and can be conceptualized as both objective engagement (data availability) or subjective engagement (system usability and experiential factors). In-app components provide an opportunity to promote engagement with RMTs while minimizing research team resources. Randomized controlled trials (RCTs) are the gold standard in quantifying the effect of in-app components on engagement with RMTs in those with MDD.Objective:This study aimed to evaluate whether a multi-parametric RMT system with a visual progress report tracking data completion, theoretically informed notifications, and access to research team contact details could promote objective and subjective engagement with remote symptom tracking over and above the system as usual.Methods:A 2-arm, parallel-group RCT (participant-blinded) with 1:1 randomization was conducted with 100 participants with MDD over 12 weeks. Participants in both arms employed the RADAR-base system, involving a smartphone app for weekly symptom assessments and a wearable Fitbit device for continuous passive tracking. Participants in the intervention arm (n=50) also had access to the additional in-app components. The primary outcome was objective engagement with the system, measured as the percentage of weekly questionnaires during follow-up. Secondary outcomes comprised measures of subjective engagement (system engagement, system usability, and emotional self-awareness).Results:Levels of completion of the PHQ-9 task were similar in the control (69.2%) and intervention (68.1%) arms (p-value for difference between arms = 0.83, 95% CI -9.32 to 11.65). Those in the intervention group reported slightly higher user engagement (1.93, 95% CI -1.91 to 5.78), emotional self-awareness (1.13, 95% CI -2.93 to 5.19) and system usability (2.29, 95% CI -5.93 to 10.52) scores at follow-up, however all confidence intervals were wide and included 0.Conclusions:The adapted system did not increase objective or subjective engagement with remote symptom tracking in our research cohort. This study provides important foundations for understanding engagement with RMTs for research, and the methodologies by which this work can be replicated in both community and clinical settings. Clinical Trial: This study was registered as a clinical trial (reference number NCT04972474; https://clinicaltrials.gov/ct2/show/NCT04972474), and published as a protocol (https://doi.org/10.2196/32653).</p
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Relationship between major depression symptom severity and sleep collected using a wristband wearable device: Multicenter longitudinal observational study
Background: Sleep problems tend to vary according to the course of the disorder in individuals with mental health problems. Research in mental health has associated sleep pathologies with depression. However, the gold standard for sleep assessment, polysomnography (PSG), is not suitable for long-term, continuous monitoring of daily sleep, and methods such as sleep diaries rely on subjective recall, which is qualitative and inaccurate. Wearable devices, on the other hand, provide a low-cost and convenient means to monitor sleep in home settings. Objective: The main aim of this study was to devise and extract sleep features from data collected using a wearable device and analyze their associations with depressive symptom severity and sleep quality as measured by the self-assessed Patient Health Questionnaire 8-item (PHQ-8). Methods: Daily sleep data were collected passively by Fitbit wristband devices, and depressive symptom severity was self-reported every 2 weeks by the PHQ-8. The data used in this paper included 2812 PHQ-8 records from 368 participants recruited from 3 study sites in the Netherlands, Spain, and the United Kingdom. We extracted 18 sleep features from Fitbit data that describe participant sleep in the following 5 aspects: sleep architecture, sleep stability, sleep quality, insomnia, and hypersomnia. Linear mixed regression models were used to explore associations between sleep features and depressive symptom severity. The z score was used to evaluate the significance of the coefficient of each feature.Results: We tested our models on the entire dataset and separately on the data of 3 different study sites. We identified 14 sleep features that were significantly (PConclusions: We demonstrated that several derived sleep features extracted from consumer wearable devices show potential for the remote measurement of sleep as biomarkers of depression in real-world settings. These findings may provide the basis for the development of clinical tools to passively monitor disease state and trajectory, with minimal burden on the participant.</p
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Challenges in using mHealth data from smartphones and wearable devices to predict depression symptom severity: retrospective analysis
Background: Major Depressive Disorder (MDD) affects millions of people world-wide, leading to lower quality of life and high medical costs. Despite the existence of psychoand pharmaco-therapy, more than 50% of people with MDD do not receive timely treatment due in part to inaccurate subjective recall and variability in the symptom course. A more objective and frequent monitoring of mental health status may not only improve on subjective recall but help guide treatment selection. Attempts have been made to explore the relationship between measures of depression and passive digital phenotypes (features) extracted from smartphones and wearables devices to remotely evaluate well-being and continuously monitor changes in symptomatology with varying degrees of success. A number of challenges exist for the analysis of this data, however. These include: (i) maintaining participant engagement over extended time periods and therefore understanding what constitutes an acceptable threshold of missing data; (ii) distinguishing between the cross-sectional and longitudinal relationships for different features to determine their utility in tracking within-individual longitudinal variation or screening participants at high risks; (iii) understanding the heterogeneity with which depression manifests itself in behavioural patterns quantified by the passive features. Objective: We aim to address these three challenges to inform future work in stratified analyses. Methods: Using smartphone and wearable data collected from 479 participants with MDD from the EU IMI RADAR-CNS programme, we extracted 21 features reflecting mobility, sleep, and phone use. We investigated the impact of the number of days of available data on feature quality using intraclass correlation coefficients and Bland-Altman analysis. We then investigated the nature of the correlation between the 8-item Patient Health Questionnaire depression scale (PHQ-8; measured every 14 days) and the features using the participant-mean correlation coefficient, repeated measures correlation coefficient, and linear mixed effects model. Furthermore, we stratified the participants based on their behavioural difference, quantified by the features, between periods of high (depression) and low (no depression) PHQ-8 scores using the Gaussian mixture model. Results: We demonstrated that 8 (range: 2-12) days were needed for reliable calculation of most features in the 14-day time window. We observed that features such as sleep onset time correlated better with PHQ-8 scores cross-sectionally than longitudinally, while features such as awake duration after sleep onset correlated well with PHQ-8 longitudinally but worse cross-sectionally. Finally, we found that participants could be separated into 3 distinct clusters according to their behavioural difference between periods of depression and no depression. Conclusions: This work contributes to our understanding of how these mobile health derived features are associated with depression symptom severity to inform future work in stratified analyses
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Longitudinal relationships between depressive symptom severity and phone-measured mobility: dynamic structural equation modeling study
Background: The mobility of an individual measured by phone-collected location data has been found to be associated with depression; however, the longitudinal relationships (the temporal direction of relationships) between depressive symptom severity and phone-measured mobility have yet to be fully explored. Objective: We aimed to explore the relationships and the direction of the relationships between depressive symptom severity and phone-measured mobility over time. Methods: Data used in this paper came from a major EU program, called the Remote Assessment of Disease and Relapse-Major Depressive Disorder, which was conducted in 3 European countries. Depressive symptom severity was measured with the 8-item Patient Health Questionnaire (PHQ-8) through mobile phones every 2 weeks. Participants' location data were recorded by GPS and network sensors in mobile phones every 10 minutes, and 11 mobility features were extracted from location data for the 2 weeks prior to the PHQ-8 assessment. Dynamic structural equation modeling was used to explore the longitudinal relationships between depressive symptom severity and phone-measured mobility. Results: This study included 2341 PHQ-8 records and corresponding phone-collected location data from 290 participants (age: median 50.0 IQR 34.0, 59.0) years; of whom 215 (74.1%) were female, and 149 (51.4%) were employed. Significant negative correlations were found between depressive symptom severity and phone-measured mobility, and these correlations were more significant at the within-individual level than the between-individual level. For the direction of relationships over time, Homestay (time at home) (φ=0.09, P=.01), Location Entropy (time distribution on different locations) (φ=-0.04, P=.02), and Residential Location Count (reflecting traveling) (φ=0.05, P=.02) were significantly correlated with the subsequent changes in the PHQ-8 score, while changes in the PHQ-8 score significantly affected (φ=-0.07, PConclusions: Several phone-derived mobility features have the potential to predict future depression, which may provide support for future clinical applications, relapse prevention, and remote mental health monitoring practices in real-world settings.</p
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The association between home stay and symptom severity in major depressive disorder: preliminary findings from a multicenter observational study using geolocation data from smartphones
Background: Most smartphones and wearables are currently equipped with location sensing (using GPS and mobile network information), which enables continuous location tracking of their users. Several studies have reported that various mobility metrics, as well as home stay, that is, the amount of time an individual spends at home in a day, are associated with symptom severity in people with major depressive disorder (MDD). Owing to the use of small and homogeneous cohorts of participants, it is uncertain whether the findings reported in those studies generalize to a broader population of individuals with MDD symptoms.Objective: The objective of this study is to examine the relationship between the overall severity of depressive symptoms, as assessed by the 8-item Patient Health Questionnaire, and median daily home stay over the 2 weeks preceding the completion of a questionnaire in individuals with MDD. Methods: We used questionnaire and geolocation data of 164 participants with MDD collected in the observational Remote Assessment of Disease and Relapse–Major Depressive Disorder study. The participants were recruited from three study sites: King’s College London in the United Kingdom (109/164, 66.5%); Vrije Universiteit Medisch Centrum in Amsterdam, the Netherlands (17/164, 10.4%); and Centro de Investigación Biomédica en Red in Barcelona, Spain (38/164, 23.2%). We used a linear regression model and a resampling technique (n=100 draws) to investigate the relationship between home stay and the overall severity of MDD symptoms. Participant age at enrollment, gender, occupational status, and geolocation data quality metrics were included in the model as additional explanatory variables. The 95% 2-sided CIs were used to evaluate the significance of model variables. Results: Participant age and severity of MDD symptoms were found to be significantly related to home stay, with older (95% CI 0.161-0.325) and more severely affected individuals (95% CI 0.015-0.184) spending more time at home. The association between home stay and symptoms severity appeared to be stronger on weekdays (95% CI 0.023-0.178, median 0.098; home stay: 25th-75th percentiles 17.8-22.8, median 20.9 hours a day) than on weekends (95% CI −0.079 to 0.149, median 0.052; home stay: 25th-75th percentiles 19.7-23.5, median 22.3 hours a day). Furthermore, we found a significant modulation of home stay by occupational status, with employment reducing home stay (employed participants: 25th-75th percentiles 16.1-22.1, median 19.7 hours a day; unemployed participants: 25th-75th percentiles 20.4-23.5, median 22.6 hours a day). Conclusions: Our findings suggest that home stay is associated with symptom severity in MDD and demonstrate the importance of accounting for confounding factors in future studies. In addition, they illustrate that passive sensing of individuals with depression is feasible and could provide clinically relevant information to monitor the course of illness in patients with MDD.</p