Combining mobile-health (mHealth) and artificial intelligence (AI) methods to avoid suicide attempts: the Smartcrises study protocol

The screening of digital footprint for clinical purposes relies on the capacity of wearable technologies to collect data and extract relevant information’s for patient management. Artificial intelligence (AI) techniques allow processing of real-time observational information and continuously learning from data to build understanding. We designed a system able to get clinical sense from digital footprints based on the smartphone’s native sensors and advanced machine learning and signal processing techniques in order to identify suicide risk. Method/design: The Smartcrisis study is a cross-national comparative study. The study goal is to determine the relationship between suicide risk and changes in sleep quality and disturbed appetite. Outpatients from the Hospital Fundación Jiménez Díaz Psychiatry Department (Madrid, Spain) and the University Hospital of Nimes (France) will be proposed to participate to the study. Two smartphone applications and a wearable armband will be used to capture the data. In the intervention group, a smartphone application (MEmind) will allow for the ecological momentary assessment (EMA) data capture related with sleep, appetite and suicide ideations. Discussion: Some concerns regarding data security might be raised. Our system complies with the highest level of security regarding patients’ data. Several important ethical considerations related to EMA method must also be considered. EMA methods entails a non-negligible time commitment on behalf of the participants. EMA rely on daily, or sometimes more frequent, Smartphone notifications. Furthermore, recording participants’ daily experiences in a continuous manner is an integral part of EMA. This approach may be significantly more than asking a participant to complete a retrospective questionnaire but also more accurate in terms of symptoms monitoring. Overall, we believe that Smartcrises could participate to a paradigm shift from the traditional identification of risks factors to personalized prevention strategies tailored to characteristics for each patientThis study was partly funded by Fundación Jiménez Díaz Hospital, Instituto de Salud Carlos III (PI16/01852), Delegación del Gobierno para el Plan Nacional de Drogas (20151073), American Foundation for Suicide Prevention (AFSP) (LSRG-1-005-16), the Madrid Regional Government (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM) and Structural Funds of the European Union. MINECO/FEDER (‘ADVENTURE’, id. TEC2015–69868-C2–1-R) and MCIU Explora Grant ‘aMBITION’ (id. TEC2017–92552-EXP), the French Embassy in Madrid, Spain, The foundation de l’avenir, and the Fondation de France. The work of D. Ramírez and A. Artés-Rodríguez has been partly supported by Ministerio de Economía of Spain under projects: OTOSIS (TEC2013–41718-R), AID (TEC2014–62194-EXP) and the COMONSENS Network (TEC2015–69648-REDC), by the Ministerio de Economía of Spain jointly with the European Commission (ERDF) under projects ADVENTURE (TEC2015– 69868-C2–1-R) and CAIMAN (TEC2017–86921-C2–2-R), and by the Comunidad de Madrid under project CASI-CAM-CM (S2013/ICE-2845). The work of P. Moreno-Muñoz has been supported by FPI grant BES-2016-07762

Evaluating the inter-rater reliability of the Scale to Assess Unawareness of Mental Disorder using the DOMENIC method

Insight in psychosis is a complex construct, conceptualized as a continuous and multidimensional phenomenon. It comprises the awareness of having a mental disorder, treatment compliance, the ability to label unusual mental events as symptoms of the disorder, and the awareness of the social conse­quences of the disorder. Insight has an important impact on the outcome of psychosis and has been related to quality of life, psychosocial functioning, severity of symptomatology, therapeutic compliance, and number of readmissions. Thus, insight assessment is crucial in patients with psychosis. But in real-world clinical settings, a single patient being assessed and/or treated by several clinicians is a common situation, and given the complexity of the phenomenon of insight, it is difficult to ensure that all clinicians are referring to the same construct. Using questionnaires could help clinicians to deal with this situation. The Scale to Assess Unawareness of Mental Disorder (SUMD) is a widely used instrument to explore insight in clinical trials and epidemiological studies that has proved to be adequate in terms of validity and reliability with the usual statistical procedures. Nevertheless, it is not easy to use, and heterogeneity across studies can compromise the results (Dumas et al., 2013). We proposed an inter-rater reliability study to explore differences in the assessment of insight using this instrument. Procedures based on the calculation of Kappa coefficients, weighted Kappa, or interclass corre­lation coefficient (ICC) require a sample of several subjects who are evaluated by a small number of examiners and, for our purpose, this reflects an inefficient strategy. Therefore, we used the Detection of Multiple Examiners Not in Consensus (DOMENIC) method, elaborated by Cicchetti et al. (1997), which allows the inter-rater reliability for one single patient and several raters to be deter­mined. By using the DOMENIC method, we can see that items referring to insight of the negative symptoms of psychosis may cause the greatest difficulty for raters, a difficulty that, according to our data, does not seem to be significantly related to their clinical experience. Retraining clinicians in this area could be the best alternative to improve the reli­ability of the appraisals. Thus, the DOMENIC method could be a useful tool in the preparation phases of a study with this type of scale to easily identify areas of disagreement and investigators who need training to improve inter-rater reliability.2023-2

Deep Sequential Models for Suicidal Ideation from Multiple Source Data

This paper presents a novel method for predicting suicidal ideation from electronic health records (EHR) and ecological momentary assessment (EMA) data using deep sequential models. Both EHR longitudinal data and EMA question forms are defined by asynchronous, variable length, randomly sampled data sequences. In our method, we model each of them with a recurrent neural network, and both sequences are aligned by concatenating the hidden state of each of them using temporal marks. Furthermore, we incorporate attention schemes to improve performance in long sequences and time-independent pre-trained schemes to cope with very short sequences. Using a database of 1023 patients, our experimental results show that the addition of EMA records boosts the system recall to predict the suicidal ideation diagnosis from 48.13% obtained exclusively from EHR-based state-of-the-art methods to 67.78%. Additionally, our method provides interpretability through the t-distributed stochastic neighbor embedding (t-SNE) representation of the latent space. Furthermore, the most relevant input features are identified and interpreted medically.This work was supported in part by the Spanish MINECO under Grants TEC2015-69868-C2-1-R, TEC2016-78434-C3-3-R, and TEC2017-92552-EXP, in part by Spanish MICINN under Grant RTI2018-099655-B-I00, in part by Comunidad de Madrid under Grants IND2017/TIC-7618, IND2018/TIC-9649, Y2018/TCS-4705, and B2017/BMD-3740 AGES-CM 2CM, in part by BBVA Foundation under Deep-DARWiN - FBBVA Grant for scientific research teams 2018, in part by ISCIII under Grant PI16/01852, and in part by AFSP under Grant LSRG-1-005-16

Trajectory analysis of suicidal ideation in Spanish college students using ecological momentary assessment

Suicide is a preventable death in young people. It is well known that suicide behavior is a multicausal phenomenon. However, suicidal ideation (SI) commonly underlies suicide, and Ecological Momentary Assessment (EMA) can help us to better characterize it and its risk and protective factors in the short term. We aimed, first, to investigate the estimated prevalence and trajectories of SI in a community sample of Spanish college students using an EMA methodology and, second, explore the associations between risk and protective factors and SI categorized as moderate or lo

Patients at high risk of suicide before and during a COVID-19 lockdown: ecological momentary assessment study

The coronavirus disease 2019 (COVID-19) outbreak may have affected the mental health of patients at high risk of suicide. In this study we explored the wish to die and other suicide risk factors using smartphone-based ecological momentary assessment (EMA) in patients with a history of suicidal thoughts and behaviour. Contrary to our expectations we found a decrease in the wish to die during lockdown. This is consistent with previous studies showing that suicide rates decrease during periods of social emergency. Smartphone-based EMA can allow us to remotely assess patients and overcome the physical barriers imposed by lockdown.This study received grant support from Instituto de Salud Carlos III (ISCIII PI13/02200; PI16/ 01852; CM19/00026), Delegación del Gobierno para el Plan Nacional de Drogas (20151073), the American Foundation for Suicide Prevention (LSRG-1-005-16), the Ministerio de Ciencia, Innovación y Universidades (RTI2018-099655-B-I00; TEC2017-92552-EXP) and by the Comunidad de Madrid (Y2018/TCS-4705, PRACTICO-CM)

Estilo Atribucional Y Antecedentes De Conducta Suicida En Primeros Episodios Psicóticos

Objetivo: La conducta suicida (CS) es común en personas que han sufrido un primer episodio psicótico (PEP), al igual que las alteraciones neurocognitivas y de cognición social. Respecto a esta, destaca el estilo atribucional. Existe evidencia de que un estilo atribucional desadaptativo respecto a los demás está relacionado con mayor riesgo suicida. A pesar de que hay factores de riesgo bien establecidos para la CS en psicosis, el papel de la neurocognición y la cognición social sigue sin estar claro. Este estudio tiene como objetivo explorar la relación entre antecedentes de CS y aspectos neurocognitivos y de cognición social en personas con PEP, prestando especial atención al estilo atribucional. Método: 190 participantes con PEP fueron reclutados de dos estudios multicéntricos. Se formaron dos grupos en función de la presencia/ausencia de antecedentes de CS para comparar los datos demográficos, clínicos y cognitivos. Se realizó un análisis multivariante y, en aquellas variables estadísticamente significativas (p<0,05), se aplicó un modelo de regresión logística. Resultados: No se encontraron diferencias en las variables demográficas, clínicas ni de funcionamiento neurocognitivo. El estilo atribucional (sesgo externalizador) resultó estadísticamente significativo (t=2,07; p=0,041) y mantuvo significación tras aplicar la regresión logística (OR 0,847; IC 95% 0,734-0,977; p=0,023). Conclusiones: En personas con PEP, el funcionamiento neurocognitivo no se asocia con antecedentes de CS, aunque, respecto a la cognición social, un sesgo externalizador extremadamente bajo parece estar relacionado con antecedentes de CS. Estos resultados sugieren que lo que facilita la aparición de CS no es un mejor o peor funcionamiento cognitivo sino la percepción negativa del trastorno, alimentada por una tendencia a realizar atribuciones internas de los eventos negativos. Esto tiene importantes implicaciones en la práctica clínica por su valor en la prevención de posibles CS.2022-2

Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia

Background: Although insight in schizophrenia spectrum disorders (SSD) has been associated with positive outcomes, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight suggests that metacognitive training (MCT) may improve insight and clinical outcomes in SSD, although this remains to be established. Methods: This single-center, assessor-blind, parallel-group, randomised clinical trial (RCT) aims to investigate the efficacy of MCT for improving insight (primary outcome), including clinical and cognitive insight, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) and the Beck Cognitive Scale (BCIS), respectively, in (at least) n = 126 outpatients with SSD at three points in time: i) at baseline (T0); ii) after treatment (T1) and iii) at 1-year follow-up (T2). SSD patients receiving MCT and controls attending a non-intervention support group will be compared on insight level changes and several clinical and cognitive secondary outcomes at T1 and T2, whilst adjusting for baseline data. Ecological momentary assessment (EMA) will be piloted to assess functioning in a subsample of participants. Discussion: To the best of our knowledge, this will be the first RCT testing the effect of group MCT on multiple insight dimensions (as primary outcome) in a sample of unselected patients with SSD, including several secondary outcomes of clinical relevance, namely symptom severity, functioning, which will also be evaluated with EMA, hospitalizations and suicidal behaviour.This study was supported by the Universidad Autónoma de Madrid and European Union via the Intertalentum Project Grant-Marie Skłodowska Curie Actions (GA 713366) to JDLM who is the Princiapl Investigator. This grant therefore funds both JDLM’s salary and the consumable expenses related to the study. JDLM, VGRR, ASEM, MLBE, LMI, LML, SSA, AAR and EBG’s salaries come from the Hospital Universitario Fundación Jiménez Díaz, where this study is currently being carried out, which therefore provides the necessary institutional/departmental support for its development. Additional departmental support concerning the use of Ecological Momentary Assessment (see Methods section, page 11 -last paragraph- and page 12 –first paragraph-, for details) is provided by the Instituto de Salud Carlos III (Madrid, Spain) (ISCIII PI16/01852) and the Madrid Regional Government (Madrid, Spain) (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM). ASD acknowledges funding supports from University College London, which covers his salar

What seems to explain suicidality in Yucatan Mexican young adults? findings from an app-based mental health screening test using the SMART-SCREEN protocol

The relationship between suicidality, depression, anxiety, and well-being was explored in young adults (median age 20.7 years) from the State of Yucatan (Mexico), which has a suicide rate double that of other Mexican states. A cross-sectional study was carried out in 20 universities in Yucatan and 9,366 students were surveyed using validated questionnaires built into a smartphone app, applying partial least squares structural equation models. High suicide risk was assessed in 10.8% of the sample. Clinically relevant depression and anxiety levels were found in 6.6% and 10.5% of the sample, respectively, and 67.8% reported high well-being. Comparably higher levels of suicide risk, depression and anxiety, and lower well-being were found in women, who were also somewhat older than men in our study. Furthermore, path analysis in the structural equation model revealed that depression was the main predictor of suicidal behaviour as well as of higher anxiety levels and lower self-perceived well-being in the total sample and in both genders. Our findings draw attention to the association between suicidality, depression, anxiety, and well-being in Yucatan young adults and gender differences with this regard. Mental health screening via smartphone might be a useful tool to reach large populations and contribute to mental health policies, including regional suicide prevention effortsOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. No funding was received for this stud

WHODAS 2.0 as a Measure of Severity of Illness: Results of a FLDA Analysis

WHODAS 2.0 is the standard measure of disability promoted by World Health Organization whereas Clinical Global Impression (CGI) is a widely used scale for determining severity of mental illness. Although a close relationship between these two scales would be expected, there are no relevant studies on the topic. In this study, we explore if WHODAS 2.0 can be used for identifying severity of illness measured by CGI using the Fisher Linear Discriminant Analysis (FLDA) and for identifying which individual items of WHODAS 2.0 best predict CGI scores given by clinicians. One hundred and twenty-two patients were assessed with WHODAS 2.0 and CGI during three months in outpatient mental health facilities of four hospitals of Madrid, Spain. Compared with the traditional correction of WHODAS 2.0, FLDA improves accuracy in near 15%, and so, with FLDA WHODAS 2.0 classifying correctly 59.0% of the patients. Furthermore, FLDA identifies item 6.6 (illness effect on personal finances) and item 4.5 (damaged sexual life) as the most important items for clinicians to score the severity of illness

Are There Gender Differences in Social Cognition in First-Episode Psychosis?

Altres ajuts: This research was funded by the Instituto de Salud Carlos III (Spanish Government, PI11/01347, PI14/00044, and PI18/00212) by the Fondo Europeo de Desarrollo Regional (FEDER), Health Department of Catalonia, PERIS call (SLT006/17/00231), Progress and Health Foundation of the Andalusian Regional Ministry of Health, grant PI-0634/2011 and PI-0193/ 2014, Obra Social La Caixa (RecerCaixa call 2013), CERCA Programme/Generalitat de Catalunya, Obra Social Sant Joan de Déu (BML) and by FI19/00062 (Ayudas para la contratación de personal predoctoral, Luciana Díaz-Cutraro is a beneficiary of a Predoctoral Training Grant in Health Research).The aim of this study was to explore gender differences in social cognition in a sample of first-episode psychosis (FEP). An observational descriptive study was performed with 191 individuals with FEP. Emotion perception was assessed using the Faces Test, theory of mind was assessed using the Hinting Task, and attributional style was assessed using the Internal, Personal and Situational Attributions Questionnaire. No gender differences were found in any of the social cognitive domains. Our results suggest that men and women with FEP achieve similar performances in social cognition. Therefore, targeting specific needs in social cognition regarding gender may not be required in early interventions for psychosis