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Toward a Mobile Platform for Real-world Digital Measurement of Depression: User-Centered Design, Data Quality, and Behavioral and Clinical Modeling.

作者信息

Nickels Stefanie, Edwards Matthew D, Poole Sarah F, Winter Dale, Gronsbell Jessica, Rozenkrants Bella, Miller David P, Fleck Mathias, McLean Alan, Peterson Bret, Chen Yuanwei, Hwang Alan, Rust-Smith David, Brant Arthur, Campbell Andrew, Chen Chen, Walter Collin, Arean Patricia A, Hsin Honor, Myers Lance J, Marks William J, Mega Jessica L, Schlosser Danielle A, Conrad Andrew J, Califf Robert M, Fromer Menachem

机构信息

Verily Life Sciences, South San Francisco, CA, United States.

Department of Computer Science, Dartmouth College, Hanover, NH, United States.

出版信息

JMIR Ment Health. 2021 Aug 10;8(8):e27589. doi: 10.2196/27589.


DOI:10.2196/27589
PMID:34383685
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8386379/
Abstract

BACKGROUND: Although effective mental health treatments exist, the ability to match individuals to optimal treatments is poor, and timely assessment of response is difficult. One reason for these challenges is the lack of objective measurement of psychiatric symptoms. Sensors and active tasks recorded by smartphones provide a low-burden, low-cost, and scalable way to capture real-world data from patients that could augment clinical decision-making and move the field of mental health closer to measurement-based care. OBJECTIVE: This study tests the feasibility of a fully remote study on individuals with self-reported depression using an Android-based smartphone app to collect subjective and objective measures associated with depression severity. The goals of this pilot study are to develop an engaging user interface for high task adherence through user-centered design; test the quality of collected data from passive sensors; start building clinically relevant behavioral measures (features) from passive sensors and active inputs; and preliminarily explore connections between these features and depression severity. METHODS: A total of 600 participants were asked to download the study app to join this fully remote, observational 12-week study. The app passively collected 20 sensor data streams (eg, ambient audio level, location, and inertial measurement units), and participants were asked to complete daily survey tasks, weekly voice diaries, and the clinically validated Patient Health Questionnaire (PHQ-9) self-survey. Pairwise correlations between derived behavioral features (eg, weekly minutes spent at home) and PHQ-9 were computed. Using these behavioral features, we also constructed an elastic net penalized multivariate logistic regression model predicting depressed versus nondepressed PHQ-9 scores (ie, dichotomized PHQ-9). RESULTS: A total of 415 individuals logged into the app. Over the course of the 12-week study, these participants completed 83.35% (4151/4980) of the PHQ-9s. Applying data sufficiency rules for minimally necessary daily and weekly data resulted in 3779 participant-weeks of data across 384 participants. Using a subset of 34 behavioral features, we found that 11 features showed a significant (P<.001 Benjamini-Hochberg adjusted) Spearman correlation with weekly PHQ-9, including voice diary-derived word sentiment and ambient audio levels. Restricting the data to those cases in which all 34 behavioral features were present, we had available 1013 participant-weeks from 186 participants. The logistic regression model predicting depression status resulted in a 10-fold cross-validated mean area under the curve of 0.656 (SD 0.079). CONCLUSIONS: This study finds a strong proof of concept for the use of a smartphone-based assessment of depression outcomes. Behavioral features derived from passive sensors and active tasks show promising correlations with a validated clinical measure of depression (PHQ-9). Future work is needed to increase scale that may permit the construction of more complex (eg, nonlinear) predictive models and better handle data missingness.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/bcbeec52f1fa/mental_v8i8e27589_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/36bd4fae2b5d/mental_v8i8e27589_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/75542d390504/mental_v8i8e27589_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/9c8aeb8b98d2/mental_v8i8e27589_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/da6731fd9111/mental_v8i8e27589_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/bcbeec52f1fa/mental_v8i8e27589_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/36bd4fae2b5d/mental_v8i8e27589_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/75542d390504/mental_v8i8e27589_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/9c8aeb8b98d2/mental_v8i8e27589_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/da6731fd9111/mental_v8i8e27589_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cbea/8386379/bcbeec52f1fa/mental_v8i8e27589_fig5.jpg

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[5]
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[6]
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本文引用的文献

[1]
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[2]
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Depress Anxiety. 2018-8-21

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Correlations Between Objective Behavioral Features Collected From Mobile and Wearable Devices and Depressive Mood Symptoms in Patients With Affective Disorders: Systematic Review.

JMIR Mhealth Uhealth. 2018-8-13

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Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial.

Lancet Psychiatry. 2018-7

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JAMA. 2018-4-10

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JAMA. 2017-10-3

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Statistical correction of the Winner's Curse explains replication variability in quantitative trait genome-wide association studies.

PLoS Genet. 2017-7-17

[9]
Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild.

JMIR Mhealth Uhealth. 2016-9-21

[10]
A Tipping Point for Measurement-Based Care.

Psychiatr Serv. 2017-2-1

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