Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Faculty of Behavioral and Movement Sciences, Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands.
Psychol Med. 2023 Aug;53(11):5060-5069. doi: 10.1017/S0033291722002069. Epub 2022 Jul 14.
This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness.
Participants were formerly depressed patients ( = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item 'I feel restless', for each individual separately.
An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases.
Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.
本验证性研究旨在考察能否通过不安感升高的个体化建模来预测抑郁症状的复发。
参与者为缓解期（逐渐）停用抗抑郁药的既往抑郁患者（n=41）。参与者每天完成 5 次基于智能手机的生态瞬时评估（EMA），为期 4 个月，共产生 21180 次观察。采用指数加权移动平均（EWMA）控制图的统计过程控制，分别为每个个体检测 EMA 项目“我感到不安”的升高。
在出现复发性抑郁症状的参与者中，68.3%检测到不安感增加，在保持缓解的参与者中，26.3%检测到不安感增加（Fisher 确切检验=0.01，敏感性为 68.3%，特异性为 73.7%）。在出现复发和不安感增加的参与者中，在抑郁的前驱期，这种增加可以在 93.3%的病例中检测到，在抑郁核心症状出现前至少 1 个月，在 66.7%的病例中可以检测到。
不安感是常见的抑郁前驱症状。EWMA 图的敏感性和特异性至少与基于横断面患者特征的预后模型一样好。当前个体化方法的一个优势是，EWMA 图实时提供个体内抑郁早期迹象增加的个性化洞察，这是在正确的时间向正确的患者发出警报的关键。
