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Wieczorek K, Ananth S, Valazquez-Pimentel D. Acoustic biomarkers in asthma: a systematic review. J Asthma 2024:1-16. [PMID: 38634718 DOI: 10.1080/02770903.2024.2344156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Current monitoring methods of asthma, such as peak expiratory flow testing, have important limitations. The emergence of automated acoustic sound analysis, capturing cough, wheeze, and inhaler use, offers a promising avenue for improving asthma diagnosis and monitoring. This systematic review evaluated the validity of acoustic biomarkers in supporting the diagnosis of asthma and its monitoring. DATA SOURCES A search was performed using two databases (PubMed and Embase) for all relevant studies published before November 2023. STUDY SELECTION 27 studies were included for analysis. Eligible studies focused on acoustic signals as digital biomarkers in asthma, utilizing recording devices to register or analyze sound. RESULTS Various respiratory acoustic signal types were analyzed, with cough and wheeze being predominant. Data collection methods included smartphones, custom sensors and digital stethoscopes. Across all studies, automated acoustic algorithms achieved average accuracy of cough and wheeze detection of 88.7% (range: 61.0 - 100.0%) with a median of 92.0%. The sensitivity of sound detection ranged from 54.0 to 100.0%, with a median of 90.3%; specificity ranged from 67.0 to 99.7%, with a median of 95.0%. Moreover, 70.4% (19/27) studies had a risk of bias identified. CONCLUSIONS This systematic review establishes the promising role of acoustic biomarkers, particularly cough and wheeze, in supporting the diagnosis of asthma and monitoring. The evidence suggests the potential for clinical integration of acoustic biomarkers, emphasizing the need for further validation in larger, clinically-diverse populations.
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Affiliation(s)
| | - Sachin Ananth
- London North West University Healthcare Trust, London, UK
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2
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Keshmiri S, Tomonaga S, Mizutani H, Doya K. Respiratory modulation of the heart rate: A potential biomarker of cardiorespiratory function in human. Comput Biol Med 2024; 173:108335. [PMID: 38564855 DOI: 10.1016/j.compbiomed.2024.108335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
In recent decade, wearable digital devices have shown potentials for the discovery of novel biomarkers of humans' physiology and behavior. Heart rate (HR) and respiration rate (RR) are most crucial bio-signals in humans' digital phenotyping research. HR is a continuous and non-invasive proxy to autonomic nervous system and ample evidence pinpoints the critical role of respiratory modulation of cardiac function. In the present study, we recorded longitudinal (7 days, 4.63 ± 1.52) HR and RR of 89 freely behaving human subjects (Female: 39, age 57.28 ± 5.67, Male: 50, age 58.48 ± 6.32) and analyzed their dynamics using linear models and information theoretic measures. While HR's linear and nonlinear characteristics were expressed within the plane of the HR-RR directed flow of information (HR→RR - RR→HR), their dynamics were determined by its RR→HR axis. More importantly, RR→HR quantified the effect of alcohol consumption on individuals' cardiorespiratory function independent of their consumed amount of alcohol, thereby signifying the presence of this habit in their daily life activities. The present findings provided evidence for the critical role of the respiratory modulation of HR, which was previously only studied in non-human animals. These results can contribute to humans' phenotyping research by presenting RR→HR as a digital diagnosis/prognosis marker of humans' cardiorespiratory pathology.
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Affiliation(s)
- Soheil Keshmiri
- Optical Neuroimaging Unit, Okinawa Institute of Science and Technology, Okinawa, Japan.
| | - Sutashu Tomonaga
- Neural Computation Unit (NCU), Okinawa Institute of Science and Technology, Okinawa, Japan.
| | - Haruo Mizutani
- Suntory Global Innovation Center Limited (SGIC), Suntory, Kyoto, Japan.
| | - Kenji Doya
- Neural Computation Unit (NCU), Okinawa Institute of Science and Technology, Okinawa, Japan.
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Zeeb H, Schüz B, Schultz T, Pigeot I. [Developments in the digitalization of public health since 2020 : Examples from the Leibniz ScienceCampus Digital Public Health Bremen]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:260-267. [PMID: 38197925 DOI: 10.1007/s00103-023-03827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
Digital public health has received a significant boost in recent years, especially due to the demands associated with the COVID-19 pandemic. In this report, we provide an overview of the developments in digitalization in the field of public health in Germany since 2020 and illustrate these with examples from the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH).The following topics are central: How do digital survey methods as well as digital biomarkers and artificial intelligence methods shape modern epidemiology and prevention research? What is the status of digitalization in public health offices? Which approaches to health economics evaluation of digital public health interventions have been utilized so far? What is the status of training and further education in digital public health?The first years of the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH) were also strongly influenced by the COVID-19 pandemic. Repeated population-based digital surveys of the LSC indicated an increase in use of health apps in the population, for example, in applications to support physical activity. The COVID-19-pandemic has also shown that the digitalization of public health enhances the risk of misinformation and disinformation.
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Affiliation(s)
- Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS, Achterstr. 30, 28359, Bremen, Deutschland.
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland.
| | - Benjamin Schüz
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
- Institut für Public Health und Pflegewissenschaften, Universität Bremen, Bremen, Deutschland
| | - Tanja Schultz
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
- Cognitive Systems Lab, Universität Bremen, Bremen, Deutschland
| | - Iris Pigeot
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS, Achterstr. 30, 28359, Bremen, Deutschland
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
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4
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Pyper E, McKeown S, Hartmann-Boyce J, Powell J. Digital Health Technology for Real-World Clinical Outcome Measurement Using Patient-Generated Data: Systematic Scoping Review. J Med Internet Res 2023; 25:e46992. [PMID: 37819698 PMCID: PMC10600647 DOI: 10.2196/46992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Digital health technologies (DHTs) play an ever-expanding role in health care management and delivery. Beyond their use as interventions, DHTs also serve as a vehicle for real-world data collection to characterize patients, their care journeys, and their responses to other clinical interventions. There is a need to comprehensively map the evidence-across all conditions and technology types-on DHT measurement of patient outcomes in the real world. OBJECTIVE We aimed to investigate the use of DHTs to measure real-world clinical outcomes using patient-generated data. METHODS We conducted this systematic scoping review in accordance with the Joanna Briggs Institute methodology. Detailed eligibility criteria documented in a preregistered protocol informed a search strategy for the following databases: MEDLINE (Ovid), CINAHL, Cochrane (CENTRAL), Embase, PsycINFO, ClinicalTrials.gov, and the EU Clinical Trials Register. We considered studies published between 2000 and 2022 wherein digital health data were collected, passively or actively, from patients with any specified health condition outside of clinical visits. Categories for key concepts, such as DHT type and analytical applications, were established where needed. Following screening and full-text review, data were extracted and analyzed using predefined fields, and findings were reported in accordance with established guidelines. RESULTS The search strategy identified 11,015 publications, with 7308 records after duplicates and reviews were removed. After screening and full-text review, 510 studies were included for extraction. These studies encompassed 169 different conditions in over 20 therapeutic areas and 44 countries. The DHTs used for mental health and addictions research (111/510, 21.8%) were the most prevalent. The most common type of DHT, mobile apps, was observed in approximately half of the studies (250/510, 49%). Most studies used only 1 DHT (346/510, 67.8%); however, the majority of technologies used were able to collect more than 1 type of data, with the most common being physiological data (189/510, 37.1%), clinical symptoms data (188/510, 36.9%), and behavioral data (171/510, 33.5%). Overall, there has been real growth in the depth and breadth of evidence, number of DHT types, and use of artificial intelligence and advanced analytics over time. CONCLUSIONS This scoping review offers a comprehensive view of the variety of types of technology, data, collection methods, analytical approaches, and therapeutic applications within this growing body of evidence. To unlock the full potential of DHT for measuring health outcomes and capturing digital biomarkers, there is a need for more rigorous research that goes beyond technology validation to demonstrate whether robust real-world data can be reliably captured from patients in their daily life and whether its capture improves patient outcomes. This study provides a valuable repository of DHT studies to inform subsequent research by health care providers, policy makers, and the life sciences industry. TRIAL REGISTRATION Open Science Framework 5TMKY; https://osf.io/5tmky/.
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Affiliation(s)
- Evelyn Pyper
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Sarah McKeown
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, United States
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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5
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Gao CX, Dwyer D, Zhu Y, Smith CL, Du L, Filia KM, Bayer J, Menssink JM, Wang T, Bergmeir C, Wood S, Cotton SM. An overview of clustering methods with guidelines for application in mental health research. Psychiatry Res 2023; 327:115265. [PMID: 37348404 DOI: 10.1016/j.psychres.2023.115265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/24/2023]
Abstract
Cluster analyzes have been widely used in mental health research to decompose inter-individual heterogeneity by identifying more homogeneous subgroups of individuals. However, despite advances in new algorithms and increasing popularity, there is little guidance on model choice, analytical framework and reporting requirements. In this paper, we aimed to address this gap by introducing the philosophy, design, advantages/disadvantages and implementation of major algorithms that are particularly relevant in mental health research. Extensions of basic models, such as kernel methods, deep learning, semi-supervised clustering, and clustering ensembles are subsequently introduced. How to choose algorithms to address common issues as well as methods for pre-clustering data processing, clustering evaluation and validation are then discussed. Importantly, we also provide general guidance on clustering workflow and reporting requirements. To facilitate the implementation of different algorithms, we provide information on R functions and libraries.
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Affiliation(s)
- Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Dominic Dwyer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Ye Zhu
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Catherine L Smith
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lan Du
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Johanna Bayer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Jana M Menssink
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Teresa Wang
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Christoph Bergmeir
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia; Department of Computer Science and Artificial Intelligence, University of Granada, Granada, Spain
| | - Stephen Wood
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
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Shin J, Bae SM. A Systematic Review of Location Data for Depression Prediction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5984. [PMID: 37297588 PMCID: PMC10252667 DOI: 10.3390/ijerph20115984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Depression contributes to a wide range of maladjustment problems. With the development of technology, objective measurement for behavior and functional indicators of depression has become possible through the passive sensing technology of digital devices. Focusing on location data, we systematically reviewed the relationship between depression and location data. We searched Scopus, PubMed, and Web of Science databases by combining terms related to passive sensing and location data with depression. Thirty-one studies were included in this review. Location data demonstrated promising predictive power for depression. Studies examining the relationship between individual location data variables and depression, homestay, entropy, and the normalized entropy variable of entropy dimension showed the most consistent and significant correlations. Furthermore, variables of distance, irregularity, and location showed significant associations in some studies. However, semantic location showed inconsistent results. This suggests that the process of geographical movement is more related to mood changes than to semantic location. Future research must converge across studies on location-data measurement methods.
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Affiliation(s)
- Jaeeun Shin
- Department of psychology, Chung-Ang University, Seoul 06974, Republic of Korea;
| | - Sung Man Bae
- Department of Psychology and Psychotherapy, Dankook University, Cheonan 31116, Republic of Korea
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7
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Bennett CC, Ross MK, Baek E, Kim D, Leow AD. Smartphone accelerometer data as a proxy for clinical data in modeling of bipolar disorder symptom trajectory. NPJ Digit Med 2022; 5:181. [PMID: 36517582 PMCID: PMC9751066 DOI: 10.1038/s41746-022-00741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Being able to track and predict fluctuations in symptoms of mental health disorders such as bipolar disorder outside the clinic walls is critical for expanding access to care for the global population. To that end, we analyze a dataset of 291 individuals from a smartphone app targeted at bipolar disorder, which contains rich details about their smartphone interactions (including typing dynamics and accelerometer motion) collected everyday over several months, along with more traditional clinical features. The aim is to evaluate whether smartphone accelerometer data could serve as a proxy for traditional clinical data, either by itself or in combination with typing dynamics. Results show that accelerometer data improves the predictive performance of machine learning models by nearly 5% over those previously reported in the literature based only on clinical data and typing dynamics. This suggests it is possible to elicit essentially the same "information" about bipolar symptomology using different data sources, in a variety of settings.
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Affiliation(s)
- Casey C. Bennett
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea ,grid.254920.80000 0001 0707 2013Department of Computing, DePaul University, Chicago, IL USA
| | - Mindy K. Ross
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois–Chicago, Chicago, IL USA
| | - EuGene Baek
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea
| | - Dohyeon Kim
- grid.49606.3d0000 0001 1364 9317Department of Intelligence Computing, Hanyang University, Seoul, Korea
| | - Alex D. Leow
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois–Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Dept. of Biomedical Engineering, University of Illinois–Chicago, Chicago, IL USA
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8
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Mow JL, Gard DE, Mueser KT, Mote J, Gill K, Leung L, Kangarloo T, Fulford D. Smartphone-based mobility metrics capture daily social motivation and behavior in schizophrenia. Schizophr Res 2022; 250:13-21. [PMID: 36242786 PMCID: PMC10372850 DOI: 10.1016/j.schres.2022.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/22/2022] [Accepted: 09/24/2022] [Indexed: 12/12/2022]
Abstract
Impaired social functioning contributes to reduced quality of life and is associated with poor physical and psychological well-being in schizophrenia, and thus is a key psychosocial treatment target. Low social motivation contributes to impaired social functioning, but is typically examined using self-report or clinical ratings, which are prone to recall biases and do not adequately capture the dynamic nature of social motivation in daily life. In the current study, we examined the utility of global positioning system (GPS)-based mobility data for capturing social motivation and behavior in people with schizophrenia. Thirty-one participants with schizophrenia engaged in a 60-day mobile intervention designed to increase social motivation and functioning. We examined associations between twice daily self-reports of social motivation and behavior (e.g., number of social interactions) collected via Ecological Momentary Assessment (EMA) and passively collected daily GPS mobility metrics (e.g., number of hours spent at home) in 26 of these participants. Findings suggested that greater mobility on a given day was associated with more EMA-reported social interactions on that day for four out of five examined mobility metrics: number of hours spent at home, number of locations visited, probability of being stationary, and likelihood of following one's typical routine. In addition, greater baseline social functioning was associated with less daily time spent at home and lower probability of following a daily routine during the intervention. GPS-based mobility thus corresponds with social behavior in daily life, suggesting that more social interactions may occur at times of greater mobility in people with schizophrenia, while subjective reports of social interest and motivation are less associated with mobility for this population.
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Affiliation(s)
- Jessica L Mow
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - David E Gard
- Psychology Department, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA
| | - Kim T Mueser
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Jasmine Mote
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Kathryn Gill
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Lawrence Leung
- Psychology Department, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA
| | - Tairmae Kangarloo
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Daniel Fulford
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
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9
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Harvey PD, Depp CA, Rizzo AA, Strauss GP, Spelber D, Carpenter LL, Kalin NH, Krystal JH, McDonald WM, Nemeroff CB, Rodriguez CI, Widge AS, Torous J. Technology and Mental Health: State of the Art for Assessment and Treatment. Am J Psychiatry 2022; 179:897-914. [PMID: 36200275 DOI: 10.1176/appi.ajp.21121254] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Technology is ubiquitous in society and is now being extensively used in mental health applications. Both assessment and treatment strategies are being developed and deployed at a rapid pace. The authors review the current domains of technology utilization, describe standards for quality evaluation, and forecast future developments. This review examines technology-based assessments of cognition, emotion, functional capacity and everyday functioning, virtual reality approaches to assessment and treatment, ecological momentary assessment, passive measurement strategies including geolocation, movement, and physiological parameters, and technology-based cognitive and functional skills training. There are many technology-based approaches that are evidence based and are supported through the results of systematic reviews and meta-analyses. Other strategies are less well supported by high-quality evidence at present, but there are evaluation standards that are well articulated at this time. There are some clear challenges in selection of applications for specific conditions, but in several areas, including cognitive training, randomized clinical trials are available to support these interventions. Some of these technology-based interventions have been approved by the U.S. Food and Drug administration, which has clear standards for which types of applications, and which claims about them, need to be reviewed by the agency and which are exempt.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Colin A Depp
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Albert A Rizzo
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Gregory P Strauss
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - David Spelber
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Linda L Carpenter
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Ned H Kalin
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - John H Krystal
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - William M McDonald
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Charles B Nemeroff
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Carolyn I Rodriguez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Alik S Widge
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - John Torous
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
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10
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Baumeister H, Garatva P, Pryss R, Ropinski T, Montag C. Digitale Phänotypisierung in der Psychologie – ein Quantensprung in der psychologischen Forschung? PSYCHOLOGISCHE RUNDSCHAU 2022. [DOI: 10.1026/0033-3042/a000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Digitale Phänotypisierung stellt einen neuen, leistungsstarken Ansatz zur Realisierung psychodiagnostischer Aufgaben in vielen Bereichen der Psychologie und Medizin dar. Die Grundidee besteht aus der Nutzung digitaler Spuren aus dem Alltag, um deren Vorhersagekraft für verschiedenste Anwendungsmöglichkeiten zu überprüfen und zu nutzen. Voraussetzungen für eine erfolgreiche Umsetzung sind elaborierte Smart Sensing Ansätze sowie Big Data-basierte Extraktions- (Data Mining) und Machine Learning-basierte Analyseverfahren. Erste empirische Studien verdeutlichen das hohe Potential, aber auch die forschungsmethodischen sowie ethischen und rechtlichen Herausforderungen, um über korrelative Zufallsbefunde hinaus belastbare Befunde zu gewinnen. Hierbei müssen rechtliche und ethische Richtlinien sicherstellen, dass die Erkenntnisse in einer für Einzelne und die Gesellschaft als Ganzes wünschenswerten Weise genutzt werden. Für die Psychologie als Lehr- und Forschungsdomäne bieten sich durch Digitale Phänotypisierung vielfältige Möglichkeiten, die zum einen eine gelebte Zusammenarbeit verschiedener Fachbereiche und zum anderen auch curriculare Erweiterungen erfordern. Die vorliegende narrative Übersicht bietet eine theoretische, nicht-technische Einführung in das Forschungsfeld der Digitalen Phänotypisierung, mit ersten empirischen Befunden sowie einer Diskussion der Möglichkeiten und Grenzen sowie notwendigen Handlungsfeldern.
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Affiliation(s)
- Harald Baumeister
- Abteilung für Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
| | - Patricia Garatva
- Abteilung für Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
| | - Rüdiger Pryss
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Deutschland
| | - Timo Ropinski
- Arbeitsgruppe Visual Computing, Institut für Medieninformatik, Universität Ulm, Deutschland
| | - Christian Montag
- Abteilung für Molekulare Psychologie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
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11
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Xia CH, Barnett I, Tapera TM, Adebimpe A, Baker JT, Bassett DS, Brotman MA, Calkins ME, Cui Z, Leibenluft E, Linguiti S, Lydon-Staley DM, Martin ML, Moore TM, Murtha K, Piiwaa K, Pines A, Roalf DR, Rush-Goebel S, Wolf DH, Ungar LH, Satterthwaite TD. Mobile footprinting: linking individual distinctiveness in mobility patterns to mood, sleep, and brain functional connectivity. Neuropsychopharmacology 2022; 47:1662-1671. [PMID: 35660803 PMCID: PMC9163291 DOI: 10.1038/s41386-022-01351-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022]
Abstract
Mapping individual differences in behavior is fundamental to personalized neuroscience, but quantifying complex behavior in real world settings remains a challenge. While mobility patterns captured by smartphones have increasingly been linked to a range of psychiatric symptoms, existing research has not specifically examined whether individuals have person-specific mobility patterns. We collected over 3000 days of mobility data from a sample of 41 adolescents and young adults (age 17-30 years, 28 female) with affective instability. We extracted summary mobility metrics from GPS and accelerometer data and used their covariance structures to identify individuals and calculated the individual identification accuracy-i.e., their "footprint distinctiveness". We found that statistical patterns of smartphone-based mobility features represented unique "footprints" that allow individual identification (p < 0.001). Critically, mobility footprints exhibited varying levels of person-specific distinctiveness (4-99%), which was associated with age and sex. Furthermore, reduced individual footprint distinctiveness was associated with instability in affect (p < 0.05) and circadian patterns (p < 0.05) as measured by environmental momentary assessment. Finally, brain functional connectivity, especially those in the somatomotor network, was linked to individual differences in mobility patterns (p < 0.05). Together, these results suggest that real-world mobility patterns may provide individual-specific signatures relevant for studies of development, sleep, and psychopathology.
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Affiliation(s)
- Cedric Huchuan Xia
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ian Barnett
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tinashe M Tapera
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Azeez Adebimpe
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Justin T Baker
- McLean Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Danielle S Bassett
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Electrical & Systems Engineering, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Santa Fe Institute, Santa Fe, NM, 87501, USA
| | - Melissa A Brotman
- National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20892, USA
| | - Monica E Calkins
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zaixu Cui
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ellen Leibenluft
- National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20892, USA
| | - Sophia Linguiti
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David M Lydon-Staley
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Melissa Lynne Martin
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tyler M Moore
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kristin Murtha
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kayla Piiwaa
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Adam Pines
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David R Roalf
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sage Rush-Goebel
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Daniel H Wolf
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lyle H Ungar
- Department of Computer and Information Science, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Genomics and Computational Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Operations, Information and Decisions, Wharton School, Philadelphia, PA, 19104, USA.,Department of Psychology, School of Arts and Sciences, Philadelphia, PA, 19104, USA
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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12
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Hagaman A, Lopez Mercado D, Poudyal A, Bemme D, Boone C, van Heerden A, Byanjankar P, Man Maharjan S, Thapa A, Kohrt BA. "Now, I have my baby so I don't go anywhere": A mixed method approach to the 'everyday' and young motherhood integrating qualitative interviews and passive digital data from mobile devices. PLoS One 2022; 17:e0269443. [PMID: 35802694 PMCID: PMC9269952 DOI: 10.1371/journal.pone.0269443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/21/2022] [Indexed: 11/18/2022] Open
Abstract
The impacts of early pregnancy and young motherhood on everyday life, including interpersonal and individual behavior, are not well-known. Passive digital sensing on mobile technology including smartphones and passive Bluetooth beacons can yield information such as geographic movement, physical activity, and mother-infant proximity to illuminate behavioral patterns of a mother's everyday in Nepal. We contribute to mixed-methods research by triangulating passive sensing data (GPS, accelerometry, Bluetooth proximity) with multiple forms of qualitative data to characterize behavioral patterns and experiences of young motherhood in the first year postpartum. We triangulated this digital information in a constant comparative analysis with in-depth interviews, daily diaries, and fieldnotes. We reveal typical behavioral patterns of rural young mothers and highlight opportunities for integrating this information to improve health and well-being.
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Affiliation(s)
- Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Damaris Lopez Mercado
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Dörte Bemme
- Department for Global Health and Social Medicine, Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Clare Boone
- Yale University, New Haven, Connecticut, United States of America
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | | | - Ada Thapa
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States of America
- George Washington School of Medicine and Health Sciences, Washington, DC, United States of America
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13
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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14
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Beukenhorst AL, Druce KL, De Cock D. Smartphones for musculoskeletal research - hype or hope? Lessons from a decennium of mHealth studies. BMC Musculoskelet Disord 2022; 23:487. [PMID: 35606783 PMCID: PMC9124742 DOI: 10.1186/s12891-022-05420-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smartphones provide opportunities for musculoskeletal research: they are integrated in participants' daily lives and can be used to collect patient-reported outcomes as well as sensor data from large groups of people. As the field of research with smartphones and smartwatches matures, it has transpired that some of the advantages of this modern technology are in fact double-edged swords. BODY: In this narrative review, we illustrate the advantages of using smartphones for data collection with 18 studies from various musculoskeletal domains. We critically appraised existing literature, debunking some myths around the advantages of smartphones: the myth that smartphone studies automatically enable high engagement, that they reach more representative samples, that they cost little, and that sensor data is objective. We provide a nuanced view of evidence in these areas and discuss strategies to increase engagement, to reach representative samples, to reduce costs and to avoid potential sources of subjectivity in analysing sensor data. CONCLUSION If smartphone studies are designed without awareness of the challenges inherent to smartphone use, they may fail or may provide biased results. Keeping participants of smartphone studies engaged longitudinally is a major challenge. Based on prior research, we provide 6 actions by researchers to increase engagement. Smartphone studies often have participants that are younger, have higher incomes and high digital literacy. We provide advice for reaching more representative participant groups, and for ensuring that study conclusions are not plagued by bias resulting from unrepresentative sampling. Costs associated with app development and testing, data storage and analysis, and tech support are substantial, even if studies use a 'bring your own device'-policy. Exchange of information on costs, collective app development and usage of open-source tools would help the musculoskeletal community reduce costs of smartphone studies. In general, transparency and wider adoption of best practices would help bringing smartphone studies to the next level. Then, the community can focus on specific challenges of smartphones in musculoskeletal contexts, such as symptom-related barriers to using smartphones for research, validating algorithms in patient populations with reduced functional ability, digitising validated questionnaires, and methods to reliably quantify pain, quality of life and fatigue.
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Affiliation(s)
- Anna L Beukenhorst
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Katie L Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Diederik De Cock
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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15
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Parziale A, Mascalzoni D. Digital Biomarkers in Psychiatric Research: Data Protection Qualifications in a Complex Ecosystem. Front Psychiatry 2022; 13:873392. [PMID: 35757212 PMCID: PMC9225201 DOI: 10.3389/fpsyt.2022.873392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric research traditionally relies on subjective observation, which is time-consuming and labor-intensive. The widespread use of digital devices, such as smartphones and wearables, enables the collection and use of vast amounts of user-generated data as "digital biomarkers." These tools may also support increased participation of psychiatric patients in research and, as a result, the production of research results that are meaningful to them. However, sharing mental health data and research results may expose patients to discrimination and stigma risks, thus discouraging participation. To earn and maintain participants' trust, the first essential requirement is to implement an appropriate data governance system with a clear and transparent allocation of data protection duties and responsibilities among the actors involved in the process. These include sponsors, investigators, operators of digital tools, as well as healthcare service providers and biobanks/databanks. While previous works have proposed practical solutions to this end, there is a lack of consideration of positive data protection law issues in the extant literature. To start filling this gap, this paper discusses the GDPR legal qualifications of controller, processor, and joint controllers in the complex ecosystem unfolded by the integration of digital biomarkers in psychiatric research, considering their implications and proposing some general practical recommendations.
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16
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Nowrouzi-Kia B, Stier J, Ayyoub L, Hutchinson L, Laframboise J, Mihailidis A. The Characteristics of Canadian University Students' Mental Health, Engagement in Activities and Use of Smartphones: A descriptive pilot study. Health Psychol Open 2021; 8:20551029211062029. [PMID: 34925871 PMCID: PMC8671687 DOI: 10.1177/20551029211062029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Mental health issues are on the rise which may impede university students’ abilities to perform daily functions and interact with other community members. The objectives of the current study are to explore (1) the characteristics of university students’ mental health and engagement in activities, (2) how students use their smartphones to support their mental health and engagement in activities, (3) student preferences for important features and functions of a smartphone application (app) that promote engagement in activities and (4) student perspectives about what data an app should collect as indicators of change in their mental health and engagement in activities. Methods We designed a pilot study and an online questionnaire with open and closed-ended questions to collect data exploring the association between student mental health and engagement in activities. The questionnaire included four sections: demographics, mental health and activity status and management, general smartphone use, and smartphone use to support mental health and engagement in activities. The data were analysed using descriptive statistics. Results A total of 56 participants were recruited to complete the online survey, with an average completion rate of 77% (n = 43). The majority of participants were 24 years of age or older (n = 34, 65.4%), and less than half were between the ages of 18 and 23 (n = 18, 34.6%). The results of participants’ engagement in self-care, productivity and leisure/play activities are reported. As well, participants’ use of smartphones to support their mental health is described. Conclusions This study provides a greater understanding of what features and functions to include and what data to collect when developing a novel app to support students’ mental health and engagement in activities. Moreover, it clarifies the bidirectional relationship between mental health changes and self-care engagement, productivity/work and leisure/play domains.
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Affiliation(s)
- Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill Stier
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Luma Ayyoub
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Hutchinson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jamie Laframboise
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehab, University Health Network, Toronto, ON, Canada
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17
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Ortiz A, Maslej MM, Husain MI, Daskalakis ZJ, Mulsant BH. Apps and gaps in bipolar disorder: A systematic review on electronic monitoring for episode prediction. J Affect Disord 2021; 295:1190-1200. [PMID: 34706433 DOI: 10.1016/j.jad.2021.08.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/18/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term clinical monitoring in bipolar disorder (BD) is an important therapeutic tool. The availability of smartphones and wearables has sparked the development of automated applications to remotely monitor patients. This systematic review focus on the current state of electronic (e-) monitoring for episode prediction in BD. METHODS We systematically reviewed the literature on e-monitoring for episode prediction in adult BD patients. The systematic review was done according to the guidelines for reporting of systematic reviews and meta-analyses (PRISMA) and was registered in PROSPERO on April 29, 2020 (CRD42020155795). We conducted a search of Web of Science, MEDLINE, EMBASE, and PsycINFO (all 2000-2020) databases. We identified and extracted data from 17 published reports on 15 relevant studies. RESULTS Studies were heterogeneous and most had substantial methodological and technical limitations. Models varied widely in their performance. Published metrics were too heterogeneous to lend themselves to a meta-analysis. Four studies reported sensitivity (range: 0.21 - 0.95); and two reported specificity for prediction of mood episodes (range: 0.36 - 0.99). Two studies reported accuracy (range: 0.64 - 0.88) and four reported area under the curve (AUC; range: 0.52-0.95). Overall, models were better in predicting manic or hypomanic episodes, but their performance depended on feature type. LIMITATIONS Our conclusions are tempered by the lack of appropriate information impeding our ability to synthesize the available evidence. CONCLUSIONS Given the clinical variability in BD, predicting mood episodes remains a challenging task. Emerging e-monitoring technology for episode prediction in BD requires more development before it can be adopted clinically.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Marta M Maslej
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, United States
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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18
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Byrne ML, Lind MN, Horn SR, Mills KL, Nelson BW, Barnes ML, Slavich GM, Allen NB. Using mobile sensing data to assess stress: Associations with perceived and lifetime stress, mental health, sleep, and inflammation. Digit Health 2021; 7:20552076211037227. [PMID: 34777852 PMCID: PMC8580497 DOI: 10.1177/20552076211037227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/17/2021] [Indexed: 12/26/2022] Open
Abstract
Background Although stress is a risk factor for mental and physical health problems, it
can be difficult to assess, especially on a continual, non-invasive basis.
Mobile sensing data, which are continuously collected from naturalistic
smartphone use, may estimate exposure to acute and chronic stressors that
have health-damaging effects. This initial validation study validated a
mobile-sensing collection tool against assessments of perceived and lifetime
stress, mental health, sleep duration, and inflammation. Methods Participants were 25 well-characterized healthy young adults
(Mage = 20.64 years, SD = 2.74; 13 men, 12
women). We collected affective text language use with a custom smartphone
keyboard. We assessed participants’ perceived and lifetime stress,
depression and anxiety levels, sleep duration, and basal inflammatory
activity (i.e. salivary C-reactive protein and interleukin-1β). Results Three measures of affective language (i.e. total positive words, total
negative words, and total affective words) were strongly associated with
lifetime stress exposure, and total negative words typed was related to
fewer hours slept (all large effect sizes:
r = 0.50 – 0.78). Total positive words, total negative
words, and total affective words typed were also associated with higher
perceived stress and lower salivary C-reactive protein levels (medium effect
sizes; r = 0.22 – 0.32). Conclusions Data from this initial longitudinal validation study suggest that total and
affective text use may be useful mobile sensing measures insofar as they are
associated with several other stress, mental health, behavioral, and
biological outcomes. This tool may thus help identify individuals at
increased risk for stress-related health problems.
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Affiliation(s)
- Michelle L Byrne
- Department of Psychology, University of Oregon, USA.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | | | - Sarah R Horn
- Department of Psychology, University of Oregon, USA
| | | | - Benjamin W Nelson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | | | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Nicholas B Allen
- Department of Psychology, University of Oregon, USA.,School of Psychological Sciences, University of Melbourne, Australia
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19
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Sheikh M, Qassem M, Kyriacou PA. Wearable, Environmental, and Smartphone-Based Passive Sensing for Mental Health Monitoring. Front Digit Health 2021; 3:662811. [PMID: 34713137 PMCID: PMC8521964 DOI: 10.3389/fdgth.2021.662811] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022] Open
Abstract
Collecting and analyzing data from sensors embedded in the context of daily life has been widely employed for the monitoring of mental health. Variations in parameters such as movement, sleep duration, heart rate, electrocardiogram, skin temperature, etc., are often associated with psychiatric disorders. Namely, accelerometer data, microphone, and call logs can be utilized to identify voice features and social activities indicative of depressive symptoms, and physiological factors such as heart rate and skin conductance can be used to detect stress and anxiety disorders. Therefore, a wide range of devices comprising a variety of sensors have been developed to capture these physiological and behavioral data and translate them into phenotypes and states related to mental health. Such systems aim to identify behaviors that are the consequence of an underlying physiological alteration, and hence, the raw sensor data are captured and converted into features that are used to define behavioral markers, often through machine learning. However, due to the complexity of passive data, these relationships are not simple and need to be well-established. Furthermore, parameters such as intrapersonal and interpersonal differences need to be considered when interpreting the data. Altogether, combining practical mobile and wearable systems with the right data analysis algorithms can provide a useful tool for the monitoring and management of mental disorders. The current review aims to comprehensively present and critically discuss all available smartphone-based, wearable, and environmental sensors for detecting such parameters in relation to the treatment and/or management of the most common mental health conditions.
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Affiliation(s)
- Mahsa Sheikh
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Science & Engineering, City, University of London, London, United Kingdom
| | - M Qassem
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Science & Engineering, City, University of London, London, United Kingdom
| | - Panicos A Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Science & Engineering, City, University of London, London, United Kingdom
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20
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Yerushalmi M, Sixsmith A, Pollock Star A, King DB, O'Rourke N. Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study. JMIR Form Res 2021; 5:e30472. [PMID: 34473069 PMCID: PMC8446838 DOI: 10.2196/30472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. OBJECTIVE We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). METHODS For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified "windows of general availability," participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner's specified availability. RESULTS Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=-.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=-.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. CONCLUSIONS These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important.
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Affiliation(s)
- Mor Yerushalmi
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Andrew Sixsmith
- Science and Technology for Aging Research (STAR) Institute, Simon Fraser University, Vancouver, BC, Canada
| | - Ariel Pollock Star
- Department of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - David B King
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Norm O'Rourke
- Department of Public Health and Multidisciplinary Center for Research on Aging, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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21
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Mobile device use among inpatients on a psychiatric unit: A preliminary study. Psychiatry Res 2021; 297:113720. [PMID: 33540205 DOI: 10.1016/j.psychres.2021.113720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Few studies have investigated barriers to mobile phone use for health purposes among patients with serious mental illness. In an inpatient psychiatric adult sample, we examined: (a) patterns and perceptions of mobile phone use and (b) the role of psychiatric diagnoses on mobile phone use for mental health purposes. Participants completed questionnaires after using a psychometrically validated scale to determine capacity for consent. Descriptive analyses revealed that most participants owned a smartphone (94%), data plan (94%), and frequently accessed the internet (75%). Only 27% used their mobile phones daily for health purposes and 47% had used their mobile phone to access their electronic medical record (EMR). Participants with psychotic disorders were significantly less likely to have mobile access to their EMR and expressed difficulty in using a mobile app for mental health purposes; whereas participants with depressive disorders expressed low interest in using their mobile devices to monitor their mental health. Adult psychiatric inpatients may have access to and be willing to use mobile phones for purposes related to mental health. However, key barriers may include frequency of mobile phone use for health purposes and lack of mobile access to the EMR, particularly among those with psychotic disorders.
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22
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Keshmiri S. Conditional Entropy: A Potential Digital Marker for Stress. ENTROPY (BASEL, SWITZERLAND) 2021; 23:286. [PMID: 33652891 PMCID: PMC7996836 DOI: 10.3390/e23030286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Recent decades have witnessed a substantial progress in the utilization of brain activity for the identification of stress digital markers. In particular, the success of entropic measures for this purpose is very appealing, considering (1) their suitability for capturing both linear and non-linear characteristics of brain activity recordings and (2) their direct association with the brain signal variability. These findings rely on external stimuli to induce the brain stress response. On the other hand, research suggests that the use of different types of experimentally induced psychological and physical stressors could potentially yield differential impacts on the brain response to stress and therefore should be dissociated from more general patterns. The present study takes a step toward addressing this issue by introducing conditional entropy (CE) as a potential electroencephalography (EEG)-based resting-state digital marker of stress. For this purpose, we use the resting-state multi-channel EEG recordings of 20 individuals whose responses to stress-related questionnaires show significantly higher and lower level of stress. Through the application of representational similarity analysis (RSA) and K-nearest-neighbor (KNN) classification, we verify the potential that the use of CE can offer to the solution concept of finding an effective digital marker for stress.
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Affiliation(s)
- Soheil Keshmiri
- Advanced Telecommunications Research Institute International (ATR), Kyoto 619-0237, Japan
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23
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Faurholt-Jepsen M, Busk J, Vinberg M, Christensen EM, HelgaÞórarinsdóttir, Frost M, Bardram JE, Kessing LV. Daily mobility patterns in patients with bipolar disorder and healthy individuals. J Affect Disord 2021; 278:413-422. [PMID: 33010566 DOI: 10.1016/j.jad.2020.09.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/25/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alterations in energy and activity in bipolar disorder (BD) differ between affective states and compared with healthy control individuals (HC). Measurements of activity could discriminate between BD and HC and in the monitoring of affective states within BD. The aims were to investigate differences in 1) passively collected smartphone-based location data (location data) between BD and HC, and 2) location data in BD between affective states. METHODS Daily, patients with BD and HC completed smartphone-based self-assessments of mood for up to nine months. Location data reflecting mobility patterns, routine and location entropy was collected daily. A total of 46 patients with BD and 31 HC providing daily data was included. RESULTS A total of 4,859 observations of smartphone-based self-assessments of mood and mobility patterns were available from patients with BD and 1,747 observations from HC. Patients with BD had lower location entropy compared with HC (B= -0.14, 95% CI= -0.24; -0.034, p=0.009). Patients with BD during a depressive state were less mobile compared with a euthymic state. Patients with BD during an affective state had lower location entropy compared with a euthymic state (p<0.0001). The AUC of combined location data was rather high in classifying patients with BD compared with HC (AUC: 0.83). LIMITATIONS Individuals willing to use smartphones for daily self-monitoring may represent a more motivated group. CONCLUSION Alterations in location data reflecting mobility patterns may be a promising measure of illness and illness activity in patients with BD and may be used to monitor the effects of treatments.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark.
| | - Jonas Busk
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
| | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
| | - HelgaÞórarinsdóttir
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
| | - Mads Frost
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
| | - Jakob E Bardram
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; Monsenso Aps, Langelinie Alle 47, Copenhagen, Denmark
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24
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Montag C, Sindermann C, Baumeister H. Digital phenotyping in psychological and medical sciences: a reflection about necessary prerequisites to reduce harm and increase benefits. Curr Opin Psychol 2020; 36:19-24. [DOI: 10.1016/j.copsyc.2020.03.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022]
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25
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Hays R, Keshavan M, Wisniewski H, Torous J. Deriving symptom networks from digital phenotyping data in serious mental illness. BJPsych Open 2020; 6:e135. [PMID: 33138889 PMCID: PMC7745255 DOI: 10.1192/bjo.2020.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Symptoms of serious mental illness are multidimensional and often interact in complex ways. Generative models offer value in elucidating the underlying relationships that characterise these networks of symptoms. AIMS In this paper we use generative models to find unique interactions of schizophrenia symptoms as experienced on a moment-by-moment basis. METHOD Self-reported mood, anxiety and psychosis symptoms, self-reported measurements of sleep quality and social function, cognitive assessment, and smartphone touch screen data from two assessments modelled after the Trail Making A and B tests were collected with a digital phenotyping app for 47 patients in active treatment for schizophrenia over a 90-day period. Patients were retrospectively divided up into various non-exclusive subgroups based on measurements of depression, anxiety, sleep duration, cognition and psychosis symptoms taken in the clinic. Associated transition probabilities for the patient cohort and for the clinical subgroups were calculated using state transitions between adjacent 3-day timesteps of pairwise survey domains. RESULTS The three highest probabilities for associated transitions across all patients were anxiety-inducing mood (0.357, P < 0.001), psychosis-inducing mood (0.276, P < 0.001), and anxiety-inducing poor sleep (0.268, P < 0.001). These transition probabilities were compared against a validation set of 17 patients from a pilot study, and no significant differences were found. Unique symptom networks were found for clinical subgroups. CONCLUSIONS Using a generative model using digital phenotyping data, we show that certain symptoms of schizophrenia may play a role in elevating other schizophrenia symptoms in future timesteps. Symptom networks show that it is feasible to create clinically interpretable models that reflect the unique symptom interactions of psychosis-spectrum illness. These results offer a framework for researchers capturing temporal dynamics, for clinicians seeking to move towards preventative care, and for patients to better understand their lived experience.
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Affiliation(s)
- Ryan Hays
- Harvard Medical School, Department of Psychiatry, Beth Israel Deaconess Medical Center, USA
| | - Matcheri Keshavan
- Harvard Medical School, Department of Psychiatry, Beth Israel Deaconess Medical Center, USA
| | - Hannah Wisniewski
- Harvard Medical School, Department of Psychiatry, Beth Israel Deaconess Medical Center, USA
| | - John Torous
- Harvard Medical School, Department of Psychiatry, Beth Israel Deaconess Medical Center, USA
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Martin-Sanchez F, Bellazzi R, Casella V, Dixon W, Lopez-Campos G, Peek N. Progress in Characterizing the Human Exposome: a Key Step for Precision Medicine. Yearb Med Inform 2020; 29:115-120. [PMID: 32303099 PMCID: PMC7442499 DOI: 10.1055/s-0040-1701975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Most diseases result from the complex interplay between genetic and environmental factors. The exposome can be defined as a systematic approach to acquire large data sets corresponding to environmental exposures of an individual along her/ his life. The objective of this contribution is to raise awareness within the health informatics community about the importance of dealing with data related to the contribution of environmental factors to individual health, particularly in the context of precision medicine informatics. METHODS This article summarizes the main findings after a panel organized by the International Medical Informatics Association - Exposome Informatics Working Group held during the last MEDINFO, in Lyon (France) in August 2019. RESULTS The members of our community presented four initiatives (PULSE, Digital exposome, Cloudy with a chance of pain, Wearable clinics), providing a detailed view of current challenges and accomplishments in processing environmental and social data from a health research perspective. Projects illustrate a wide range of research methods, digital data collection technologies, and analytics and visualization tools. This reinforces the idea that this area is now ready for health informaticians to step in and contribute their expertise, leading the application of informatics strategies to understand environmental health problems. CONCLUSIONS The featured projects illustrate applications that use exposome data for the investigation of the causes of diseases, health care, patient empowerment, and public health. They offer a rich overview of the expanding range of applications that informatics is finding in the field of environmental health, with potential impact in precision medicine.
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Spinazze P, Rykov Y, Bottle A, Car J. Digital phenotyping for assessment and prediction of mental health outcomes: a scoping review protocol. BMJ Open 2019; 9:e032255. [PMID: 31892655 PMCID: PMC6955549 DOI: 10.1136/bmjopen-2019-032255] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Rapid advancements in technology and the ubiquity of personal mobile digital devices have brought forth innovative methods of acquiring healthcare data. Smartphones can capture vast amounts of data both passively through inbuilt sensors or connected devices and actively via user engagement. This scoping review aims to evaluate evidence to date on the use of passive digital sensing/phenotyping in assessment and prediction of mental health. METHODS AND ANALYSIS The methodological framework proposed by Arksey and O'Malley will be used to conduct the review following the five-step process. A three-step search strategy will be used: (1) Initial limited search of online databases namely, MEDLINE for literature on digital phenotyping or sensing for key terms; (2) Comprehensive literature search using all identified keywords, across all relevant electronic databases: IEEE Xplore, MEDLINE, the Cochrane Database of Systematic Reviews, PubMed, the ACM Digital Library and Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index), Scopus and (3) Snowballing approach using the reference and citing lists of all identified key conceptual papers and primary studies. Data will be charted and sorted using a thematic analysis approach. ETHICS AND DISSEMINATION The findings from this systematic scoping review will be reported at scientific meetings and published in a peer-reviewed journal.
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Affiliation(s)
- Pier Spinazze
- The Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore
- Public Health & Primary Care, Imperial College London, London, UK
| | - Yuri Rykov
- The Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Alex Bottle
- Primary Care and Social Medicine, Imperial College, London, UK
| | - Josip Car
- The Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Goodday SM, Friend S. Unlocking stress and forecasting its consequences with digital technology. NPJ Digit Med 2019; 2:75. [PMID: 31372508 PMCID: PMC6668457 DOI: 10.1038/s41746-019-0151-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic stress is a major underlying origin of the top leading causes of death, globally. Yet, the mechanistic explanation of the association between stress and disease is poorly understood. This stems from the inability to adequately measure stress in its naturally occurring state and the extreme heterogeneity by inter and intraindividual characteristics. The growth and availability of digital technologies involving wearable devices and mobile phone apps afford the opportunity to dramatically improve measurement of the biological stress response in real time. In parallel, the advancement and capabilities of artificial intelligence (AI) and machine learning could discern heterogeneous, multidimensional information from individual signs of stress, and possibly inform how these signs forecast the downstream consequences of stress in the form of end-organ damage. The marriage of these tools could dramatically enhance the field of stress research contributing to impactful and empowering interventions for individuals bridging knowledge to practice, and intervention to real-world use. Here we discuss this potential, anticipated challenges, and emerging opportunities.
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Affiliation(s)
- Sarah M Goodday
- 4YouandMe, Seattle, WA USA.,2Department of Psychiatry, University of Oxford, Oxford, UK
| | - Stephen Friend
- 4YouandMe, Seattle, WA USA.,2Department of Psychiatry, University of Oxford, Oxford, UK
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