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Schat E, Tuerlinckx F, De Ketelaere B, Ceulemans E. Real-time detection of mean and variance changes in experience sampling data: A comparison of existing and novel statistical process control approaches. Behav Res Methods 2024; 56:1459-1475. [PMID: 37118646 DOI: 10.3758/s13428-023-02103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/30/2023]
Abstract
Retrospective analyses of experience sampling (ESM) data have shown that changes in mean and variance levels may serve as early warning signs of an imminent depression. Detecting such early warning signs prospectively would pave the way for timely intervention and prevention. The exponentially weighted moving average (EWMA) procedure seems a promising method to scan ESM data for the presence of mean changes in real-time. Based on simulation and empirical studies, computing and monitoring day averages using EWMA works particularly well. We therefore expand this idea to the detection of variance changes and propose to use EWMA to prospectively scan for mean changes in day variability statistics (i.e.,s 2 , s , ln( s )). When both mean and variance changes are of interest, the multivariate extension of EWMA (MEWMA) can be applied to both the day averages and a day statistic of variability. We evaluate these novel approaches to detecting variance changes by comparing them to EWMA-type procedures that have been specifically developed to detect a combination of mean and variance changes in the raw data: EWMA-S 2 , EWMA-ln(S 2 ), and EWMA- X ¯ -S 2 . We ran a simulation study to examine the performance of the two approaches in detecting mean, variance, or both types of changes. The results indicate that monitoring day statistics using (M)EWMA works well and outperforms EWMA-S 2 and EWMA-ln(S 2 ); the performance difference with EWMA- X ¯ -S 2 is smaller but notable. Based on the results, we provide recommendations on which statistic of variability to monitor based on the type of change (i.e., variance increase or decrease) one expects.
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Affiliation(s)
- Evelien Schat
- Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 Box 3713, 3000, Leuven, Belgium.
| | - Francis Tuerlinckx
- Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 Box 3713, 3000, Leuven, Belgium
| | - Bart De Ketelaere
- Mechatronics, Biostatistics and Sensors, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Eva Ceulemans
- Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 Box 3713, 3000, Leuven, Belgium
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2
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Lee J, Lee D, Ihm H, Kang HS, Yu H, Yoon J, Jang Y, Kim Y, Lee CW, Lee H, Baek JH, Ha TH, Park J, Myung W. Network structure of symptomatology of adult attention-deficit hyperactivity disorder in patients with mood disorders. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01719-2. [PMID: 38055014 DOI: 10.1007/s00406-023-01719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/04/2023] [Indexed: 12/07/2023]
Abstract
Patients with mood disorders commonly manifest comorbid psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). However, few studies have evaluated ADHD symptoms in this population. The current study aimed to explore the network structure of ADHD symptomology and identify central symptoms in patients with mood disorders. The Korean version of the Adult ADHD Self-Report Scale was used to assess the overall ADHD symptoms in 1,086 individuals diagnosed with mood disorders (major depressive disorder [n = 373], bipolar I disorder [n = 314], and bipolar II disorder [n = 399]). We used exploratory graph analysis to detect the number of communities, and the network structure was analyzed using regularized partial correlation models. We identified the central ADHD symptom using centrality indices. Network comparison tests were conducted with different subgroups of patients with mood disorders, including three mood diagnosis groups, between the patients who met the diagnostic criteria for ADHD [ADHD-suspected, n = 259] in their self-report and the others [ADHD-non-suspected, n = 827], and groups with high [n = 503] versus low [n = 252] levels of depressive state. The network analysis detected four communities: disorganization, agitation/restlessness, hyperactivity/impulsivity, and inattention. The centrality indices indicated that "feeling restless" was the core ADHD symptom. The result was replicated in the subgroup analyses within our clinically diverse population of mood disorders, encompassing three presentations: Patients with suspected ADHD, patients without suspected ADHD, and patients with a high depressive state. Our findings reveal that "feeling restless" is the central ADHD symptom. The treatment intervention for "feeling restless" may thus play a pivotal role in tackling ADHD symptoms in adult patients with mood disorders.
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Affiliation(s)
- Jakyung Lee
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Daseul Lee
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - HongKyu Ihm
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Hyo Shin Kang
- Department of Psychology, Kyungpook National University, 80 Daehak-Ro, Buk Gu, Daegu, 41566, Republic of Korea
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Joohyun Yoon
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Yoonjeong Jang
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Yuna Kim
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Chan Woo Lee
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Hyukjun Lee
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
| | - Ji Hyun Baek
- Department of Psychiatry, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jungkyu Park
- Department of Psychology, Kyungpook National University, 80 Daehak-Ro, Buk Gu, Daegu, 41566, Republic of Korea.
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea.
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Smit AC, Snippe E. Real-time monitoring of increases in restlessness to assess idiographic risk of recurrence of depressive symptoms. Psychol Med 2023; 53:5060-5069. [PMID: 35833374 PMCID: PMC10476069 DOI: 10.1017/s0033291722002069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness. METHODS Participants were formerly depressed patients (N = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item 'I feel restless', for each individual separately. RESULTS An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test p = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases. CONCLUSIONS Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.
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Affiliation(s)
- Arnout C. Smit
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Smit AC, Schat E, Ceulemans E. The Exponentially Weighted Moving Average Procedure for Detecting Changes in Intensive Longitudinal Data in Psychological Research in Real-Time: A Tutorial Showcasing Potential Applications. Assessment 2023; 30:1354-1368. [PMID: 35603660 PMCID: PMC10248291 DOI: 10.1177/10731911221086985] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Affect, behavior, and severity of psychopathological symptoms do not remain static throughout the life of an individual, but rather they change over time. Since the rise of the smartphone, longitudinal data can be obtained at higher frequencies than ever before, providing new opportunities for investigating these person-specific changes in real-time. Since 2019, researchers have started using the exponentially weighted moving average (EWMA) procedure, as a statistically sound method to reach this goal. Real-time, person-specific change detection could allow (a) researchers to adapt assessment intensity and strategy when a change occurs to obtain the most useful data at the most useful time and (b) clinicians to provide care to patients during periods in which this is most needed. The current paper provides a tutorial on how to use the EWMA procedure in psychology, as well as demonstrates its added value in a range of potential applications.
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Affiliation(s)
- Arnout C. Smit
- University of Groningen, the
Netherlands
- VU Amsterdam, the Netherlands
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5
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Transitions in depression: if, how, and when depressive symptoms return during and after discontinuing antidepressants. Qual Life Res 2022; 32:1295-1306. [PMID: 36418524 PMCID: PMC10123048 DOI: 10.1007/s11136-022-03301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
The aim of the current study is to provide insight into if, how, and when meaningful changes occur in individual patients who discontinue antidepressant medication. Agreement between macro-level quantitative symptom data, qualitative ratings, and micro-level Ecological Momentary Assessments is examined.
Methods
During and shortly after antidepressant discontinuation, depressive symptoms and ‘feeling down’ were measured in 56 participants, using the SCL-90 depression subscale weekly (macro-level) for 6 months, and 5 Ecological Momentary Assessments daily (micro-level) for 4 months (30.404 quantitative measurements in total). Qualitative information was also obtained, providing additional information to verify that changes were clinically meaningful.
Results
At the macro-level, an increase in depressive symptoms was found in 58.9% of participants that (a) was statistically reliable, (b) persisted for 3 weeks and/or required intervention, and (c) was clinically meaningful to patients. Of these increases, 30.3% happened suddenly, 42.4% gradually, and for 27.3% criteria were inconclusive. Quantitative and qualitative criteria showed a very high agreement (Cohen’s κ = 0.85) regarding if a participant experienced a recurrence of depression, but a moderate agreement (Cohen’s κ = 0.49) regarding how that change occurred. At the micro-level, 41.1% of participants experienced only sudden increases in depressed mood, 12.5% only gradual, 30.4% experienced both types of increase, and 16.1% neither.
Conclusion
Meaningful change is common in patients discontinuing antidepressants, and there is substantial heterogeneity in how and when these changes occur. Depressive symptom change at the macro-level is not the same as depressive symptom change at the micro-level.
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Piot M, Mestdagh M, Riese H, Weermeijer J, Brouwer JM, Kuppens P, Dejonckheere E, Bos FM. Practitioner and researcher perspectives on the utility of ecological momentary assessment in mental health care: A survey study. Internet Interv 2022; 30:100575. [PMID: 36193339 PMCID: PMC9526140 DOI: 10.1016/j.invent.2022.100575] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/05/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a scientific self-monitoring method to capture individuals' daily life experiences. Early on, EMA has been suggested to have the potential to improve mental health care. However, it remains unclear if and how EMA should be implemented. This requires an in-depth investigation of how practitioners and researchers view the implementation of EMA. OBJECTIVE Explore the perspectives of mental health practitioners and EMA researchers on the utility of EMA for mental health care. METHODS Practitioners (n = 89; psychiatrists, psychologists, psychiatric nurses) and EMA researchers (n = 62) completed a survey about EMA in clinical practice. This survey addressed EMA goals for practitioner and patient, requirements regarding clinical use of EMA, and (dis)advantages of EMA compared to treatment-as-usual. t-Tests were used to determine agreement with each statement and whether practitioners' and researchers' views differed significantly. Linear regression was used to explore predictors of goals and preferences (e.g., EMA experience). RESULTS Practitioners and researchers considered EMA to be a useful clinical tool for diverse stages of care. They indicated EMA to be most useful for gaining insight into the context specificity of symptoms (55.0 %), whereas receiving alerts when symptoms increase was rated the least useful (11.3 %, alerts is in 95 % of bootstrap iterations between rank 8 and 10). Compared to treatment-as-usual, EMA was considered easier to use (M = 4.87, t = 5.30, p < .001) and interpret (M = 4.52, t = 3.61, p < .001), but also more burdensome for the patient (M = 4.48, t = 3.17, p < .001). Although participants preferred personalization of the EMA diary, they also suggested that EMA should cost practitioners and patients limited time. The preference for creating personalized EMA was related to the level of experience with EMA. Finally, they highlighted the need for practitioner training and patient full-time access to the EMA feedback. CONCLUSIONS This survey study demonstrated that practitioners and researchers expect EMA to have added value for mental health care. Concrete recommendations for implementation of EMA are formulated. This may inform the development of specific clinical applications and user-friendly EMA software.
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Affiliation(s)
- Maarten Piot
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Corresponding author at: Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Leuven 3000, Belgium.
| | - Merijn Mestdagh
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
| | - Jeroen Weermeijer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jannie M.A. Brouwer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg, Belgium
| | - Fionneke M. Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
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7
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Haslbeck JMB, Ryan O. Recovering Within-Person Dynamics from Psychological Time Series. MULTIVARIATE BEHAVIORAL RESEARCH 2022; 57:735-766. [PMID: 34154483 DOI: 10.1080/00273171.2021.1896353] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Idiographic modeling is rapidly gaining popularity, promising to tap into the within-person dynamics underlying psychological phenomena. To gain theoretical understanding of these dynamics, we need to make inferences from time series models about the underlying system. Such inferences are subject to two challenges: first, time series models will arguably always be misspecified, meaning it is unclear how to make inferences to the underlying system; and second, the sampling frequency must be sufficient to capture the dynamics of interest. We discuss both problems with the following approach: we specify a toy model for emotion dynamics as the true system, generate time series data from it, and then try to recover that system with the most popular time series analysis tools. We show that making straightforward inferences from time series models about an underlying system is difficult. We also show that if the sampling frequency is insufficient, the dynamics of interest cannot be recovered. However, we also show that global characteristics of the system can be recovered reliably. We conclude by discussing the consequences of our findings for idiographic modeling and suggest a modeling methodology that goes beyond fitting time series models alone and puts formal theories at the center of theory development.
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Affiliation(s)
| | - Oisín Ryan
- Department of Methodology and Statistics, Utrecht University
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8
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Bos FM, von Klipstein L, Emerencia AC, Veermans E, Verhage T, Snippe E, Doornbos B, Hadders-Prins G, Wichers M, Riese H. A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application. JMIR Ment Health 2022; 9:e36430. [PMID: 35943762 PMCID: PMC9399881 DOI: 10.2196/36430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. OBJECTIVE This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). METHODS The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. RESULTS The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. CONCLUSIONS PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lino von Klipstein
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ando C Emerencia
- Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Erwin Veermans
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Verhage
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Grietje Hadders-Prins
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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9
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Benasi G, Fava GA, Guidi J. Prodromal Symptoms in Depression: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 90:365-372. [PMID: 34350890 DOI: 10.1159/000517953] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Appraisal of prodromal symptoms of unipolar depression may complement the traditional cross-sectional approach and provide a longitudinal perspective, according to a staging model of the illness. OBJECTIVE To provide an updated systematic review of clinical studies concerned with prodromal symptoms of unipolar depression, according to PRISMA guidelines. METHODS Keyword searches were conducted in PubMed, Scopus, and Web of Science. Longitudinal studies on prodromal symptoms and signs in adult patients primarily diagnosed with unipolar depression were selected. Findings were examined separately according to study design (i.e., retrospective or prospective). RESULTS Twenty-five studies met the criteria for inclusion in this systematic review. Findings indicate that a distinct prodromal symptomatology - commonly characterized by anxiety, tension, irritability, and somatic complaints - exists before the onset of unipolar depression. The duration of the prodromal phase was highly variable across studies, ranging from less than a month to several years. Prodromal symptoms profile and duration were consistent within individuals across depressive episodes. There was a close relationship between prodromal and residual symptoms of the same depressive episode. CONCLUSIONS The present systematic review addresses an important, and yet relatively neglected, clinical issue that deserves further investigation and may be of immediate practical value. The findings provide challenging insights into the pathogenesis and course of unipolar depression, which may result in more timely and effective treatment of recurrences. The definition of a prodromal phase in depression would benefit from the joint use of symptom identification, biomarkers, and neuroimaging.
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Affiliation(s)
- Giada Benasi
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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10
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de Boer NS, Kostić D, Ross M, de Bruin L, Glas G. Using network models in person-centered care in psychiatry: How perspectivism could help to draw boundaries. Front Psychiatry 2022; 13:925187. [PMID: 36186866 PMCID: PMC9523016 DOI: 10.3389/fpsyt.2022.925187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
In this paper, we explore the conceptual problems that arise when using network analysis in person-centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that perspectival reasoning can make more explicit what questions personalized network models can address in PCC, given their boundaries.
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Affiliation(s)
- Nina S de Boer
- Department of Philosophy, Radboud University, Nijmegen, Netherlands
| | - Daniel Kostić
- Institute for Science in Society, Radboud University, Nijmegen, Netherlands
| | - Marcos Ross
- Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leon de Bruin
- Department of Philosophy, Radboud University, Nijmegen, Netherlands.,Department of Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Gerrit Glas
- Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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11
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Kunkels YK, van Roon AM, Wichers M, Riese H. Cross-instrument feasibility, validity, and reproducibility of wireless heart rate monitors: Novel opportunities for extended daily life monitoring. Psychophysiology 2021; 58:e13898. [PMID: 34286857 PMCID: PMC10138748 DOI: 10.1111/psyp.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 03/19/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Abstract
Wired ambulatory monitoring of the electrocardiogram (ECG) is an established method used by researchers and clinicians. Recently, a new generation of wireless, compact, and relatively inexpensive heart rate monitors have become available. However, before these monitors can be used in scientific research and clinical practice, their feasibility, validity, and reproducibility characteristics have to be investigated. Therefore, we tested how two wireless heart rate monitors (i.e., the Ithlete photoplethysmography (PPG) finger sensor and the Cortrium C3 ECG monitor perform against an established wired reference method (the VU-AMS ambulatory ECG monitor). Monitors were tested on cross-instrument and test-retest reproducibility in a controlled laboratory setting, while feasibility was evaluated in protocolled ambulatory settings at home. We found that the Cortrium and the Ithlete monitors showed acceptable agreement with the VU-AMS reference in laboratory setting. In ambulatory settings, assessments were feasible with both wireless devices although more valid data were obtained with the Cortrium than with the Ithlete. We conclude that both monitors have their merits under controlled laboratory settings where motion artefacts are minimized and stationarity of the ECG signal is optimized by design. These findings are promising for long-term ambulatory ECG measurements, although more research is needed to test whether the wireless devices' feasibility, validity, and reproducibility characteristics also hold in unprotocolled daily life settings with natural variations in posture and activities.
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Affiliation(s)
- Yoram K Kunkels
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie M van Roon
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Helmich MA, Olthof M, Oldehinkel AJ, Wichers M, Bringmann LF, Smit AC. Early warning signals and critical transitions in psychopathology: challenges and recommendations. Curr Opin Psychol 2021; 41:51-58. [PMID: 33774486 DOI: 10.1016/j.copsyc.2021.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Abstract
Empirical evidence is mounting that monitoring momentary experiences for the presence of early warning signals (EWS) may allow for personalized predictions of meaningful symptom shifts in psychopathology. Studies aiming to detect EWS require intensive longitudinal measurement designs that center on individuals undergoing change. We recommend that researchers (1) define criteria for relevant symptom shifts a priori to allow specific hypothesis testing, (2) balance the observation period length and high-frequency measurements with participant burden by testing ambitious designs with pilot studies, and (3) choose variables that are meaningful to their patient group and facilitate replication by others. Thoroughly considered designs are necessary to assess the promise of EWS as a clinical tool to detect, prevent, or encourage impending symptom changes in psychopathology.
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Affiliation(s)
- Marieke A Helmich
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB Groningen, The Netherlands.
| | - Merlijn Olthof
- Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Albertine J Oldehinkel
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB Groningen, The Netherlands
| | - Laura F Bringmann
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB Groningen, The Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Arnout C Smit
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB Groningen, The Netherlands
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13
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Wichers M, Smit AC, Snippe E. Early Warning Signals Based on Momentary Affect Dynamics can Expose Nearby Transitions in Depression: A Confirmatory Single-Subject Time-Series Study. J Pers Oriented Res 2021; 6:1-15. [PMID: 33569148 PMCID: PMC7842626 DOI: 10.17505/jpor.2020.22042] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In complex systems early warning signals such as rising autocorrelation, variance and network connectivity are hypothesized to anticipate relevant shifts in a system. For direct evidence hereof in depression, designs are needed in which early warning signals and symptom transitions are prospectively assessed within an individual. Therefore, this study aimed to detect personalized early warning signals preceding the occurrence of a major symptom transition. Methods Six single-subject time-series studies were conducted, collecting frequent observations of momentary affective states during a time-period when participants were at increased risk of a symptom transition. Momentary affect states were reported three times a day over three to six months (95-183 days). Depressive symptoms were measured weekly using the Symptom CheckList-90. Presence of sudden symptom transitions was assessed using change point analysis. Early warning signals were analysed using moving window techniques. Results As change point analysis revealed a significant and sudden symptom transition in one participant in the studied period, early warning signals were examined in this person. Autocorrelation (r=0·51; p<2.2e-16), and variance (r=0·53; p<2.2e-16) in ‘feeling down’, and network connectivity (r=0·42; p<2.2e-16) significantly increased a month before this transition occurred. These early warnings also preceded the rise in absolute levels of ‘feeling down’ and the participant’s personal indication of risk for transition. Conclusions This study replicated the findings of a previous study and confirmed the presence of rising early warning signals a month before the symptom transition occurred. Results show the potential of early warning signals to improve personalized risk assessment in the field of psychiatry.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen (UMCG), Dept. of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Arnout C Smit
- University of Groningen, University Medical Center Groningen (UMCG), Dept. of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen (UMCG), Dept. of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
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14
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de Vries LP, Baselmans BML, Bartels M. Smartphone-Based Ecological Momentary Assessment of Well-Being: A Systematic Review and Recommendations for Future Studies. JOURNAL OF HAPPINESS STUDIES 2021; 22:2361-2408. [PMID: 34720691 PMCID: PMC8550316 DOI: 10.1007/s10902-020-00324-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 05/07/2023]
Abstract
Feelings of well-being and happiness fluctuate over time and contexts. Ecological Momentary Assessment (EMA) studies can capture fluctuations in momentary behavior, and experiences by assessing these multiple times per day. Traditionally, EMA was performed using pen and paper. Recently, due to technological advances EMA studies can be conducted more easily with smartphones, a device ubiquitous in our society. The goal of this review was to evaluate the literature on smartphone-based EMA in well-being research in healthy subjects. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching PubMed and Web of Science, we identified 53 studies using smartphone-based EMA of well-being. Studies were heterogeneous in designs, context, and measures. The average study duration was 12.8 days, with well-being assessed 2-12 times per day. Half of the studies included objective data (e.g. location). Only 47.2% reported compliance, indicating a mean of 71.6%. Well-being fluctuated daily and weekly, with higher well-being in evenings and weekends. These fluctuations disappeared when location and activity were accounted for. On average, being in nature and physical activity relates to higher well-being. Working relates to lower well-being, but workplace and company do influence well-being. The important advantages of using smartphones instead of other devices to collect EMAs are the easier data collection and flexible designs. Smartphone-based EMA reach far larger maximum sample sizes and more easily add objective data to their designs than palm-top/PDA studies. Smartphone-based EMA research is feasible to gain insight in well-being fluctuations and its determinants and offers the opportunity for parallel objective data collection. Most studies currently focus on group comparisons, while studies on individual differences in well-being patterns and fluctuations are lacking. We provide recommendations for future smartphone-based EMA research regarding measures, objective data and analyses.
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Affiliation(s)
- Lianne P. de Vries
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Bart M. L. Baselmans
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD Australia
| | - Meike Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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15
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Bos FM, Snippe E, Bruggeman R, Doornbos B, Wichers M, van der Krieke L. Recommendations for the use of long-term experience sampling in bipolar disorder care: a qualitative study of patient and clinician experiences. Int J Bipolar Disord 2020; 8:38. [PMID: 33258015 PMCID: PMC7704990 DOI: 10.1186/s40345-020-00201-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Self-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder. However, current self-monitoring methods are limited to once-daily retrospectively assessed mood, which may not suit the rapid mood fluctuations in bipolar disorder. The experience sampling method (ESM), which assesses mood in real-time several times a day, may overcome these limitations. This study set out to assess the experiences of patients and clinicians with the addition of ESM monitoring, real-time alerts, and personalized feedback to clinical care. Participants were twenty patients with bipolar disorder type I/II and their clinicians. For four months, patients completed five ESM assessments per day on mood, symptoms, and activities. Weekly symptom questionnaires alerted patients and clinicians to potential episodes. After the monitoring, a personalized feedback report based on the patient’s data was discussed between patient and clinician. Three months later, patient and clinician were both interviewed. Results Thematic analysis of the transcripts resulted in four themes: perceived effects of the monitoring, alerts, and feedback, and recommendations for implementation of ESM. ESM was perceived as helping patients to cope better with their disorder by increasing awareness, offering new insights, and encouraging life style adjustments. ESM was further believed to facilitate communication between patient and clinician and to lead to new treatment directions. However, high assessment burden and pre-occupation with negative mood and having a disorder were also described. Patients and clinicians advocated for increased personalization and embedding of ESM in care. Conclusions This study demonstrates that long-term ESM monitoring, alerts, and personalized feedback are perceived as beneficial to the treatment and self-management of patients with bipolar disorder. Future research should further test the clinical utility of ESM. Clinically relevant feedback and technology need to be developed to enable personalized integration of ESM in clinical care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lian van der Krieke
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Olthof M, Hasselman F, Lichtwarck-Aschoff A. Complexity in psychological self-ratings: implications for research and practice. BMC Med 2020; 18:317. [PMID: 33028317 PMCID: PMC7542948 DOI: 10.1186/s12916-020-01727-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Psychopathology research is changing focus from group-based "disease models" to a personalized approach inspired by complex systems theories. This approach, which has already produced novel and valuable insights into the complex nature of psychopathology, often relies on repeated self-ratings of individual patients. So far, it has been unknown whether such self-ratings, the presumed observables of the individual patient as a complex system, actually display complex dynamics. We examine this basic assumption of a complex systems approach to psychopathology by testing repeated self-ratings for three markers of complexity: memory, the presence of (time-varying) short- and long-range temporal correlations; regime shifts, transitions between different dynamic regimes; and sensitive dependence on initial conditions, also known as the "butterfly effect," the divergence of initially similar trajectories. METHODS We analyzed repeated self-ratings (1476 time points) from a single patient for the three markers of complexity using Bartels rank test, (partial) autocorrelation functions, time-varying autoregression, a non-stationarity test, change point analysis, and the Sugihara-May algorithm. RESULTS Self-ratings concerning psychological states (e.g., the item "I feel down") exhibited all complexity markers: time-varying short- and long-term memory, multiple regime shifts, and sensitive dependence on initial conditions. Unexpectedly, self-ratings concerning physical sensations (e.g., the item "I am hungry") exhibited less complex dynamics and their behavior was more similar to random variables. CONCLUSIONS Psychological self-ratings display complex dynamics. The presence of complexity in repeated self-ratings means that we have to acknowledge that (1) repeated self-ratings yield a complex pattern of data and not a set of (nearly) independent data points, (2) humans are "moving targets" whose self-ratings display non-stationary change processes including regime shifts, and (3) long-term prediction of individual trajectories may be fundamentally impossible. These findings point to a limitation of popular statistical time series models whose assumptions are violated by the presence of these complexity markers. We conclude that a complex systems approach to mental health should appreciate complexity as a fundamental aspect of psychopathology research by adopting the models and methods of complexity science. Promising first steps in this direction, such as research on real-time process monitoring, short-term prediction, and just-in-time interventions, are discussed.
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Affiliation(s)
- Merlijn Olthof
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Fred Hasselman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- School of Pedagogical and Educational Sciences, Radboud University, Nijmegen, The Netherlands
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