The spatiotemporal movement of patients in and out of a psychiatric hospital: an observational GPS study

Abstract

Background: Movement is a basic component of health. Little is known about the spatiotemporal movement of patients with mental disorders. The aim of this study was to determine how spatiotemporal movement of patients related to their symptoms and wellbeing.

Method: A total of 106 patients (inpatients (n = 69) and outpatients (n = 37)) treated for a wide range of mental disorders (transdiagnostic sample) carried a GPS-enabled smartphone for one week at the beginning of treatment. Algorithms were applied to establish spatiotemporal clusters and subsequently related to known characteristics of these groups (i.e., at the hospital, at home). Symptomatology, Wellbeing, and Psychological flexibility were also assessed.

Results: Spatiotemporal patterns of inpatients and outpatients showed differences consistent with predictions (e.g., outpatients showed higher active areas). These patterns were largely unassociated with symptoms (except for agoraphobic symptoms). Greater movement and variety of movement were more predictive of wellbeing, however, in both inpatients and outpatients.

Conclusion: Measuring spatiotemporal patterns is feasible, predictive of wellbeing, and may be a marker of patient functioning. Ethical issues of collecting GPS data are discussed.

Keywords: Global positioning system (GPS); Spatiotemporal movement; Transdiagnostic; Wellbeing.

Fig. 1

Example of Spatiotemporal Movement of one person. Spatiotemporal activity pattern of a selected patient during one day. The ST-DBSCAN algorithm estimated six clusters in this case. Numbers denote GPS signals of a specific cluster in temporal order of recording (1 = first cluster, 6 = last cluster recorded throughout the day). Color-shaded areas refer to the hulls around individual clusters. The broken line denotes the hull boundary around all GPS signals recorded during the entire day. Grey dots denote GPS signals allocated to “in transit” destinations. 1=turquoise, 2=brown, 3=violet, 4=red (carmine), 5=green, 6=yellow

Fig. 2

Relationship between phobic anxiety, wellbeing, and psychological flexibility & Individual activity area and Location variance.Scatterplots of the association between phobic anxiety (upper row), emotinal well-being (middle row), and psychological flexibility (bottom line) and either individual activity area (left column) or location variance (right column)