Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort

Francesca L Beaudoin^{1

2}, Xinming An³, Archana Basu⁴, Yinyao Ji⁵, Mochuan Liu^{5

6}, Ronald C Kessler⁷, Robert F Doughtery⁸, Donglin Zeng⁶, Kenneth A Bollen⁹, Stacey L House¹⁰, Jennifer S Stevens¹¹, Thomas C Neylan¹², Gari D Clifford^{13

14}, Tanja Jovanovic¹⁵, Sarah D Linnstaedt³, Laura T Germine^{16

17

18}, Scott L Rauch^{16

18

19}, John P Haran²⁰, Alan B Storrow²¹, Christopher Lewandowski²², Paul I Musey Jr²³, Phyllis L Hendry²⁴, Sophia Sheikh²⁴, Christopher W Jones²⁵, Brittany E Punches^{26

27}, Michael C Kurz^{28

29

30}, Robert A Swor³¹, Vishnu P Murty³², Meghan E McGrath³³, Lauren A Hudak³⁴, Jose L Pascual^{35

36}, Elizabeth M Datner^{37

38}, Anna M Chang³⁹, Claire Pearson⁴⁰, David A Peak⁴¹, Roland C Merchant⁴², Robert M Domeier⁴³, Niels K Rathlev⁴⁴, Brian J O' Neil⁴⁰, Paulina Sergot⁴⁵, Leon D Sanchez^{46

47}, Steven E Bruce⁴⁸, Justin T Baker⁸, Jutta Joormann⁴⁹, Mark W Miller^{50

51}, Robert H Pietrzak^{52

53}, Deanna M Barch⁵⁴, Diego A Pizzagalli^{18

55}, John F Sheridan^{56

57}, Jordan W Smoller^{58

59}, Steven E Harte^{60

61}, James M Elliott^{62

63

64}, Karestan C Koenen⁴, Kerry J Ressler^{18

55}, Samuel A McLean^{65

66}

Affiliations

¹ Department of Epidemiology, Brown University, Providence, RI, USA.
² Department of Emergency Medicine, Brown University, Providence, RI, USA.
³ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁵ Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
⁷ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁸ Mindstrong Health, Mountain View, CA, USA.
⁹ Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
¹² Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
¹⁴ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
¹⁵ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, USA.
¹⁶ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
¹⁷ The Many Brains Project, Belmont, MA, USA.
¹⁸ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
¹⁹ Department of Psychiatry, McLean Hospital, Belmont, MA, USA.
²⁰ Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
²¹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²² Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
²³ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁴ Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA.
²⁵ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²⁶ Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²⁷ College of Nursing, University of Cincinnati, Cincinnati, OH, USA.
²⁸ Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
²⁹ Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA.
³⁰ Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA.
³¹ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
³² Department of Psychology, Temple University, Philadelphia, PA, USA.
³³ Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA.
³⁴ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
³⁵ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
³⁶ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³⁷ Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA.
³⁸ Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
³⁹ Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA.
⁴⁰ Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
⁴¹ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁴² Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁴³ Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA.
⁴⁴ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
⁴⁵ Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA.
⁴⁶ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁴⁷ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
⁴⁸ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
⁴⁹ Department of Psychology, Yale University, West Haven, CT, USA.
⁵⁰ National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA.
⁵¹ Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
⁵² National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA.
⁵³ Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA.
⁵⁴ Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
⁵⁵ Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
⁵⁶ Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, USA.
⁵⁷ Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA.
⁵⁸ Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
⁵⁹ Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA.
⁶⁰ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁶¹ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁶² Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia.
⁶³ Faculty of Medicine and Health, University of Sydney, Northern Sydney Local, Health District, NSW, Australia.
⁶⁴ Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁶⁵ Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. smclean@aims.unc.edu.
⁶⁶ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. smclean@aims.unc.edu.

PMID: 36609484
PMCID: PMC9823011
DOI: 10.1038/s41398-022-02289-y

Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort

Francesca L Beaudoin et al. Transl Psychiatry. 2023.

. 2023 Jan 7;13(1):4.

doi: 10.1038/s41398-022-02289-y.

Authors

Affiliations

¹ Department of Epidemiology, Brown University, Providence, RI, USA.
² Department of Emergency Medicine, Brown University, Providence, RI, USA.
³ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁵ Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
⁷ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁸ Mindstrong Health, Mountain View, CA, USA.
⁹ Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
¹² Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
¹⁴ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
¹⁵ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, USA.
¹⁶ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
¹⁷ The Many Brains Project, Belmont, MA, USA.
¹⁸ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
¹⁹ Department of Psychiatry, McLean Hospital, Belmont, MA, USA.
²⁰ Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
²¹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²² Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
²³ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁴ Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA.
²⁵ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²⁶ Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²⁷ College of Nursing, University of Cincinnati, Cincinnati, OH, USA.
²⁸ Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
²⁹ Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA.
³⁰ Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA.
³¹ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
³² Department of Psychology, Temple University, Philadelphia, PA, USA.
³³ Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA.
³⁴ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
³⁵ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
³⁶ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³⁷ Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA.
³⁸ Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
³⁹ Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA.
⁴⁰ Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
⁴¹ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁴² Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁴³ Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA.
⁴⁴ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
⁴⁵ Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA.
⁴⁶ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁴⁷ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
⁴⁸ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
⁴⁹ Department of Psychology, Yale University, West Haven, CT, USA.
⁵⁰ National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA.
⁵¹ Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
⁵² National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA.
⁵³ Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA.
⁵⁴ Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
⁵⁵ Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
⁵⁶ Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, USA.
⁵⁷ Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA.
⁵⁸ Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
⁵⁹ Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA.
⁶⁰ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁶¹ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁶² Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia.
⁶³ Faculty of Medicine and Health, University of Sydney, Northern Sydney Local, Health District, NSW, Australia.
⁶⁴ Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁶⁵ Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. smclean@aims.unc.edu.
⁶⁶ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. smclean@aims.unc.edu.

PMID: 36609484
PMCID: PMC9823011
DOI: 10.1038/s41398-022-02289-y

Abstract

The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes ( http://itr.med.unc.edu/aurora/parcoord/ ). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.

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Conflict of interest statement

In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., RallyPoint Networks, Inc., Sage Pharmaceuticals, and Takeda. In the last three years, Dr. Clifford has received research funding from the NSF, NIH, and LifeBell AI, and unrestricted donations from AliveCor, Amazon Research, the Center for Discovery, the Gordon and Betty Moore Foundation, MathWorks, Microsoft Research, the Gates Foundation, Google, One Mind Foundation, and Samsung Research. Dr. Clifford has a financial interest in AliveCor and receives unrestricted funding from the company. He also is the CTO of MindChild Medical and CSO of LifeBell AI and has ownership in both companies. These relationships are unconnected to the current work. Dr. Germine is on the scientific advisory board of the nonprofit Sage Bionetworks, for which she receives a small honorarium. Dr. Sheikh has received funding from the Florida Medical Malpractice Joint Underwriter’s Association Dr. Alvin E. Smith Safety of Healthcare Services Grant, Allergan Foundation, the NIH/NIA-funded Jacksonville Aging Studies Center (JAX-ASCENT; R33AG05654), the Substance Abuse and Mental Health Services Administration (1H79TI083101-01), and the Florida Blue Foundation. Dr. Jones reports no direct conflicts related to this paper and no ongoing conflicts. He has been an investigator on studies funded by Hologic Inc., Janssen, and AstraZeneca, for which his department has received research funding. Over the past 3 years, Dr. Pizzagalli has received consulting fees from BlackThorn Therapeutics, Boehringer Ingelheim, Compass Pathway, Concert Pharmaceuticals, Engrail Therapeutics, Neurocrine Biosciences, Otsuka Pharmaceuticals, and Takeda Pharmaceuticals; one honorarium from Alkermes, and research funding from Millennium Pharmaceuticals. In addition, he has received stock options from BlackThorn Therapeutics. No funding from these entities was used to support the current work, and all views expressed are solely those of the authors. Dr. Elliott reports support from the National Institutes of Health (NIH) through Grant Numbers R01HD079076 & R03HD094577, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Center for Medical Rehabilitation Research, and consulting fees (<$15,000 per annum) from Orofacial Therapeutics, LLC. Dr. Ressler has served on advisory boards for Takeda, Resilience Therapeutics, Janssen, and Verily/Google. His research has been sponsored by Alkermes and Brainsway and he has worked as a consultant for Alkermes. Dr. McLean served as a consultant for Walter Reed and for Arbor Medical Innovations. The remaining authors declare no competing interests.

Figures

**Fig. 1. Common posttraumatic symptom trajectories during the eight weeks after motor vehicle collision (MVC).**
Common trajectories within each symptom domain were identified using latent growth curve mixture models developed from measurement models created using serial assessments of each symptom domain. (Each domain assessed six times in the first eight weeks after MVC.) Percentages within the legend for each symptom domain represent the percentage of trauma survivors within each latent class. The thickness of the lines represents the proportion of participants in each latent cluster. ↓: decreasing over time, ↓↓: major decrease over time, ↑: increasing over time.

**Fig. 2. Correlations among common post-traumatic symptoms during the eight weeks after motor vehicle collision (MVC).**
Correlations among intercepts a and slopes b of the trajectories of common post-traumatic symptoms during the eight weeks after motor vehicle collision (MVC) are displayed; darker shading indicates a higher correlation. Trajectory intercepts from latent growth curve models represent peritraumatic symptom levels in the initial days after MVC. Slopes represent changes in symptoms during the first 8 weeks after trauma.

See this image and copyright information in PMC

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Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort

Affiliations

Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical