Predicting and Monitoring Symptoms in Patients Diagnosed With Depression Using Smartphone Data: Observational Study

Abstract

Background: Clinical diagnostic assessments and the outcome monitoring of patients with depression rely predominantly on interviews by professionals and the use of self-report questionnaires. The ubiquity of smartphones and other personal consumer devices has prompted research into the potential of data collected via these devices to serve as digital behavioral markers for indicating the presence and monitoring of the outcome of depression.

Objective: This paper explores the potential of using behavioral data collected with smartphones to detect and monitor depression symptoms in patients diagnosed with depression. Specifically, it investigates whether this data can accurately classify the presence of depression, as well as monitor the changes in depressive states over time.

Methods: In a prospective cohort study, we collected smartphone behavioral data for up to 1 year. The study consists of observations from 164 participants, including healthy controls (n=31) and patients diagnosed with various depressive disorders: major depressive disorder (MDD; n=85), MDD with comorbid borderline personality disorder (n=27), and major depressive episodes with bipolar disorder (n=21). Data were labeled based on depression severity using 9-item Patient Health Questionnaire (PHQ-9) scores. We performed statistical analysis and used supervised machine learning on the data to classify the severity of depression and observe changes in the depression state over time.

Results: Our correlation analysis revealed 32 behavioral markers associated with the changes in depressive state. Our analysis classified patients who are depressed with an accuracy of 82% (95% CI 80%-84%) and change in the presence of depression with an accuracy of 75% (95% CI 72%-76%). Notably, the most important smartphone features for classifying depression states were screen-off events, battery charge levels, communication patterns, app usage, and location data. Similarly, for predicting changes in depression state, the most important features were related to location, battery level, screen, and accelerometer data patterns.

Conclusions: The use of smartphone digital behavioral markers to supplement clinical evaluations may aid in detecting the presence and changes in severity of symptoms of depression, particularly if combined with intermittent use of self-report of symptoms.

Keywords: data analysis; depression monitoring; depression symptoms; digital behavioral data; digital phenotyping; mHealth; mobile health; mobile phone; smartphone.

Figure 1

The MoMo-Mood study data collection and preparation schema. MoMo-Mood: Mobile Monitoring of Mood; PHQ-9: 9-item Patient Health Questionnaire.

Figure 2

Schematics of data aggregation and alignment. PHQ-9: 9-item Patient Health Questionnaire.

Figure 3

Schema for depression presence and transition prediction using passive behavioral data. An asterisk (*) depicts a model using the PHQ-9 measurement from the preceding biweekly period as a predictor. Time point t0 on the analysis timeline represents the active phase, and points from t1 to t26 represent the passive phase. PHQ-9: 9-item Patient Health Questionnaire.

Figure 4

PHQ-9 score distributions for control and patient groups.To assess differences in PHQ-9 scores across various groups, we used a generalized estimating equations approach. We chose the method due to its effectiveness in dealing with correlated response data and its ability to provide robust SEs. The analysis revealed statistically significant differences in PHQ-9 scores between the control group and each of the patient groups. The significance of these differences was high, with P<.001 for each comparison. MDD: major depressive disorder; MDD|BPD: major depressive disorder with comorbid borderline personality disorder; MDE|BD: major depressive episodes with bipolar disorder; PHQ-9: 9-item Patient Health Questionnaire.

Figure 5

Averaged PHQ-9 score trends for controls and patient groups (standard deviations depicted by shaded regions). MDD: major depressive disorder; MDD|BPD: major depressive disorder with comorbid borderline personality disorder; MDE|BD: major depressive episodes with bipolar disorder; PHQ-9: 9-item Patient Health Questionnaire.