Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories

Lisa Vizer¹, Jennifer Pierce², Yinyao Ji³, Meredith A Bucher³, Mochuan Liu⁴, Lyle Ungar⁵, Salvatore Giorgi⁵, Zhaopeng Xing⁶, Stacey L House⁷, Francesca L Beaudoin^{8

9}, Jennifer S Stevens¹⁰, Thomas C Neylan¹¹, Gari D Clifford^{12

13}, Tanja Jovanovic¹⁴, Sarah D Linnstaedt¹⁵, Donglin Zeng⁴, Laura T Germine^{16

17

18}, Kenneth A Bollen¹⁹, Scott L Rauch^{16

18

20}, John P Haran²¹, Alan B Storrow²², Christopher Lewandowski²³, Paul I Musey Jr²⁴, Phyllis L Hendry²⁵, Sophia Sheikh²⁵, Christopher W Jones²⁶, Brittany E Punches^{27

28}, Lauren A Hudak²⁹, Jose L Pascual^{30

31}, Mark J Seamon^{31

32}, Erica Harris³³, Claire Pearson³⁴, David A Peak^{35

36}, Roland C Merchant³⁷, Robert M Domeier³⁸, Brian J O'Neil³⁹, Paulina Sergot⁴⁰, Leon D Sanchez^{36

37}, Steven E Bruce⁴¹, Steven E Harte^{42

43}, Ronald C Kessler⁴⁴, Karestan C Koenen⁴⁵, Samuel A McLean^{3

46}, Xinming An¹⁵

Affiliations

¹ Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
² Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109 USA.
³ Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
⁴ Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
⁵ Computer and Information Science, University of Pennsylvania, Philadelphia, PA 19104 USA.
⁶ CVS Health, New York, NY 10029 USA.
⁷ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63110 USA.
⁸ Department of Epidemiology, Brown University, Providence, RI 02930 USA.
⁹ Department of Emergency Medicine, Brown University, Providence, RI 02930 USA.
¹⁰ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329 USA.
¹¹ Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA 94143 USA.
¹² Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA 30332 USA.
¹³ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332 USA.
¹⁴ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48202 USA.
¹⁵ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
¹⁶ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA 02478 USA.
¹⁷ The Many Brains Project, Belmont, MA 02478 USA.
¹⁸ Department of Psychiatry, Harvard Medical School, Boston, MA 02115 USA.
¹⁹ Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
²⁰ Department of Psychiatry, McLean Hospital, Belmont, MA 02478 USA.
²¹ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655 USA.
²² Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232 USA.
²³ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48202 USA.
²⁴ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA.
²⁵ Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL 32209 USA.
²⁶ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103 USA.
²⁷ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH 43210 USA.
²⁸ Ohio State University College of Nursing, Columbus, OH 43210 USA.
²⁹ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30329 USA.
³⁰ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104 USA.
³¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.
³² Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA 19104 USA.
³³ Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA 19107 USA.
³⁴ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI 48236 USA.
³⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114 USA.
³⁶ Department of Emergency Medicine, Harvard Medical School, Boston, MA 02115 USA.
³⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115 USA.
³⁸ Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI 48197 USA.
³⁹ Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI 48202 USA.
⁴⁰ Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX 77030 USA.
⁴¹ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121 USA.
⁴² Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109 USA.
⁴³ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI 48109 USA.
⁴⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA 02115 USA.
⁴⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115 USA.
⁴⁶ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.

PMID: 40406207
PMCID: PMC12092297
DOI: 10.1038/s44277-025-00028-x

Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories

Lisa Vizer et al. NPP Digit Psychiatry Neurosci. 2025.

. 2025;3(1):8.

doi: 10.1038/s44277-025-00028-x. Epub 2025 May 20.

Authors

Affiliations

¹ Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
² Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109 USA.
³ Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
⁴ Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
⁵ Computer and Information Science, University of Pennsylvania, Philadelphia, PA 19104 USA.
⁶ CVS Health, New York, NY 10029 USA.
⁷ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63110 USA.
⁸ Department of Epidemiology, Brown University, Providence, RI 02930 USA.
⁹ Department of Emergency Medicine, Brown University, Providence, RI 02930 USA.
¹⁰ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329 USA.
¹¹ Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA 94143 USA.
¹² Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA 30332 USA.
¹³ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332 USA.
¹⁴ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48202 USA.
¹⁵ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
¹⁶ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA 02478 USA.
¹⁷ The Many Brains Project, Belmont, MA 02478 USA.
¹⁸ Department of Psychiatry, Harvard Medical School, Boston, MA 02115 USA.
¹⁹ Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.
²⁰ Department of Psychiatry, McLean Hospital, Belmont, MA 02478 USA.
²¹ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655 USA.
²² Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232 USA.
²³ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48202 USA.
²⁴ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA.
²⁵ Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL 32209 USA.
²⁶ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103 USA.
²⁷ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH 43210 USA.
²⁸ Ohio State University College of Nursing, Columbus, OH 43210 USA.
²⁹ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30329 USA.
³⁰ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104 USA.
³¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.
³² Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA 19104 USA.
³³ Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA 19107 USA.
³⁴ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI 48236 USA.
³⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114 USA.
³⁶ Department of Emergency Medicine, Harvard Medical School, Boston, MA 02115 USA.
³⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115 USA.
³⁸ Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI 48197 USA.
³⁹ Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI 48202 USA.
⁴⁰ Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX 77030 USA.
⁴¹ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121 USA.
⁴² Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109 USA.
⁴³ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI 48109 USA.
⁴⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA 02115 USA.
⁴⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115 USA.
⁴⁶ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559 USA.

PMID: 40406207
PMCID: PMC12092297
DOI: 10.1038/s44277-025-00028-x

Abstract

Language features may reflect underlying cognitive and emotional processes following a traumatic event that portend clinical outcomes. The authors sought to determine whether language features from usual smartphone use were markers associated with concurrent posttraumatic symptoms and worsening or improving posttraumatic symptoms over time following a traumatic exposure. This investigation was a secondary analysis of the Advancing Understanding of RecOvery afteR traumA study, a longitudinal study of traumatic outcomes among survivors recruited from 33 emergency departments across the United States. Adverse posttraumatic sequelae were assessed over the six months following the initial traumatic exposure. Language features were extracted from usual smartphone use in a specialized app. Bivariate linear mixed models were used to identify and validate language features that are markers associated with posttraumatic symptoms. Participants were 1744 trauma survivors, with a mean age of 39 [SD = 13] years old, and 56% were female. Fourteen language features were associated with severity level of posttraumatic symptoms at specific timepoints (cross-sectional markers) and five features were associated with change in severity level of posttraumatic symptoms (longitudinal markers). References to the body and health or illness were predictive of worsening pain, somatic, and thinking/concentration/fatigue symptom severity over time. An increase in references to others was associated with improvement in somatic symptom severity over time and increases in expressions of causation or cognitive processes were associated with improvement in pain symptom severity over time. Language features derived from usual smartphone use can convey important information about health, functioning, and recovery following a traumatic event. Clinicians might utilize such information to determine who may experience a high symptom burden or risk of worsening posttraumatic symptoms.

Keywords: Diagnostic markers; Neurological manifestations.

Plain language summary

Via usual smartphone use following trauma exposure, this study identified language markers associated with patient-reported severity and change in severity for multiple symptoms. Using language markers as a proxy for the status of and changes in specific symptoms supports efficient remote health status monitoring and can provide clinicians with valuable real-time insights into health, functioning, and recovery. These insights can be leveraged to guide targeted interventions tailored to individual trauma survivors.

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Conflict of interest statement

Competing interestsDr. Vizer reports no financial relationships with commercial interests. Dr. Pierce receives support from the National Institute of Mental Health, K01 MH126079. Ms. Ji reports no financial relationships with commercial interests. Dr. Bucher reports no financial relationships with commercial interests. Dr. Liu reports no financial relationships with commercial interests. Dr. Ungar reports no financial relationships with commercial interests. Dr. Giorgi reports no financial relationships with commercial interests. Dr. Xing reports no financial relationships with commercial interests. Dr. House reports no financial relationships with commercial interests. Dr. Beaudoin reports no financial relationships with commercial interests. Dr. Stevens reports no financial relationships with commercial interests. Dr. Neylan has received research support from NIH, VA, and Rainwater Charitable Foundation, and consulting income from Jazz Pharmaceuticals. In the last three years Dr Clifford has received research funding from the NSF, NIH and LifeBell AI, and unrestricted donations from AliveCor Inc, Amazon Research, the Center for Discovery, the Gates Foundation, Google, the Gordon and Betty Moore Foundation, MathWorks, Microsoft Research, Nextsense Inc, One Mind Foundation, and the Rett Research Foundation. Dr Clifford has financial interest in AliveCor Inc and Nextsense Inc. He also is the CTO of MindChild Medical with significant stock. These relationships are unconnected to the current work. Dr. Jovanovic receives support from the National Institute of Mental Health, R01 MH129495. Dr. Linnstaedt reports no financial relationships with commercial interests. Dr. Germine receives funding from the National Institute of Mental Health (R01 MH121617) and is on the board of the Many Brains Project. Her family also has equity in Intelerad Medical Systems, Inc. Dr. Bollen reports no financial relationships with commercial interests. Dr. Rauch reported serving as secretary of the Society of Biological Psychiatry; serving as a board member of Community Psychiatry and Mindpath Health; serving as a board member of National Association of Behavioral Healthcare; serving as secretary and a board member for the Anxiety and Depression Association of America; serving as a board member of the National Network of Depression Centers; receiving royalties from Oxford University Press, American Psychiatric Publishing Inc, and Springer Publishing; and receiving personal fees from the Society of Biological Psychiatry, Community Psychiatry and Mindpath Health, and National Association of Behavioral Healthcare outside the submitted work. Dr. Haran reports no financial relationships with commercial interests. Dr. Storrow reports no financial relationships with commercial interests. Dr. Lewandowski reports no financial relationships with commercial interests. Dr. Musey reports no financial relationships with commercial interests. Dr. Hendry reports no financial relationships with commercial interests. Dr. Sheikh reports no financial relationships with commercial interests. Dr. Jones has no competing interests related to this work, though he has been an investigator on studies funded by AstraZeneca, Vapotherm, Abbott, and Ophirex. Dr. Punches reports no financial relationships with commercial interests. Dr. Hudak reports no financial relationships with commercial interests. Dr. Pascual reports no financial relationships with commercial interests. Dr. Seamon reports no financial relationships with commercial interests. Dr. Harris reports no financial relationships with commercial interests. Dr. Pearson reports no financial relationships with commercial interests. Dr. Peak reports no financial relationships with commercial interests. Dr. Merchant reports no financial relationships with commercial interests. Dr. Domeier reports no financial relationships with commercial interests. Dr. O’Neil reports no financial relationships with commercial interests. Dr. Sergot reports no financial relationships with commercial interests. Dr. Sanchez reports no financial relationships with commercial interests. Dr. Bruce reports no financial relationships with commercial interests. Dr. Harte has no competing interest related to this work, though in the last three years he has received research funding from NIH, Aptinyx, and Arbor Medical Innovations, and consulting payments from Memorial Sloan Kettering Cancer Center, Wayne State University, Indiana University Indianapolis, The Ohio State University, Dana Farber Cancer Institute, and Stanford University. In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Holmusk, Partners Healthcare, Inc., RallyPoint Networks, Inc., and Sage Therapeutics. He has stock options in Cerebral Inc., Mirah, PYM, and Roga Sciences. Dr. Koenen has been a paid scientific consultant for the US Department of Justice and Covington Burling, LLP over the last three years. She receives royalties from Guilford Press and Oxford University Press. Dr. McLean has served as a consultant for Walter Reed Army Institute for Research, Arbor Medical Innovations, and BioXcel Therapeutics, Inc. Dr. An reports no financial relationships with commercial interests. The remaining authors have nothing to disclose.

Figures

**Fig. 1**
Median adverse posttraumatic neuropsychiatric symptom scores over the first 6 months after trauma exposure.

See this image and copyright information in PMC

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Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories

Affiliations

Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories

Authors

Affiliations

Abstract

Plain language summary

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources