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Time spent on smartphone and GPS location sensor data detect depression

NORTHWESTERN UNIVERSITY

CHICAGO — You can fake a smile, but your phone knows the truth. Depression can be detected from your smartphone sensor data by tracking the number of minutes you use the phone and your daily geographical locations, reports a small Northwestern Medicine study.

The more time you spend using your phone, the more likely you are depressed. The average daily usage for depressed individuals was about 68 minutes, while for non-depressed individuals it was about 17 minutes.

Spending most of your time at home and most of your time in fewer locations — as measured by GPS tracking — also are linked to depression. And, having a less regular day-to-day schedule, leaving your house and going to work at different times each day, for example, also is linked to depression.

Based on the phone sensor data, Northwestern scientists could identify people with depressive symptoms with 87 percent accuracy.

“The significance of this is we can detect if a person has depressive symptoms and the severity of those symptoms without asking them any questions,” said senior author David Mohr, director of the Center for Behavioral Intervention Technologies at Northwestern University Feinberg School of Medicine. “We now have an objective measure of behavior related to depression. And we’re detecting it passively. Phones can provide data unobtrusively and with no effort on the part of the user.”

The research could ultimately lead to monitoring people at risk of depression and enabling health care providers to intervene more quickly.

The study will be published July 15 in the Journal of Medical Internet Research.

The smart phone data was more reliable in detecting depression than daily questions participants answered about how sad they were feeling on a scale of 1 to 10. Their answers may be rote and often are not reliable, said lead author Sohrob Saeb, a postdoctoral fellow and computer scientist in preventive medicine at Feinberg.

“The data showing depressed people tended not to go many places reflects the loss of motivation seen in depression,” said Mohr, who is a clinical psychologist and professor of preventive medicine at Feinberg. “When people are depressed, they tend to withdraw and don’t have the motivation or energy to go out and do things.”

While the phone usage data didn’t identify how people were using their phones, Mohr suspects people who spent the most time on them were surfing the web or playing games, rather than talking to friends.

“People are likely, when on their phones, to avoid thinking about things that are troubling, painful feelings or difficult relationships,” Mohr said. “It’s an avoidance behavior we see in depression.”

Saeb analyzed the GPS locations and phone usage for 28 individuals (20 females and eight males, average age of 29) over two weeks. The sensor tracked GPS locations every five minutes.

To determine the relationship between phone usage and geographical location and depression, the subjects took a widely used standardized questionnaire measuring depression, the PHQ-9, at the beginning of the two-week study. The PHQ-9 asks about symptoms used to diagnose depression such as sadness, loss of pleasure, hopelessness, disturbances in sleep and appetite, and difficulty concentrating. Then, Saeb developed algorithms using the GPS and phone usage data collected from the phone, and correlated the results of those GPS and phone usage algorithms with the subjects’ depression test results.

Of the participants, 14 did not have any signs of depression and 14 had symptoms ranging from mild to severe depression.

The goal of the research is to passively detect depression and different levels of emotional states related to depression, Saeb said.

The information ultimately could be used to monitor people who are at risk of depression to, perhaps, offer them interventions if the sensor detected depression or to deliver the information to their clinicians.

Future Northwestern research will look at whether getting people to change those behaviors linked to depression improves their mood.

“We will see if we can reduce symptoms of depression by encouraging people to visit more locations throughout the day, have a more regular routine, spend more time in a variety of places or reduce mobile phone use,” Saeb said.

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This research was funded by research grants P20 MH090318 and K08 MH 102336 from the National Institute of Mental Health of the National Institutes of Health.

The Centers for Disease Control and Prevention’s November 28, 2014, Morbidity and Mortality Weekly Report (MMWR), highlighted that in 2010, 20% of all visits to primary care physicians included at least one of the following mental health indicators: depression screening, counseling, a mental health diagnosis or reason for visit, psychotherapy, or provision of a psychotropic drug. The percentage of mental health–related visits to primary care physicians increased with age through age 59 years and then stabilized. Approximately 6% of visits were for children that were 11 years old or younger and approximately 31% of visits were for adults aged 75 years or older were associated with mental health care. The data was obtained from the 2010 National Ambulatory Medical Care Survey, which can be found at http://www.cdc.gov/nchs/ahcd.htm

* A mental health visit was defined by at least one of the following: ordering or provision of depression screening, psychotherapy, or other mental health counseling; a mental health diagnosis or reason for visit; or a psychotropic medication that was ordered, supplied, administered, or continued at the visit. Mental health diagnosis, reason for visit, and psychotropic medications were based on certain categories. Source: Olfson M, Kroenke K, Wang S, Blanco C. Trends in office-based mental health care provided by psychiatrists and primary care physicians. J Clin Psychiatry 2014;75:247–53.

† Includes physicians in primary care specialties: general and family practice, internal medicine, pediatrics, and obstetrics/gynecology.

§ 95% confidence interval

In any given year, 1 in 10 adults in the U.S. are affected by depression. Depression is a brain disorder that affects how you feel, think, and act. People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.

Signs and symptoms include:

>      Persistent sad, anxious, or “empty” feelings

>      Feelings of hopelessness or pessimism

>      Feelings of guilt, worthlessness, or helplessness

>      Irritability, restlessness

>      Loss of interest in activities or hobbies once pleasurable, including sex

>      Fatigue and decreased energy

>      Difficulty concentrating, remembering details, and making decisions

>      Insomnia, early-morning wakefulness, or excessive sleeping

>      Overeating, or appetite loss

>      Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

>      Thoughts of suicide, suicide attempts

There are different treatment options that can help, which may include medication, therapy, or combination of both. With effective treatment, the symptoms of depression will gradually get better.

If you are in crisis or thinking about harming yourself, or know someone who is, tell someone who can help immediately.

>      Do not leave your friend or relative alone, and do not isolate yourself.

>      Call 911 or go to a hospital emergency room to get immediate help, or ask a friend or family member to help you do these things.

>      Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.

For more resources and information on depression and other mental health disorders, please visit:

Online Mental Health Screening

The Mental Health Association of Minnesota has partnered with Screening for Mental Health, Inc. to provide free online screening for mood and anxiety disorders. This anonymous online assessment screens for depression, bipolar disorder, generalized anxiety disorder, and post-traumatic stress disorder. This screening is not a substitute for a diagnosis, but it will help determine whether or not a consultation from a health professional would be helpful. If you want to follow-up with a health provider, but have limited or no health insurance, MHAM can help find a sliding fee clinic or other medical coverage options. To speak with an advocate, call 651-493-6634 or 800-862-1799.

https://mentalhealthmn.org/be-informed/education-programs/online-screening-for-mood-and-anxiety-disorders

Get Help. Get Well.

Get Help Get Well helps people understand what to expect when seeking mental health care for the first time. Get Help Get Well includes information on…

>      The first steps to obtaining care; healthcare providers to see initially; and factors to consider when seeking a healthcare provider.

>      What may occur in the initial appointment; questions that may be asked by the health professional; and questions the patient may want to ask their health provider

https://mentalhealthmn.org/be-informed/get-help-get-well

Depression and Bipolar Support Alliance

The Depression and Bipolar Support Alliance (DBSA) is the leading peer-directed national organization focusing on the two most prevalent mental health conditions, depression and bipolar disorder. DBSA provides online resources and peer support groups.

http://www.dbsalliance.org/site/PageServer?pagename=home

Support Groups in Minnesota

You are not alone out there. Utilize support groups to share mental health needs and concerns affecting your life and the lives of others.

MHAM Sponsored Support Groups: DBSA Support Groups (Depression & Bipolar Support Alliance)

https://mentalhealthmn.org/mental-health-advocacy/individual-advocacy/access-to-health-care-and-community-services/support-groups/dbsa-support-groups

Other Minnesota Support Groups and Activity Centers

https://mentalhealthmn.org/find-support/resource-list/support-groups-activity-centers/all-support-groups

National Institute of Mental Health

The National Institute of Mental Health (NIMH) provides the latest research and information on depression and other mental health conditions.

http://www.nimh.nih.gov/health/topics/depression/index.shtml

MentalHealth.gov

MentalHealth.gov provides information and resources on mental illness for people experiencing a mental health disorder, family and friends, and other members of the community.

http://www.mentalhealth.gov/index.html

In any given year, about 7% of the U.S. adult population experiences a major depressive episode (MDE). In a recent issue of The NSDUH Report from the Substance Abuse and Mental Health Services Administration looked at combined data from the 2008 to 2012 National Surveys on Drug Use and Health (NSDUH) that showed that more than one third of adults with past year MDE (38.3%) did not talk to a health professional or alternative service professional during the past 12 months. Of those who did seek help, 48% consulted with a health professional, 10.7% percent talked to both a health professional and an alternative service professional, and 2.9% talked to alternative service professional. The report suggests that primary care providers should consider using screening tools to identify patients that may be experiencing depression.

To view the The NSDUH Report: http://www.samhsa.gov/data/spotlight/spot133-major-depressive-episode-2014.pdf

For information on resources and the latest news and research on depression, please visit the MHAM website at https://mentalhealthmn.org/be-informed/mental-health-resources/depression

In Minnesota, individuals with serious mental illnesses lose 24 years of life expectancy compared to those without these disorders. Cardiovascular disease, diabetes, high blood pressure and cholesterol, and obesity contribute to this early mortality. However, many of these health risks can be prevented or managed by early detection, treatment, and healthy lifestyle changes. An integrated healthcare approach can effectively address these issues and improve the health outcomes for people with mental illnesses.

The following infographic from SAMHSA-HRSA Center for Integrated Health Solutions explores the problem and illustrates the impact on communities and individuals. Click on the image below to see the full infographic.

For people with serious mental illness (SMI) the risk for being overweight or obese is significant. Four out of five people with SMI are overweight or obese in the United States. According to the Centers for Disease Control and Prevention (CDC), being overweight or obese can increase your risk for coronary heart disease, type 2 diabetes, some cancers, hypertension, dyslipidemia, stroke, and other health conditions. A recent study, published in the New England Journal of Medicine, shows that tailored lifestyle programs for people with serious mental health conditions can be effective in achieving healthy weight loss.  

The study consisted of 291 participants from 10 outpatient psychiatric rehabilitation programs that were randomly assigned to an intervention group or control group. The study found that the intervention group that received regular weekly group exercise classes and individual/group weight management classes had significant weight loss compared to the control group that had basic information on nutrition and exercise at the beginning of the study.

After 18 months the participants in the intervention group:

• on average, lost 7 pounds more than the control group.
• 38% lost 5% or more of their initial weight, as compared to 23% for the control group.
•  nearly 1 in 5 participants lost 10% or more of their initial weight, as compared to 1 in 14 participants in the control group.

The study also found that the participants from the intervention group who were taking certain psychotropic medications known to cause weight gain still had significant weight loss as well. This study shows that when effective resources are provided, people with SMI can implement healthy lifestyle changes with good results, despite the many challenges that they face.

For more information on this study, please visit the National Institute of Mental Health website:  http://www.nimh.nih.gov/science-news/2013/nih-study-shows-people-with-serious-mental-illnesses-can-lose-weight.shtml

Also, please check out our wellness and recovery resources.

Antipsychotic medications can be effective in treating psychotic symptoms among people with schizophrenia or related disorders. Unfortunately, some commonly used antipsychotics are associated with serious metabolic side effects such as weight gain and heightened cholesterol levels. These health complications can lead to heart disease or diabetes.

In some circumstances, it may be possible for people experiencing metabolic side effects to switch to a different antipsychotic.  However, doctors are often reluctant to make changes in patient’s drug regimen when the current medication appears to keep the person’s psychotic symptoms under control.  When considering a switch to a new antipsychotic, doctors must perform a careful balancing act, weighing the possible benefit of reduced metabolic side effects against the possible risk of symptom relapse or medication failure.

In an effort to address such concerns, a National Institute of Mental Health (NIMH) has published research designed to determine if an antipsychotic medication switch could be made safely and without sacrificing the clinical stability of the participants.

The study enrolled people who were taking a commonly used antipsychotic and were experiencing serious metabolic side effects.  Half of the participants were assigned to continue taking their current medication and half of them were switched to an antipsychotic that was associated with fewer metabolic risks.  All participants were put on a diet and exercise program designed to reduce the risk of cardiovascular disease.

After 6 months, the researchers found that those who had switched antipsychotics had improved cholesterol levels and had lost more weight, on average, than those who had stayed with their original medication. In addition, those who had switched medication did not experience any more illness relapses or worsening of psychotic symptoms than those who stayed on their original medication.

However, participants who changed to a new antipsychotic were more likely to stop taking their medication compared to those who continued to take their original medication.  Almost 44 percent of those who switched antipsychotics discontinued their new medication, as compared to the 24.5 percent of those who were assigned to stay on their current medication. The study’s authors suggest that since both the participants and clinicians knew which drug the participant was taking, patients who switched antipsychotics may have felt uncomfortable about the change.  Participants also may have been more likely to discontinue their medication when doctors noticed the first signs of difficulties.

Among persons with serious mental illnesses such as schizophrenia, schizoaffective disorder, and bipolar affective disorder, the metabolic side effects associated with second-generation antipsychotics may contribute to early deaths.  As a 2006 report by the National Association of State Mental Health Program Directors notes, persons with serious mental illnesses die an average of 25 years earlier than members of the general population and are at an elevated risk of dying from diabetes and heart disease.  In response to the health crisis affecting those with serious mental illness, Minnesota has launched a branch of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 10 by 10 Wellness Campaign.  This program seeks to increase the life expectancy of persons with serious mental illness by 10 years in 10 years through developing measures by which to track the health of persons with mental illnesses, raising awareness among consumers and mental health professionals, and by encouraging psychiatrists and primary care physicians to talk with patients about health risks and tools for health management.

To learn more about incorporating physical wellness in mental health recovery, please check out Steps to Wellness and Take Charge on the MHAM website.

This article was contributed by Claire Jamison, a volunteer for MHAM.  

According to findings from the 2007 National Health Interview Survey (NHIS), approximately 38% of American adults used some form of complementary or alternative medicine (CAM) and spent about $33.9 billion on CAM services and products. The increased use of CAM shows that individuals are seeking ways to enhance their health and wellness; however, the effectiveness and safety of many CAM therapies are relatively unknown.

To gain a better understanding of the effectiveness and safety of CAM, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, sponsors and conducts research using scientific methods and advanced technologies to study CAM practices. On the NCCAM website, there are several health topics and studies that address CAM practices, including mental health. This information can help guide informed decision-making among individuals and healthcare professionals.

It’s important to talk to your doctor if you decide to use CAM practices, especially if you have existing health conditions, using prescription medications, or over-the-counter medications. The following tips, provided by NCCAM, can help you talk to your health care providers about CAM.

> When completing patient history forms, be sure to include all therapies and treatments you use. Make a list in advance.
> Tell your health care providers about all therapies or treatments—including over-the-counter and prescription medicines, as well as dietary and herbal supplements.
> Don’t wait for your providers to ask about your CAM use. Be proactive.
> If you are considering a new CAM therapy, ask your health care providers about its safety, effectiveness, and possible interactions with medications, both prescription and nonprescription. (Download the Steps to Wellness Medication Form to keep track of your medications, including dietary and herbal supplements)

For more information, please visit the NCCAM website at www.nccam.nih.gov

Which of these treatments is most effective?  This is a question that doesn’t always have a clear answer.  Antidepressants have become the most frequently prescribed drug in doctor’s offices and outpatient clinics today.  In fact, between 1996 and 2005 the number of people in the United States taking antidepressants has doubled in size.

In a recent study, “Psychotherapy Versus Second-Generation Antidepressants in the Treatment of Depression”, researchers attempted to find a more clear answer to this frequently asked question.  This study when compared to past research focused more on comparing the “newest” drugs (i.e. Paxil, Zoloft, and Prozac) to psychotherapy administered by a “qualified” provider.  A majority of previous studies were comparing older drugs to psychotherapy which left an incomplete picture of the comparative effectiveness.

This study was a meta-analysis, meaning they looked at data from 15 studies of similar topics.  In the process of choosing these 15 they had to eliminate studies that were using inadequate treatment methods. This would include studies that included untrained psychotherapists or variables that affected treatment quality such as:  switching of treatments, changing of dosages of medication and/or changing frequency of psychotherapy.  Another factor taken into consideration was the level of depression of the participants.  Depending on severity of depression (mild, moderate, or severe) outcomes and effectiveness of medication and psychotherapy may vary and treatment recommendations may differ.  To improve accuracy this study focused only on participants that were diagnosed with major depressive disorder.

The result of this study found that psychotherapy can be just as effective in the treatment of depression when compared to the newest of antidepressant medications. It was also noted that in the long run psychotherapy showed slightly better results.

So the question is; did they come up with a clear answer?  When comparing risks, benefits, and cost the course of treatment is ultimately up to the individual and their providers.  Some questions to discuss with your doctor might include:

• How severe are my symptoms? How long have I experienced these symptoms?  In what ways do they impair my goals for my health?  Other research has indicated that anti-depressants are most effective for depression that is severe and/or chronic.
• Are their side effects that are more concerning to me?
• What are barriers to me following a treatment?  Can I remember to take medications as directed?  How will I get to appointments for therapy?  Do I have a plan for what to do if I relapse?

We still need more research to be completed that focuses on the effectiveness of these treatments.  Depression today is the fourth leading cause of disability in the United States and it is predicted to be the second by 2020.  It is essential for people with mental illnesses to understand the facts so they can make educated decisions with their doctors about which treatments are most suitable to their specific needs.

This post was written by MHAM Intern Jahna Sandkamp.

The Food and Drug Administration (FDA) notified health care professionals and the public of medication error reports in which patients were given risperidone (Risperdal) instead of ropinirole (Requip) and vice versa. In some cases, individuals who took the wrong medication needed to be hospitalized. The FDA determined that the factors contributing to the confusion between the two products include: 1) similarities of both the brand (proprietary) and generic (established) names; 2) similarities of the container labels and carton packaging; 3) illegible handwriting on prescriptions; and 4) overlapping product characteristics, such as the drug strengths, dosage forms, and dosing intervals.

Individuals who take Requip, Risperdal, or their generic equivalents are reminded to take note of the name and appearance of their medication, know why they are taking it, and to ask questions when the medication appears different than what they expect. Healthcare professionals are reminded to clearly print or spell out the medication name on prescriptions and make certain their patients know the name of their prescribed medication and their reason for taking it.

For additional information on this FDA drug safety alert, please link to: http://www.fda.gov/Drugs/DrugSafety/ucm258805.htm