Use of a Mobile Health (mHealth) Platform for Remote Assessment of Suicidal Ideation, Depression, and Anxiety: A Longitudinal Retrospective Study

ABSTRACT Introduction There is growing support for the use of integrated measurement-based care to capture symptom data in real time so treatment providers can make informed decisions about intervention strategies for mental health problems, such as depression and anxiety, both of which are known to increase suicide. We examined the potential scalability and effectiveness of a mobile health (mHealth) application with integrated behavioral health functions to capture remote patient-reported measurement of suicidal ideation and overall symptoms of depression and anxiety. Methods This study was an observational retrospective review of deidentified patient data, including symptoms of suicidal ideation, depression, and anxiety as measured by the Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder 7 (GAD-7) scale, which were administered to and completed by patients on a smartphone or desktop application. After controlling for age, sex, and the presence of moderate versus severe symptoms at baseline, mean scores were analyzed with the Student's t-test. Results Of patients who took the PHQ-9 assessment at baseline and 8 weeks later (n = 764), the proportion who endorsed suicidal thinking decreased from 25% to 14.66% (p < 0.001) over 8 weeks. The mean PHQ-9 score was reduced from 14.69 (standard error [SE], 4.09) to 10.50 (SE, 5.94; p < 0.001), and a subset of individuals who continued use and took the PHQ-9 again at 24 weeks (n = 185) had a further decrease to 9.03 (SE, 7.09, p < 0.01). Although 21.62% of this subset still had suicidal thinking, the frequency of suicidal thoughts decreased. Of patients who took the GAD-7 at baseline and 8 weeks (n = 797) the mean score decreased from 14.20 (SE, 3.31) to 10.08 (SE, 5.55; p < 0.001) at 8 weeks and to 7.48 (SE, 6.54; p < 0.001) for a subset (n = 278) who continued use and took a GAD-7 at 24 weeks (n = 278). The sum of subgroup samples is larger than the whole because of instances of comorbid depression and anxiety. Conclusion Remote assessments within technology-supported integrated behavioral health care were feasible at scale. Change in symptoms could be observed at the individual and group level in real time, which may allow clinical teams to adjust treatments and improve outcomes. Prospective controlled studies are needed to determine what factors contribute to reductions in symptom severity.

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Development of the NeuroFlow Severity Score and Comparison With Validated Measures for Depression and Anxiety

10.1101/2021.02.04.21251158 ◽

2021 ◽

Author(s):

William Lynch ◽

Michael L. Platt ◽

Adam Pardes

Keyword(s):

Health Care ◽

Linear Regression ◽

Behavioral Health ◽

Severity Score ◽

Behavioral Health Care ◽

The United States ◽

Strong Positive Correlation ◽

Depression And Anxiety ◽

Measurement Based Care ◽

Patient Reported

ABSTRACTPurposeAlthough depression and anxiety are the leading causes of disability in the United States, respectively, fewer than half of people diagnosed with these conditions receive appropriate treatment, and fewer than 10% receive measurement-based care (MBC), which is defined as behavioral health care based on and adapted in response to patient outcomes data collected throughout treatment. The NeuroFlow platform was developed with the goal of making MBC easier to deliver and more accessible within integrated behavioral health care. Data from over 3,000 users of the NeuroFlow platform were used to develop the NeuroFlow Severity Score (NFSS), a potential new measure for depression and anxiety. To begin evaluating the potential usefulness of this new measure, NFSSs were compared with validated measures for depression and anxiety, the Personal Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale, and clinician assessment.MethodsThe NFSS platform is used to record patient-reported and passively collected data related to behavioral health. An artificial-intelligence derived algorithm was developed that condenses this large number of measurements into a single score for longitudinal tracking of an individual’s depression and anxiety symptoms. Linear regression and Bland-Altman analyses were used to evaluate relationships and differences between NFSS and PHQ-9 or GAD-7 scores from over 35,000 NeuroFlow users. The NFSS was also compared to assessment by a panel of expert clinicians for a subset of 250 individuals.ResultsLinear regression results showed a strong correlation between NFSS and PHQ-9 (r=.74, P<.001) and GAD-7 (r=.80, P<.001) changes. There was also a strong positive correlation between the NFSS and expert panel clinical assessment (r=.80-.84, P<.001). Bland-Altman analysis and evaluation of outliers on regression analysis, however, show that the NFSS has significant differences from the PHQ-9.ConclusionsClinicians can reliably use the NFSS as a proxy measure for monitoring symptoms of depression and anxiety longitudinally. The NFSS may identify at-risk individuals who are not identified by the PHQ-9. Further research is warranted to evaluate the sensitivity and specificity of the NFSS.

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Mobile Health Platform to Augment Integrated Behavioral Health Care: Pilot in a Large Health System (Preprint)

10.2196/preprints.36021 ◽

2021 ◽

Author(s):

Khatiya Moon ◽

Michael Sobolev ◽

Megan Grella ◽

George Alvarado ◽

Manish Sapra ◽

...

Keyword(s):

Health Care ◽

Behavioral Health ◽

Mobile Health ◽

Collaborative Care ◽

Behavioral Health Care ◽

Implementation Barriers ◽

Health Care Managers ◽

Improvement Rate ◽

Integrated Behavioral Health ◽

Care Managers

BACKGROUND Digital and mobile technologies have potential to improve the delivery and scale of integrated care models. OBJECTIVE We aimed to assess acceptability and feasibility, preliminary clinical outcomes, and implementation barriers of a mobile health platform used to augment an existing integrated behavioral health program. METHODS The mobile platform was used by three behavioral health care managers responsible for coordinating disease management in six primary care practices. 89 of 245 individuals (36%) who were referred by their PCP for behavioral health services consented to app-augmented behavioral health care. The mobile health platform functions included chat communication, monthly depression self-report assessments, and psychoeducational content. RESULTS The clinical improvement rate in our sample was 72% although follow-up assessments were only available for 49% of participants. At least one action in the mobile app was completed by 87% of participants (n=78; median=7; IQR=12, 0-130). Behavioral health care managers cited increased documentation burden and language as barriers to use. CONCLUSIONS Our pilot of mobile technology in collaborative care highlights important implementation barriers. Future research should systematically evaluate the implementation of digital and mobile health technology in collaborative care.

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Are Korean children free from suicide? Risk and protective factors within a transactional–ecological perspective

Journal of Child Health Care ◽

10.1177/1367493519874969 ◽

2019 ◽

Vol 24 (3) ◽

pp. 473-485

Author(s):

Yoon-Joo Cho

Keyword(s):

Suicidal Ideation ◽

Protective Factors ◽

School Violence ◽

Family Income ◽

Suicide Attempts ◽

Significant Variable ◽

Depression And Anxiety ◽

Korean Children ◽

The Mean ◽

Parental Figure

This study aimed to explore and identify the trends and risks, as well as the protective factors of child suicide in Korea. Data from the 10th year Korea Welfare Panel Study in 2016 were used. These data were collected from 458 fourth to sixth grade boys and girls in elementary schools. The results showed that the mean suicidal ideation score was 1.55, the suicide attempt rate was .9%, and the mean number of suicide attempts was .2. Suicidal ideation was more prevalent in children who reported the absence of a parental figure, frequent experiences of school violence, increased Internet use, and decreased guidance and supervision from parents. The presence of parental figure explained the greatest amount of variance. Logistic regression analysis with suicide attempts as the dependent variable demonstrated that family income was a significant variable. Regarding the mediating roles of depression and anxiety, Internet usage directly affected children’s suicidal ideation, while the experience of school violence, academic stress, and parents’ guidance and supervision affected suicidal ideation, which was mediated by the child’s depression and anxiety. Depression and anxiety had a positive impact on suicidal ideation. Based on these results, implications and interventions were suggested.

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Comparing Real-Time Self-Tracking and Device-Recorded Exercise Data in Subjects with Type 1 Diabetes

Applied Clinical Informatics ◽

10.1055/s-0038-1676458 ◽

2018 ◽

Vol 09 (04) ◽

pp. 919-926 ◽

Cited By ~ 2

Author(s):

Danielle Groat ◽

Hyo Kwon ◽

Maria Grando ◽

Curtiss Cook ◽

Bithika Thompson

Keyword(s):

Type 1 Diabetes ◽

Real Time ◽

Rate Of Change ◽

Data Sources ◽

Insulin Pump Therapy ◽

Exercise Behaviors ◽

Glucose Levels ◽

Patient Reported ◽

The Mean

Background Insulin therapy, medical nutrition therapy, and physical activity are required for the treatment of type 1 diabetes (T1D). There is a lack of studies in real-life environments that characterize patient-reported data from logs, activity trackers, and medical devices (e.g., glucose sensors) in the context of exercise. Objective The objective of this study was to compare data from continuous glucose monitor (CGM), wristband heart rate monitor (WHRM), and self-tracking with a smartphone application (app), iDECIDE, with regards to exercise behaviors and rate of change in glucose levels. Methods Participants with T1D on insulin pump therapy tracked exercise for 1 month with the smartphone app while WHRM and CGM recorded data in real time. Exercise behaviors tracked with the app were compared against WHRM. The rate of change in glucose levels, as recorded by CGM, resulting from exercise was compared between exercise events documented with the app and recorded by the WHRM. Results Twelve participants generated 277 exercise events. Tracking with the app aligned well with WHRM with respect to frequency, 3.0 (2.1) and 2.5 (1.8) days per week, respectively (p = 0.60). Duration had very high agreement, the mean duration from the app was 65.6 (55.2) and 64.8 (54.9) minutes from WHRM (p = 0.45). Intensity had a low concordance between the data sources (Cohen's kappa = 0.2). The mean rate of change of glucose during exercise was –0.27 mg/(dL*min) and was not significantly different between data sources or intensity (p = 0.21). Conclusion We collated and analyzed data from three heterogeneous sources from free-living participants. Patients' perceived intensity of exercise can serve as a surrogate for exercise tracked by a WHRM when considering the glycemic impact of exercise on self-care regimens.

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HSR19-103: Burden of Self-Reported Mental Health Among Women With Cervical Cancer (CC) in the United States

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7190 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-103

Author(s):

Chizoba Nwankwo ◽

Michael J. Doane

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Mental Health Services ◽

Propensity Score ◽

Health Services ◽

The United States ◽

Depression And Anxiety ◽

Symptoms Of Depression ◽

The Past ◽

Patient Reported

Background: Globally, CC is the fourth most common cancer in women, with 569,847 new cases and 311,365 deaths from CC reported in 2018. Little is known about the burden of living with CC, especially related to mental health. This study examined patient-reported outcomes, including symptoms of depression and anxiety, amongst women with and without a diagnosis of CC. Methods: Data were aggregated from the 2016–2018 U.S. National Health and Wellness Surveys, a nationally representative, self-administered, internet-based survey of adults (N=247,484). Women who reported a physician-diagnosis of CC were matched 1:1 by propensity scores to a sample of women who did not report any cancer diagnoses. Propensity score matching was conducted using the following sociodemographic characteristics: age, race, possession of health insurance, smoking status, comorbidity status, body mass index, income, and year of survey completion. Bivariate analyses (ie, chi-square and t-tests) assessed differences in mental health outcomes between these 2 matched groups of female respondents. Outcomes included the following: (1) depressive severity via the Patient Health Questionnaire (PHQ-9), (2) suicidal ideation via the PHQ-9 (ie, thoughts of being better off dead on several days or more during the past 2 weeks), (3) anxiety severity via the Generalized Anxiety Disorder 7-Item Scale (GAD-7), and (4) healthcare resource use for mental health services (ie, visits to psychologists and psychiatrists during past 6 months). Results: Analyses of the propensity score matched sample of 1,044 women with a CC diagnosis versus 1,044 without a CC diagnosis showed that CC respondents reported significantly more severe scores of both depression (7.3 vs 6.0; P<.001) and anxiety (5.7 vs 4.7; P<.001). Although not statistically significant, a numerically greater proportion of CC respondents reported suicidal ideation during the past 2 weeks (19.0% vs 16.0%; P=.158). Respondents with CC were marginally more likely to visit a psychologist (8.6% vs 6.4%; P=.056) and were significantly more likely to visit a psychiatrist (8.6% vs 6.2%; P=.037) at least once during the prior 6 months than respondents without CC. Conclusions: CC is associated with mental health burden, including more severe symptoms of depression and anxiety as well as greater use of mental health services. This study highlights the likely impact of CC for both patients as well as the healthcare system

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Development of a Severity Score and Comparison With Validated Measures for Depression and Anxiety: Validation Study (Preprint)

10.2196/preprints.30313 ◽

2021 ◽

Author(s):

William Lynch ◽

Michael L Platt ◽

Adam Pardes

Keyword(s):

Health Care ◽

Linear Regression ◽

Behavioral Health ◽

Severity Score ◽

Behavioral Health Care ◽

Strong Positive Correlation ◽

Depression And Anxiety ◽

Measurement Based Care ◽

Severity Scores ◽

Patient Reported

BACKGROUND Less than 10% of the individuals seeking behavioral health care receive measurement-based care (MBC). Technology has the potential to implement MBC in a secure and efficient manner. To test this idea, a mobile health (mHealth) platform was developed with the goal of making MBC easier to deliver by clinicians and more accessible to patients within integrated behavioral health care. Data from over 3000 users of the mHealth platform were used to develop an output severity score, a robust screening measure for depression and anxiety. OBJECTIVE The aim of this study is to compare severity scores with scores from validated assessments for depression and anxiety and scores from clinician review to evaluate the potential added value of this new measure. METHODS The severity score uses patient-reported and passively collected data related to behavioral health on an mHealth platform. An artificial intelligence–derived algorithm was developed that condenses behavioral health data into a single, quantifiable measure for longitudinal tracking of an individual’s depression and anxiety symptoms. Linear regression and Bland-Altman analyses were used to evaluate the relationships and differences between severity scores and Personal Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) scores from over 35,000 mHealth platform users. The severity score was also compared with a review by a panel of expert clinicians for a subset of 250 individuals. RESULTS Linear regression results showed a strong correlation between the severity score and PHQ-9 (r=0.74; P<.001) and GAD-7 (r=0.80; P<.001) changes. A strong positive correlation was also found between the severity score and expert panel clinical review (r=0.80-0.84; P<.001). However, Bland-Altman analysis and the evaluation of outliers on regression analysis showed that the severity score was significantly different from the PHQ-9. CONCLUSIONS Clinicians can reliably use the mHealth severity score as a proxy measure for screening and monitoring behavioral health symptoms longitudinally. The severity score may identify at-risk individuals who are not identified by the PHQ-9. Further research is warranted to evaluate the sensitivity and specificity of the severity score.

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Depression, anxiety, and suicidal ideation in young adults 5 years after undergoing bariatric surgery as adolescents

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-020-01024-0 ◽

2020 ◽

Author(s):

Kajsa Järvholm ◽

Torsten Olbers ◽

Markku Peltonen ◽

Claude Marcus ◽

Carl-Erik Flodmark ◽

...

Keyword(s):

Mental Health ◽

Bariatric Surgery ◽

Young Adults ◽

Suicidal Ideation ◽

Depression And Anxiety ◽

Level Of Evidence ◽

Clinical Trial Registration ◽

Symptoms Of Depression ◽

The Mean

Abstract Purpose Metabolic and bariatric surgery (MBS) is increasingly used in adolescents. The aim was to explore symptoms of depression and anxiety in young adults over 5 years’ follow-up after undergoing MBS. Methods Beck Depression Inventory-2 and the Beck Anxiety Inventory were used to assess symptoms of depression and anxiety in 62 patients 1, 2, and 5 years after having Roux-en-Y gastric bypass at 13–18 years of age. Mental health, eating-related problems, and weight outcomes were tested for association with suicidal ideation at the 5-year follow-up. Results At the 5-year follow-up, the mean score for depression was 11.4 (± 12.4), indicating minimal symptoms of depression. The mean score for anxiety was 12.82 (± 11.50), indicating mild anxiety symptoms. Still, several participants reported moderate or severe symptoms of depression (26%) and anxiety (32%). Women reported more symptoms than men (P = 0.03 and 0.04). No significant changes were found in self-reported symptoms of depression and anxiety between the 1-year and the 5-year follow-up (P = 0.367 and 0.934). Suicidal ideation was reported by 16% at the 5-year follow-up. Participants reporting suicidal ideation had lost significantly less excess weight than participants without suicidal ideation (P = 0.009). Conclusion Five years after adolescent MBS, a substantial minority still struggles with mental health issues, and women are more burdened than men. Our results indicate an association between less optimal weight loss and suicidal ideation 5 years after MBS. The findings emphasize the importance of offering long-term follow-up and mental health treatment several years after MBS. Level of evidence Level III, cohort study. Clinical trial registration The study is registered with ClinicalTrials.gov (NCT00289705). First posted February 10, 2006.

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