Migration of digital functional capacity assessments from device resident to cloud-based delivery: Development and convergent validity.

Decentralized clinical trials are leading to rapid changes in assessment technology, including an expansion of interest in remote delivery. As technology changes, some of the updates include migration to fully cloud-based software and data management, with attendant differences in hardware, response modalities, and modifications in the level of tester engagement. It is rare to see systematic descriptions of the process of migration and upgrading of technology-related assessments. We present comparative data on successive generations of two widely used functional capacity measures, the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the Functional Capacity Assessment and Training System (FUNSAT). Four samples of healthy older individuals completed either the original device-resident, computer-administered versions, or cloud-based, tablet-delivered versions of these tasks. For the VRFCAT, performance and correlations with age were similar across versions, although performance was slightly (5 %) faster with iPad delivery. For the FUNSAT, performance and correlations with age and cognitive task scores were generally similar across versions for English Speakers, though there were some differences related to the testing language for the cloud-based version. These results support the feasibility of migrating digital assessments to cloud-based delivery and substantiate fundamental similarity across delivery strategies.

Measuring Environmental and Behavioral Drivers of Chronic Diseases Using Smartphone-Based Digital Phenotyping: Intensive Longitudinal Observational mHealth Substudy Embedded in 2 Prospective Cohorts of Adults.

BACKGROUND: Previous studies investigating environmental and behavioral drivers of chronic disease have often had limited temporal and spatial data coverage. Smartphone-based digital phenotyping mitigates the limitations of these studies by using intensive data collection schemes that take advantage of the widespread use of smartphones while allowing for less burdensome data collection and longer follow-up periods. In addition, smartphone apps can be programmed to conduct daily or intraday surveys on health behaviors and psychological well-being. OBJECTIVE: The aim of this study was to investigate the feasibility and scalability of embedding smartphone-based digital phenotyping in large epidemiological cohorts by examining participant adherence to a smartphone-based data collection protocol in 2 ongoing nationwide prospective cohort studies. METHODS: Participants (N=2394) of the Beiwe Substudy of the Nurses' Health Study 3 and Growing Up Today Study were followed over 1 year. During this time, they completed questionnaires every 10 days delivered via the Beiwe smartphone app covering topics such as emotions, stress and enjoyment, physical activity, access to green spaces, pets, diet (vegetables, meats, beverages, nuts and dairy, and fruits), sleep, and sitting. These questionnaires aimed to measure participants' key health behaviors to combine them with objectively assessed high-resolution GPS and accelerometer data provided by participants during the same period. RESULTS: Between July 2021 and June 2023, we received 11.1 TB of GPS and accelerometer data from 2394 participants and 23,682 survey responses. The average follow-up time for each participant was 214 (SD 148) days. During this period, participants provided an average of 14.8 (SD 5.9) valid hours of GPS data and 13.2 (SD 4.8) valid hours of accelerometer data. Using a 10-hour cutoff, we found that 51.46% (1232/2394) and 53.23% (1274/2394) of participants had >50% of valid data collection days for GPS and accelerometer data, respectively. In addition, each participant submitted an average of 10 (SD 11) surveys during the same period, with a mean response rate of 36% across all surveys (SD 17%; median 41%). After initial processing of GPS and accelerometer data, we also found that participants spent an average of 14.6 (SD 7.5) hours per day at home and 1.6 (SD 1.6) hours per day on trips. We also recorded an average of 1046 (SD 1029) steps per day. CONCLUSIONS: In this study, smartphone-based digital phenotyping was used to collect intensive longitudinal data on lifestyle and behavioral factors in 2 well-established prospective cohorts. Our assessment of adherence to smartphone-based data collection protocols over 1 year suggests that adherence in our study was either higher or similar to most previous studies with shorter follow-up periods and smaller sample sizes. Our efforts resulted in a large dataset on health behaviors that can be linked to spatial datasets to examine environmental and behavioral drivers of chronic disease.

"Anything that would help is a positive development": feasibility, tolerability, and user experience of smartphone-based digital phenotyping for people with and without type 2 diabetes.

Background: Digital phenotyping, the in-situ collection of passive (phone sensor) and active (daily surveys) data using a digital device, may provide new insights into the complex relationship between daily behaviour and mood for people with type 2 diabetes. However, there are critical knowledge gaps regarding its use in people with type 2 diabetes. This study assessed feasibility, tolerability, and user experience of digital phenotyping in people with and without type 2 diabetes after participation in a 2-month digital phenotyping study in Ireland. At study completion, participants rated methodology elements from "not a problem" to a "serious problem" on a 5-point scale and reported their comfort with the potential future use of digital phenotyping in healthcare, with space for qualitative expansion. Results: Eighty-two participants completed baseline. Attrition was 18.8%. Missing data ranged from 9-44% depending on data stream. Sixty-eight participants (82.9%) completed the user experience questionnaire (51.5% with type 2 diabetes; 61.8% female; median age-group 50-59). Tolerability of digital phenotyping was high, with "not a problem" being selected 76.5%-89.7% of the time across questions. People with type 2 diabetes (93.9%) were significantly more likely to be comfortable with their future healthcare provider having access to their digital phenotyping data than those without (53.1%), χ2 (1) = 14.01, p = < .001. Free text responses reflected a range of positive and negative experiences with the study methodology. Conclusions: An uncompensated, 2-month digital phenotyping study was feasible among people with and without diabetes, with low attrition and reasonable missing data rates. Participants found digital phenotyping to be acceptable, and even enjoyable. The potential benefits of digital phenotyping for healthcare may be more apparent to people with type 2 diabetes than the general population. Supplementary Information: The online version contains supplementary material available at 10.1186/s44247-024-00116-6.

Bridging the mental health gap: The scope, challenges, and future of digital psychiatry in India.

The mental health burden in India is increasing at unprecedented rates. The increased demand for mental health care and the undersupply of services has widened the treatment gap. Due to several factors, such as increasing service costs and the circumstances surrounding the COVID-19 pandemic, India has witnessed an inclination toward using digital mental health solutions to overcome the treatment gap. Drawing from the collective evidence and experience in implementing mental health solutions using digital phenotyping and smartphone app-based care delivery in India, we define the scope, potential, and challenges of implementing synchronous and asynchronous digital mental health solutions that can serve as a template for improving global mental health.

Associations between keystroke and stylus metadata and depressive symptoms in adolescents.

BACKGROUND: Adolescents often experience a heightened incidence of depressive symptoms, which can persist without early intervention. However, adolescents often struggle to identify depressive symptoms, and even when they are aware of these symptoms, seeking help is not always their immediate response. This study aimed to explore the relationship between passively collected digital data, specifically keystroke and stylus data collected via mobile devices, and the manifestation of depressive symptoms. METHODS: A total of 927 first-year middle school students from schools in Seoul solved Korean language and math problems. Throughout this study, 77 types of keystroke and stylus data were collected, including parameters such as the number of key presses, tap pressure, stroke speed, and stroke acceleration. Depressive symptoms were measured using the self-rated Patient Health Questionnaire-9 (PHQ-9). RESULTS: Multiple regression analysis highlighted the significance of stroke length, speed, and acceleration, the average y-coordinate, the tap pressure, and the number of incorrect answers in relation to PHQ-9 scores. The keystroke and stylus metadata were able to reflect mood, energy, cognitive abilities, and psychomotor symptoms among adolescents with depressive symptoms. CONCLUSIONS: This study demonstrates the potential of automatically collected data during school exams or classes for the early screening of clinical depressive symptoms in students. This study has the potential to serve as a cornerstone in the development of digital data frameworks for the early detection of depressive symptoms in adolescents.

A template and tutorial for preregistering studies using passive smartphone measures.

Passive smartphone measures hold significant potential and are increasingly employed in psychological and biomedical research to capture an individual's behavior. These measures involve the near-continuous and unobtrusive collection of data from smartphones without requiring active input from participants. For example, GPS sensors are used to determine the (social) context of a person, and accelerometers to measure movement. However, utilizing passive smartphone measures presents methodological challenges during data collection and analysis. Researchers must make multiple decisions when working with such measures, which can result in different conclusions. Unfortunately, the transparency of these decision-making processes is often lacking. The implementation of open science practices is only beginning to emerge in digital phenotyping studies and varies widely across studies. Well-intentioned researchers may fail to report on some decisions due to the variety of choices that must be made. To address this issue and enhance reproducibility in digital phenotyping studies, we propose the adoption of preregistration as a way forward. Although there have been some attempts to preregister digital phenotyping studies, a template for registering such studies is currently missing. This could be problematic due to the high level of complexity that requires a well-structured template. Therefore, our objective was to develop a preregistration template that is easy to use and understandable for researchers. Additionally, we explain this template and provide resources to assist researchers in making informed decisions regarding data collection, cleaning, and analysis. Overall, we aim to make researchers' choices explicit, enhance transparency, and elevate the standards for studies utilizing passive smartphone measures.

Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study.

BACKGROUND: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users' perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user's concerns and the challenges they experience using the app will facilitate adoption and continued engagement. OBJECTIVE: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. METHODS: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. RESULTS: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. CONCLUSIONS: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area.

Beyond Step Count: Are We Ready to Use Digital Phenotyping to Make Actionable Individual Predictions in Psychiatry?

Some models for mental disorders or behaviors (eg, suicide) have been successfully developed, allowing predictions at the population level. However, current demographic and clinical variables are neither sensitive nor specific enough for making individual actionable clinical predictions. A major hope of the "Decade of the Brain" was that biological measures (biomarkers) would solve these issues and lead to precision psychiatry. However, as models are based on sociodemographic and clinical data, even when these biomarkers differ significantly between groups of patients and control participants, they are still neither sensitive nor specific enough to be applied to individual patients. Technological advances over the past decade offer a promising approach based on new measures that may be essential for understanding mental disorders and predicting their trajectories. Several new tools allow us to continuously monitor objective behavioral measures (eg, hours of sleep) and densely sample subjective measures (eg, mood). The promise of this approach, referred to as digital phenotyping, was recognized almost a decade ago, with its potential impact on psychiatry being compared to the impact of the microscope on biological sciences. However, despite the intuitive belief that collecting densely sampled data (big data) improves clinical outcomes, recent clinical trials have not shown that incorporating digital phenotyping improves clinical outcomes. This viewpoint provides a stepwise development and implementation approach, similar to the one that has been successful in the prediction and prevention of cardiovascular disease, to achieve clinically actionable predictions in psychiatry.

Evaluating speech latencies during structured psychiatric interviews as an automated objective measure of psychomotor slowing.

We sought to derive an objective measure of psychomotor slowing from speech analytics during a psychiatric interview to avoid potential burden of dedicated neurophysiological testing. Speech latency, which reflects response time between speakers, shows promise from the literature. Speech data was obtained from 274 subjects with a diagnosis of bipolar I depression enrolled in a randomized, doubleblind, 6-week phase 2 clinical trial. Audio recordings of structured Montgomery-Åsberg Depression Rating Scale (MADRS) interviews at 6 time points were examined (k = 1,352). We evaluated speech latencies, and other aspects of speech, for temporal stability, convergent validity, sensitivity/responsivity to clinical change, and generalization across seven socio-linguistically diverse countries. Speech latency was minimally associated with demographic features, and explained nearly a third of the variance in depression (categorically defined). Speech latency significantly decreased as depression symptoms improved over time, explaining nearly 20 % of variance in depression remission. Classification for differentiating people with versus without concurrent depression was high (AUCs > 0.85) both cross-sectionally and longitudinally. Results replicated across countries. Other speech features offered modest incremental contribution. Neurophysiological speech parameters with face validity can be derived from psychiatric interviews without the added patient burden of additional testing.

Enrichment using speech latencies improves treatment effect size in a clinical trial of bipolar depression.

Clinical trials in depression lack objective measures. Speech latencies are an objective measure of psychomotor slowing with face validity and empirical support. 'Turn latency' is the response time between speakers. Retrospective analysis was carried-out on the utility of turn latencies as an enrichment tool in a clinical trial of bipolar I depression. Speech data was obtained from 274 participants during 1,352 Montgomery-Åsberg Depression Rating Scale (MADRS) recordings in a randomized, placebo controlled, 6-week clinical trial of SEP-4199 (200 mg or 400 mg). Post-randomization turn latencies were compared between patients with moderate to severe depression and patients whose depression had remitted. A cutoff was determined and applied to turn latencies pre-randomization to classify individuals into two groups: Speech Latencies Slow (SL-Slow) and Speech Latencies Normal (SL-Normal). At week 6, SL-Slow (N = 172) showed significant separation in MADRS scores between placebo and treatment arms. SL-Normal (N = 102) showed larger MADRS improvements and no significant separation between placebo and treatment arms. Excluding SL-Normal increased primary outcome effect size by 52 % and 100 % for the treatment arms. Turn latencies are an objective measure available from standard clinical assessments and may assess the severity of symptoms more accurately and screen out placebo responders.

Transforming Digital Phenotyping Raw Data Into Actionable Biomarkers, Quality Metrics, and Data Visualizations Using Cortex Software Package: Tutorial.

As digital phenotyping, the capture of active and passive data from consumer devices such as smartphones, becomes more common, the need to properly process the data and derive replicable features from it has become paramount. Cortex is an open-source data processing pipeline for digital phenotyping data, optimized for use with the mindLAMP apps, which is used by nearly 100 research teams across the world. Cortex is designed to help teams (1) assess digital phenotyping data quality in real time, (2) derive replicable clinical features from the data, and (3) enable easy-to-share data visualizations. Cortex offers many options to work with digital phenotyping data, although some common approaches are likely of value to all teams using it. This paper highlights the reasoning, code, and example steps necessary to fully work with digital phenotyping data in a streamlined manner. Covering how to work with the data, assess its quality, derive features, and visualize findings, this paper is designed to offer the reader the knowledge and skills to apply toward analyzing any digital phenotyping data set. More specifically, the paper will teach the reader the ins and outs of the Cortex Python package. This includes background information on its interaction with the mindLAMP platform, some basic commands to learn what data can be pulled and how, and more advanced use of the package mixed with basic Python with the goal of creating a correlation matrix. After the tutorial, different use cases of Cortex are discussed, along with limitations. Toward highlighting clinical applications, this paper also provides 3 easy ways to implement examples of Cortex use in real-world settings. By understanding how to work with digital phenotyping data and providing ready-to-deploy code with Cortex, the paper aims to show how the new field of digital phenotyping can be both accessible to all and rigorous in methodology.

Understanding Alcohol Consumption and Its Antecedents and Consequences in Daily Life: The Why and the How.

Most of the scientific research on alcohol consumption behavior in humans is laboratory-based, as reflected by the ratio of laboratory vs. real-life contributions to this handbook. Studies in daily life, although having a long history in addiction research (Shiffman et al., Ann Behav Med 16:203-209, 1994), are in the minority. This is surprising, given that patients with substance use disorders are suffering in daily life and not in the laboratory setting. In other words, drinking patterns and symptoms of alcohol use disorder evolve not in the lab but in daily life, where patients show difficulties in limiting their alcohol intake accompanied with all kinds of related problems. The ultimate goal of all interventions, independent of being tailored toward restricted drinking or abstinence, is again an altered behavior in real life. Translated to practice, patients' behavior in the lab may not translate to daily life, often showing minimal ecological validity. Therefore, we have to question to which degree lab-based research findings translate into daily life. Fortunately, the current digital revolution provided us with more and more tools, enabling us to monitor, analyze, and change behavior in human everyday life. Our chapter does not intend to give a comprehensive overview of the daily life research on alcohol consumption over the last few decades as others do (Morgenstern et al., Alcohol Res Curr Rev 36:109, 2014; Piasecki, Alcohol Clin Exp Res 43:564-577, 2019; Shiffman, Psychol Asses 21:486-497, 2009; Votaw and Witkiewitz, Clin Psychol Sci 9:535-562, 2021; Wray et al., Alcohol Res Curr Rev 36:19-27, 2014). Instead, we aim at the following: first, to highlight the key advantages of ecological momentary assessment to motivate scientists to add daily life research components to their laboratory research and, second, to provide some guidance on how to begin with daily life research.

Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study.

BACKGROUND: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. OBJECTIVE: This study leverages adolescents' everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. METHODS: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent's person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. RESULTS: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. CONCLUSIONS: This study leverages depressed adolescents' everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43931.

The Role of Defeatist Performance Beliefs in State Fluctuations of Negative Symptoms in Schizophrenia Measured in Daily Life via Ecological Momentary Assessment.

BACKGROUND AND HYPOTHESIS: The Cognitive Model of Negative Symptoms is a prominent model that posits that defeatist performance beliefs (DPB) are a key psychological mechanism underlying negative symptoms in those with schizophrenia (SZ). However, the ecological validity of the model has not been established, and temporally specific evaluations of the model's hypotheses have not been conducted. This study tested the model's key hypotheses in real-world environments using ecological momentary assessment (EMA). STUDY DESIGN: Fifty-two outpatients with SZ and 55 healthy controls (CN) completed 6 days of EMA. Multilevel models examined concurrent and time-lagged associations between DPB and negative symptoms in daily life. STUDY RESULTS: SZ displayed greater DPB in daily life than CN. Furthermore, greater DPB were associated with greater concurrently assessed negative symptoms (anhedonia, avolition, and asociality) in daily life. Time-lagged analyses indicated that in both groups, greater DPB at time t led to elevations in negative symptoms (anhedonia, avolition, or asociality) at t + 1 above and beyond the effects of negative symptoms at time t. CONCLUSIONS: Results support the ecological validity of the Cognitive Model of Negative Symptoms and identify a temporally specific association between DPB and subsequent negative symptoms that is consistent with the model's hypotheses and a putative mechanistic pathway in Cognitive Behavioral Therapy for negative symptoms. Findings suggest that DPB are a psychological factor contributing to negative symptoms in real-world environments. Implications for measuring DPB in daily life and providing just-in-time mobile health-based interventions to target this mechanism are discussed.

Toward Next-Generation Phenomics: Precision Medicine, Spaceflight, Astronaut Omics, and Beyond.

Large investments over many decades in genomics in diverse fields such as precision medicine, plant biology, and recently, in space life science research and astronaut omics were not accompanied by a commensurate focus on high-throughput and granular characterization of phenotypes, thus resulting in a "phenomics lag" in systems science. There are also limits to what can be achieved through increases in sample sizes in genotype-phenotype association studies without commensurate advances in phenomics. These challenges beg a question. What might next-generation phenomics look like, given that the Internet of Things and artificial intelligence offer prospects and challenges for high-throughput digital phenotyping as a key component of next-generation phenomics? While attempting to answer this question, I also reflect on governance of digital technology and next-generation phenomics. I argue that it is timely to broaden the technical discourses through a lens of political theory. In this context, this analysis briefly engages with the recent book "The Earthly Community: Reflections on the Last Utopia," written by the historian and political theorist Achille Mbembe. The question posed by the book, "Will we be able to invent different modes of measuring that might open up the possibility of a different aesthetics, a different politics of inhabiting the Earth, of repairing and sharing the planet?" is directly relevant to healing of human diseases in ways that are cognizant of the interdependency of human and nonhuman animal health, and critical and historically informed governance of digital technologies that promise to benefit next-generation phenomics.

ScAnalyzer: an image processing tool to monitor plant disease symptoms and pathogen spread in Arabidopsis thaliana leaves.

BACKGROUND: Plants are known to be infected by a wide range of pathogenic microbes. To study plant diseases caused by microbes, it is imperative to be able to monitor disease symptoms and microbial colonization in a quantitative and objective manner. In contrast to more traditional measures that use manual assignments of disease categories, image processing provides a more accurate and objective quantification of plant disease symptoms. Besides monitoring disease symptoms, computational image processing provides additional information on the spatial localization of pathogenic microbes in different plant tissues. RESULTS: Here we report on an image analysis tool called ScAnalyzer to monitor disease symptoms and bacterial spread in Arabidopsis thaliana leaves. Thereto, detached leaves are assembled in a grid and scanned, which enables automated separation of individual samples. A pixel color threshold is used to segment healthy (green) from chlorotic (yellow) leaf areas. The spread of luminescence-tagged bacteria is monitored via light-sensitive films, which are processed in a similar manner as the leaf scans. We show that this tool is able to capture previously identified differences in susceptibility of the model plant A. thaliana to the bacterial pathogen Xanthomonas campestris pv. campestris. Moreover, we show that the ScAnalyzer pipeline provides a more detailed assessment of bacterial spread within plant leaves than previously used methods. Finally, by combining the disease symptom values with bacterial spread values from the same leaves, we show that bacterial spread precedes visual disease symptoms. CONCLUSION: Taken together, we present an automated script to monitor plant disease symptoms and microbial spread in A. thaliana leaves. The freely available software ( https://github.com/MolPlantPathology/ScAnalyzer ) has the potential to standardize the analysis of disease assays between different groups.

Prospective Follow-Up of Adolescents With and at Risk for Depression: Protocol and Methods of the Identifying Depression Early in Adolescence Risk Stratified Cohort Longitudinal Assessments.

Objective: To present the protocol and methods for the prospective longitudinal assessments-including clinical and digital phenotyping approaches-of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study, which comprises Brazilian adolescents stratified at baseline by risk of developing depression or presence of depression. Method: Of 7,720 screened adolescents aged 14 to 16 years, we recruited 150 participants (75 boys, 75 girls) based on a composite risk score: 50 with low risk for developing depression (LR), 50 with high risk for developing depression (HR), and 50 with an active untreated major depressive episode (MDD). Three annual follow-up assessments were conducted, involving clinical measures (parent- and adolescent-reported questionnaires and psychiatrist assessments), active and passive data sensing via smartphones, and neurobiological measures (neuroimaging and biological material samples). Retention rates were 96% (Wave 1), 94% (Wave 2), and 88% (Wave 3), with no significant differences by sex or group (p > .05). Participants highlighted their familiarity with the research team and assessment process as a motivator for sustained engagement. Discussion: This protocol relied on novel aspects, such as the use of a WhatsApp bot, which is particularly pertinent for low- to-middle-income countries, and the collection of information from diverse sources in a longitudinal design, encompassing clinical data, self-reports, parental reports, Global Positioning System (GPS) data, and ecological momentary assessments. The study engaged adolescents over an extensive period and demonstrated the feasibility of conducting a prospective follow-up study with a risk-enriched cohort of adolescents in a middle-income country, integrating mobile technology with traditional methodologies to enhance longitudinal data collection.

This article details the study protocol and methods used in the longitudinal assessment of 150 Brazilian teenagers with depression and at risk for depression as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo). Over 3 years, the authors collected clinical and digital data using innovative mobile technology, including a WhatsApp bot. Most adolescents participated in all the study phases, showing feasibility of prospective follow-up in a middle-income country. This approach allowed for a deeper understanding of depression in young populations, particularly in areas where mental health research is scarce.

Leveraging Social Media to Predict COVID-19-Induced Disruptions to Mental Well-Being Among University Students: Modeling Study.

BACKGROUND: Large-scale crisis events such as COVID-19 often have secondary impacts on individuals' mental well-being. University students are particularly vulnerable to such impacts. Traditional survey-based methods to identify those in need of support do not scale over large populations and they do not provide timely insights. We pursue an alternative approach through social media data and machine learning. Our models aim to complement surveys and provide early, precise, and objective predictions of students disrupted by COVID-19. OBJECTIVE: This study aims to demonstrate the feasibility of language on private social media as an indicator of crisis-induced disruption to mental well-being. METHODS: We modeled 4124 Facebook posts provided by 43 undergraduate students, spanning over 2 years. We extracted temporal trends in the psycholinguistic attributes of their posts and comments. These trends were used as features to predict how COVID-19 disrupted their mental well-being. RESULTS: The social media-enabled model had an F1-score of 0.79, which was a 39% improvement over a model trained on the self-reported mental state of the participant. The features we used showed promise in predicting other mental states such as anxiety, depression, social, isolation, and suicidal behavior (F1-scores varied between 0.85 and 0.93). We also found that selecting the windows of time 7 months after the COVID-19-induced lockdown presented better results, therefore, paving the way for data minimization. CONCLUSIONS: We predicted COVID-19-induced disruptions to mental well-being by developing a machine learning model that leveraged language on private social media. The language in these posts described psycholinguistic trends in students' online behavior. These longitudinal trends helped predict mental well-being disruption better than models trained on correlated mental health questionnaires. Our work inspires further research into the potential applications of early, precise, and automatic warnings for individuals concerned about their mental health in times of crisis.

The Potential for Digital Phenotyping in Understanding Mindfulness App Engagement Patterns: A Pilot Study.

Background: Low app engagement is a central barrier to digital mental health efficacy. With mindfulness-based mental health apps growing in popularity, there is a need for new understanding of factors influencing engagement. This study utilized digital phenotyping to understand real-time patterns of engagement around app-based mindfulness. Different engagement metrics are presented that measure both the total number of app-based activities participants completed each week, as well as the proportion of days that participants engaged with the app each week. Method: Data were derived from two iterations of a four-week study exploring app engagement in college students (n = 169). This secondary analysis investigated the relationships between general and mindfulness-based app engagement with passive data metrics (sleep duration, home time, and screen duration) at a weekly level, as well as the relationship between demographics and engagement. Additional clinically focused analysis was performed on three case studies of participants with high mindfulness activity completion. Results: Demographic variables such as gender, race/ethnicity, and age lacked a significant association with mindfulness app-based engagement. Passive data variables such as sleep and screen duration were significant predictors for different metrics of general and mindfulness-based app engagement at a weekly level. There was a significant interaction effect for screen duration between the number of mindfulness activities completed and whether or not the participant received a mindfulness notification. K-means clusters analyses using passive data features to predict mindfulness activity completion had low performance. Conclusions: While there are no simple solutions to predicting engagement with mindfulness apps, utilizing digital phenotyping approaches at a population and personal level offers new potential. The signal from digital phenotyping warrants more investigation; even small increases in engagement with mindfulness apps may have a tremendous impact given their already high prevalence of engagement, availability, and potential to engage patients across demographics.

Developing Methods for Assessing Mental Activity Using Human-Smartphone Interactions: Comparative Analysis of Activity Levels and Phase Patterns in General Mental Activities, Working Mental Activities, and Physical Activities.

BACKGROUND: Human biological rhythms are commonly assessed through physical activity (PA) measurement, but mental activity may offer a more substantial reflection of human biological rhythms. OBJECTIVE: This study proposes a novel approach based on human-smartphone interaction to compute mental activity, encompassing general mental activity (GMA) and working mental activity (WMA). METHODS: A total of 24 health care professionals participated, wearing wrist actigraphy devices and using the "Staff Hours" app for more than 457 person-days, including 332 workdays and 125 nonworkdays. PA was measured using actigraphy, while GMA and WMA were assessed based on patterns of smartphone interactions. To model WMA, machine learning techniques such as extreme gradient boosting and convolutional neural networks were applied, using human-smartphone interaction patterns and GPS-defined work hours. The data were organized by date and divided into person-days, with an 80:20 split for training and testing data sets to minimize overfitting and maximize model robustness. The study also adopted the M10 metric to quantify daily activity levels by calculating the average acceleration during the 10-hour period of highest activity each day, which facilitated the assessment of the interrelations between PA, GMA, and WMA and sleep indicators. Phase differences, such as those between PA and GMA, were defined using a second-order Butterworth filter and Hilbert transform to extract and calculate circadian rhythms and instantaneous phases. This calculation involved subtracting the phase of the reference signal from that of the target signal and averaging these differences to provide a stable and clear measure of the phase relationship between the signals. Additionally, multilevel modeling explored associations between sleep indicators (total sleep time, midpoint of sleep) and next-day activity levels, accounting for the data's nested structure. RESULTS: Significant differences in activity levels were noted between workdays and nonworkdays, with WMA occurring approximately 1.08 hours earlier than PA during workdays (P<.001). Conversely, GMA was observed to commence about 1.22 hours later than PA (P<.001). Furthermore, a significant negative correlation was identified between the activity level of WMA and the previous night's midpoint of sleep (ß=-0.263, P<.001), indicating that later bedtimes and wake times were linked to reduced activity levels in WMA the following day. However, there was no significant correlation between WMA's activity levels and total sleep time. Similarly, no significant correlations were found between the activity levels of PA and GMA and sleep indicators from the previous night. CONCLUSIONS: This study significantly advances the understanding of human biological rhythms by developing and highlighting GMA and WMA as key indicators, derived from human-smartphone interactions. These findings offer novel insights into how mental activities, alongside PA, are intricately linked to sleep patterns, emphasizing the potential of GMA and WMA in behavioral and health studies.