Mood Monitoring App on Par With Standard Psych Assessments

Megan Brooks

May 16, 2016

ATLANTA ― Daily mood monitoring using a smartphone app can yield information that is on par with clinician-administered psychometric assessments in patients with moderate to severe depression, results of a small pilot study suggest.

"Most available literature highlights potential use of smartphone applications for depression screening, but this is the first study reporting on usefulness in clinically depressed populations who may benefit from extra support in the pursuit of treatment," the researchers note.

Nidal Moukaddam, MD, PhD, assistant professor of psychiatry at Baylor College of Medicine, Houston, Texas, presented the results here at the American Psychiatric Association (APA) 2016 Annual Meeting.

High Adherence

The study included 25 patients (mean age, 51 years) with major depressive disorder, with or without comorbid anxiety disorder. During an 8-week period, patients tracked their daily moods using the Smartphone and Online Usage-Based Evaluation for Depression (SOLVD) app, which had been downloaded onto the patients' mobile devices.

The app also captures sensor data, such as text messaging time, phone calls, and browser use. Depression and anxiety symptoms were measured biweekly using standard clinician psychometric tools ― the Patient Health Questionaire-9 (PHQ-9), the Hamilton Rating Scale for Depression (HAM-D), and the Hamilton Anxiety Rating Scale (HAM-A).

Dr Nidal Moukaddam

Patients did "really well" inputting their daily mood into the app as directed, with an adherence rate of about 82%, said Dr Moukaddam. Patient feedback on the app showed they were "enjoying" using it, she noted. In addition, the patients' rate of attendance of in-person assessment sessions was high (95% adherence).

The data suggest that for patients with moderate to severe depression, the correlation between self-reported mood and clinically administered questionnaires is higher in comparison with patients who have milder depression.

The correlation between self-reported mood score using the smartphone app averaged over a 2-week period and the biweekly PHQ-9 score was 0.73 for patients with moderate to severe depression and 0.36 for those with milder depression.

For the HAM-D, correlation with the raw mood scores was 0.5 for the moderate to severe group and 0.003 for the milder group; for the HAM-A, the correlation was 0.47 and 0.15, respectively.

There were also correlations between PHQ-9 results and the app's sensor activity results, such as how many steps were taken daily, the frequency of text messaging, and time spent text messaging. For example, "when depression got worse, they didn't text message as much," Dr Moukaddam noted.

The current study suggests that smartphone data may be "useable and useful in patients with moderate to severe depression," Dr Moukaddam said during an APA press briefing. In particular, such data may be a "valuable tool to help predict depression severity. [It] may serve as an educational tool for patients and as an adjunct for information gathering for the physician and as a tool to improve physician-patient relationship," she said.

The researchers caution that the results are preliminary and need to be replicated in larger studies. They plan to expand the study to the adolescent and perinatal population.

Wave of the Future

Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation, in New York City, who moderated the briefing, said, "This is a very important study, because I think a lot of our future will include making use of smartphones and other devices to help in treatment."

John Torous, MD, of Harvard University and Beth Israel Deaconess Medical Center, in Boston, Massachusetts, who also studies smartphone apps for mental health care but who was not involved in the current study, agrees. "Studies like this are very important, as they offer the clinical data that the field needs to transform smartphones from consumer devices into healthcare tools," he told Medscape Medical News. "The focus on the phone as a tool that can help us better understand psychiatric illnesses and focus on validation makes this research important."

But the field as a whole is in "an odd place," Dr Torous noted. "People are beginning to fully realize the potential of digital tools like smartphones to bring new data streams into mental health and also offer potential new treatments (eg, therapy on the phone), but industry has taken the lead in putting out many rather dubious mental health apps, and the academic research to validate these new tools is still largely lacking. Several literature reviews of apps in the various app stores have shown how few useful and how many even dangerous apps are out there, ready for download," he noted.

Mental health monitoring with smartphones is "getting very exciting, but also brings with it new ethical, legal, data analysis challenges as well," Dr Torous concluded.

The authors, Dr Borenstein, and Dr Torous have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2016 Annual Meeting: Abstract 7188, presented May 14, 2016.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.