Towards precision in the diagnostic profiling of patients: leveraging symptom dynamics as a clinical characterisation dimension in the assessment of major depressive disorder.

BACKGROUND: International guidelines present overall symptom severity as the key dimension for clinical characterisation of major depressive disorder (MDD). However, differences may reside within severity levels related to how symptoms interact in an individual patient, called symptom dynamics. AIMS: To investigate these individual differences by estimating the proportion of patients that display differences in their symptom dynamics while sharing the same overall symptom severity. METHOD: Participants with MDD (n = 73; mean age 34.6 years, s.d. = 13.1; 56.2% female) rated their baseline symptom severity using the Inventory for Depressive Symptomatology Self-Report (IDS-SR). Momentary indicators for depressive symptoms were then collected through ecological momentary assessments five times per day for 28 days; 8395 observations were conducted (average per person: 115; s.d. = 16.8). Each participant's symptom dynamics were estimated using person-specific dynamic network models. Individual differences in these symptom relationship patterns in groups of participants sharing the same symptom severity levels were estimated using individual network invariance tests. Subsequently, the overall proportion of participants that displayed differential symptom dynamics while sharing the same symptom severity was calculated. A supplementary simulation study was conducted to investigate the accuracy of our methodology against false-positive results. RESULTS: Differential symptom dynamics were identified across 63.0% (95% bootstrapped CI 41.0-82.1) of participants within the same severity group. The average false detection of individual differences was 2.2%. CONCLUSIONS: The majority of participants within the same depressive symptom severity group displayed differential symptom dynamics. Examining symptom dynamics provides information about person-specific psychopathological expression beyond severity levels by revealing how symptoms aggravate each other over time. These results suggest that symptom dynamics may be a promising new dimension for clinical characterisation, warranting replication in independent samples. To inform personalised treatment planning, a next step concerns linking different symptom relationship patterns to treatment response and clinical course, including patterns related to spontaneous recovery and forms of disorder progression.

Personalised and Sustainable IEQ Monitoring: Use of Multi-Modal and Pervasive Technologies.

BACKGROUND: Monitoring indoor environmental quality (IEQ) is important to better understand occupant health. Passive IEQ monitoring with digital technologies may provide insightful quantitative data to better inform, e.g., health interventions. Yet, many traditional approaches with known IEQ technologies have limited utility due to high costs or coarse granularity-focusing on the collective rather than individuals. Equally, subjective approaches (e.g., manual surveys) have poor adherence (i.e., are burdensome). There is a need for holistic IEQ measurement techniques that are sustainable (affordable, i.e., low-cost) and personalised. Here, the aim of this case report is to explore the use of low-cost digital approaches to gather personalised quantitative and qualitative data. METHODS: This study deploys a personalised monitoring approach with IEQ devices coupled to wearables, weather data, and qualitative data, captured through a post-study interview. RESULTS: The mixed-method, single-case approach gathered data continuously for six months with a reduced burden, by using digital technologies to affirm environmental factors, which were subjectively evaluated by the participant. Quantitative data reinforced qualitative data, removing the need for generalising qualitative findings against a collective. CONCLUSIONS: This study showed that the single-case, mixed-method approach used here can provide a holistic approach not previously obtainable with traditional pen-and-paper techniques alone. The use of a low-cost multi-modal device linked with common home and wearable technology suggest a contemporary and sustainable IEQ measurement approach that could inform future work to better determine occupant health.

"It is not just about the alcohol": service users' views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence.

BACKGROUND: The involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised. METHODS: A focus group was conducted and data were analysed using a framework synthesis approach. RESULTS: Service users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0-20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments. CONCLUSIONS: Patients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.