Predicting states of elevated negative affect in adolescents from smartphone sensors: a novel personalized machine learning approach.

BACKGROUND: Adolescence is characterized by profound change, including increases in negative emotions. Approximately 84% of American adolescents own a smartphone, which can continuously and unobtrusively track variables potentially predictive of heightened negative emotions (e.g. activity levels, location, pattern of phone usage). The extent to which built-in smartphone sensors can reliably predict states of elevated negative affect in adolescents is an open question. METHODS: Adolescent participants (n = 22; ages 13-18) with low to high levels of depressive symptoms were followed for 15 weeks using a combination of ecological momentary assessments (EMAs) and continuously collected passive smartphone sensor data. EMAs probed negative emotional states (i.e. anger, sadness and anxiety) 2-3 times per day every other week throughout the study (total: 1145 EMA measurements). Smartphone accelerometer, location and device state data were collected to derive 14 discrete estimates of behavior, including activity level, percentage of time spent at home, sleep onset and duration, and phone usage. RESULTS: A personalized ensemble machine learning model derived from smartphone sensor data outperformed other statistical approaches (e.g. linear mixed model) and predicted states of elevated anger and anxiety with acceptable discrimination ability (area under the curve (AUC) = 74% and 71%, respectively), but demonstrated more modest discrimination ability for predicting states of high sadness (AUC = 66%). CONCLUSIONS: To the extent that smartphone data could provide reasonably accurate real-time predictions of states of high negative affect in teens, brief 'just-in-time' interventions could be immediately deployed via smartphone notifications or mental health apps to alleviate these states.

Multi-modal assessment of reward functioning in adolescent anhedonia.

BACKGROUND: Anhedonia is a core symptom of depression that predicts worse treatment outcomes. Dysfunction in neural reward circuits is thought to contribute to anhedonia. However, whether laboratory-based assessments of anhedonia and reward-related neural function translate to adolescents' subjective affective experiences in real-world contexts remains unclear. METHODS: We recruited a sample of adolescents (n = 82; ages 12-18; mean = 15.83) who varied in anhedonia and measured the relationships among clinician-rated and self-reported anhedonia, behaviorally assessed reward learning ability, neural response to monetary reward and loss (as assessed with functional magnetic resonance imaging), and repeated ecological momentary assessment (EMA) of positive affect (PA) and negative affect (NA) in daily life. RESULTS: Anhedonia was associated with lower mean PA and higher mean NA across the 5-day EMA period. Anhedonia was not related to impaired behavioral reward learning, but low PA was associated with reduced nucleus accumbens response during reward anticipation and reduced medial prefrontal cortex (mPFC) response during reward outcome. Greater mean NA was associated with increased mPFC response to loss outcome. CONCLUSIONS: Traditional laboratory-based measures of anhedonia were associated with lower subjective PA and higher subjective NA in youths' daily lives. Lower subjective PA and higher subjective NA were associated with decreased reward-related striatal functioning. Higher NA was also related to increased mPFC activity to loss. Collectively, these findings demonstrate that laboratory-based measures of anhedonia translate to real-world contexts and that subjective ratings of PA and NA may be associated with neural response to reward and loss.

A transactional mediation model of risk for the intergenerational transmission of depression: The role of maternal criticism.

In this study, we sought to combine two lines of research to better understand risk for the intergenerational transmission of depression. The first focuses on the role of maternal criticism as a potential mechanism of risk for depression in youth while the second builds from interpersonal and stress generation models regarding the potential impact of youth depression on future escalations in maternal criticism. Specifically, we examined the role of maternal criticism within a transactional mediation model using data from a multi-wave study. Participants were 251 mother-offspring pairs consisting of mothers with (n = 129) and without (n = 122) a history of major depressive disorder (MDD) during their child's lifetime who completed assessments every 6 months for 2 years. We found support for the hypothesized transactional mediational model in which maternal expressed emotion-criticism (EE-Crit) mediated the link between maternal history of MDD and residual change in youth's depressive symptoms over the previous 6 months and, reciprocally, youth depressive symptoms mediated the relation between maternal MDD history and residual change in EE-Crit 6 months later. These results indicate that maternal criticism and offspring depressive symptoms may contribute to a vicious cycle of depression risk, which should be considered for interventions targeted toward youth at risk of developing MDD.

Transactional Relations Between Peer Victimization and Depressive Symptoms Among Youth at Risk of Developing Depression: Evidence for Gender Differences.

Offspring of mothers with a history of major depressive disorder (MDD) are at high risk of developing the disorder themselves, yet specific mechanisms of risk remain unclear. One hypothesized mechanism is interpersonal stress, which has been shown to be elevated in offspring of mothers with a history of MDD. The goal of this study was to examine the role of a specific form of interpersonal stress, peer victimization (overt and relational). In doing so, we not only examined the impact of peer victimization on changes in youth depression, but also youth depression on changes in peer victimization, consistent with stress generation models. Participants were 251 mothers with (n = 129) or without (n = 122) a history of MDD and their child (aged 8-14 years at baseline) who were assessed every six months for two years. Using random intercepts cross-lagged panel models (RI-CLPM), we were able to separate between-subject effects (mother MDD group differences in average levels of peer victimization and offspring depressive symptoms) and within-subject effects (transactional influences between within-subject fluctuations in peer victimization and depressive symptoms among offspring over time). Overall, these effects were stronger for relational victimization than for overt victimization and stronger for girls than boys. These results support the role of peer victimization, particularly relational victimization, as a risk factor among offspring of mothers with MDD, particularly girls, and highlight transactional relations between relational victimization and depressive symptoms in girls over time, which may create a vicious cycle of risk.

Personalized prescriptions of therapeutic skills from patient characteristics: An ecological momentary assessment approach.

OBJECTIVE: Rather than relying on a single psychotherapeutic orientation, most clinicians draw from a range of therapeutic approaches to treat their clients. To date, no data-driven approach exists for personalized predictions of which skill domain would be most therapeutically beneficial for a given patient. The present study combined ecological momentary assessment (EMA) and machine learning to test a data-driven approach for predicting patient-specific skill-outcome associations. METHOD: Fifty (Mage = 37 years old, 54% female, 84% White) adults received training in behavioral therapy (BT) and dialectical behavior therapy (DBT) skills within a behavioral health partial hospital program (PHP). Following discharge, patients received four EMA surveys per day for 2 weeks (total observations = 2,036) assessing the use of therapeutic skills and positive/negative affect (PA/NA). Clinical and demographic characteristics were submitted to elastic net regularization to predict, via cross-validation, patient-specific associations between the use of BT versus DBT skills and level of PA/NA. RESULTS: Cross-validated accuracy was 81% (sensitivity = 93% and specificity = 63%) in predicting whether a patient would exhibit a stronger association between the use of BT versus DBT skills and PA level. Predictors of positive DBT skills-PA associations included higher levels of nonsuicidal self-injury (NSSI) and sleep disturbance, whereas predictors of positive BT skills-PA relations included higher emotional lability and anxiety disorder comorbidity, and lower psychomotor retardation/agitation and worthlessness/guilt. Corresponding models with NA yielded no predictors. CONCLUSIONS: Findings from this initial proof-of-concept study highlight the potential of data-driven approaches to inform personalized prescriptions of which skill domains may be most therapeutically beneficial for a given patient. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mind-Wandering in Adolescents Predicts Worse Affect and Is Linked to Aberrant Default Mode Network-Salience Network Connectivity.

OBJECTIVE: Understanding the fluctuating emotional and cognitive states of adolescents with depressive symptoms requires fine-grained and naturalistic measurements. This study used ecological momentary assessment (EMA) to investigate the affective correlates and consequences of mind-wandering in adolescents with anhedonia (AH) and typically developing (TD) controls. In addition, we examined the association between mind-wandering and resting state functional connectivity between the medial prefrontal cortex (mPFC), a core hub of the default mode network (DMN) linked to internally oriented mentation, and networks linked to attentional control (dorsal attention network [DAN]) and affect/salience detection (salience network [SN]). METHOD: A total of 65 adolescents, aged 12 to 18 years (TD = 36; AH = 29), completed a resting state functional magnetic resonance imaging scan and subsequently used a smartphone application for ecological momentary assessment (EMA) data collection (2-3 times/d for 5 days). Each survey (N = 678) prompted adolescents to report on their current positive and negative affect (PA and NA), cognition, and activity. RESULTS: The frequency of mind-wandering was higher for AH (70.0% of EMA samples) relative to TD (59.2%) participants, and the participants with AH were more likely to mind-wander to unpleasant content. Mind-wandering was associated with higher concurrent NA, even when controlling for plausible confounds (eg, current activity, social companion, rumination). Time-lagged analyses revealed a bidirectional association between mind-wandering and PA. Greater levels of mind-wandering within the AH group were associated with stronger mPFC-SN/DAN connectivity. CONCLUSION: Rates of mind-wandering were high, especially among adolescents with anhedonia, and predicted worse affect. The relation between mind-wandering and enhanced mPFC-SN coupling may reflect heightened bottom-up influence of affective and sensory salience on DMN-mediated internally oriented thought.