Identifying mechanisms of persecutory ideation maintenance with smartphone technology: Examining threat importance, certainty, rumination, and behavior change.

Previous cross-sectional and laboratory research has identified risk factors for persecutory ideation including rumination, negative affect, and safety-seeking behaviors. Questions remain about what in-the-moment factors link general negative affect to PI as well as which maintain PI over time. In the present study, N = 219 individuals completed momentary assessments of PI as well as four factors (attributing threats as certain and important, ruminating, and changing one's behavior in response) proposed to maintain PI over time. Linear mixed effects models were used to analyze multiple time-varying relationships, including these factors predicting negative affect and vice versa, as well as factors predicting maintenance of PI over time. Linear mixed effects models were used to analyze multiple time-varying relationships, examining each PI-related factor predicting negative affect, negative affect predicting each PI-related factor, as well as each factor predicting maintenance of PI over time. All four factors were associated with increases in subsequent day self-reported severity of PI, suggesting all four increased the likelihood of maintaining or worsening next-day PI. Results of this study confirm that the proposed factors are key in maintaining a cycle by which PI and negative affect are maintained over time. These factors may represent targets for momentary interventions.

Depressive symptoms as a heterogeneous and constantly evolving dynamical system: Idiographic depressive symptom networks of rapid symptom changes among persons with major depressive disorder.

Major depressive disorder (MDD) is conceptualized by individual symptoms occurring most of the day for at least two weeks. Despite this operationalization, MDD is highly variable with persons showing greater variation within and across days. Moreover, MDD is highly heterogeneous, varying considerably across people in both function and form. Recent efforts have examined MDD heterogeneity byinvestigating how symptoms influence one another over time across individuals in a system; however, these efforts have assumed that symptom dynamics are static and do not dynamically change over time. Nevertheless, it is possible that individual MDD system dynamics change continuously across time. Participants (N = 105) completed ratings of MDD symptoms three times a day for 90 days, and we conducted time varying vector autoregressive models to investigate the idiographic symptom networks. We then illustrated this finding with a case series of five persons with MDD. Supporting prior research, results indicate there is high heterogeneity across persons as individual network composition is unique from person to person. In addition, for most persons, individual symptom networks change dramatically across the 90 days, as evidenced by 86% of individuals experiencing at least one change in their most influential symptom and the median number of shifts being 3 over the 90 days. Additionally, most individuals had at least one symptom that acted as both the most and least influential symptom at any given point over the 90-day period. Our findings offer further insight into short-term symptom dynamics, suggesting that MDD is heterogeneous both across and within persons over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using Smartphones to Identify Momentary Characteristics of Persecutory Ideation Associated With Functional Disability.

Objectives: Though often a feature of schizophrenia-spectrum disorders, persecutory ideation (PI) is also common in other psychiatric disorders as well as among individuals who are otherwise healthy. Emerging technologies allow for a more thorough understanding of the momentary phenomenological characteristics that determine whether PI leads to significant distress and dysfunction. This study aims to identify the momentary phenomenological features of PI associated with distress, dysfunction, and need for clinical care. Methods: A total of 231 individuals with at least moderate PI from 43 US states participated in a study involving 30 days of data collection using a smartphone data collection system combining ecological momentary assessment and passive sensors, wherein they reported on occurrence of PI as well as related appraisals, responses, and cooccurring states. Most (N = 120, 51.9%) participants reported never having received treatment for their PI, while 50 participants had received inpatient treatment (21.6%), and 60 (26.4%) had received outpatient care only. Results: Individuals with greater functional disability did not differ in PI frequency but were more likely at the moment to describe threats as important to them, to ruminate about those threats, to experience distress related to them, and to change their behavior in response. Groups based on treatment-seeking patterns largely did not differ in baseline measures or momentary phenomenology of PI as assessed by self-report or passive sensors. Conclusions: Smartphone data collection allows for granular assessment of PI-related phenomena. Functional disability is associated with differences in appraisals of and responses to PI at the moment.

The relationship between appraisals of auditory verbal hallucinations and real-time affect and social functioning.

In addition to being a hallmark symptom of schizophrenia-spectrum disorders, auditory verbal hallucinations (AVH) are present in a range of psychiatric disorders as well as among individuals who are otherwise healthy. People who experience AVH are heterogeneous, and research has aimed to better understand what characteristics distinguish, among those who experience AVH, those who experience significant disruption and distress from those who do not. The cognitive model of AVH suggests that appraisals of voices determine the extent to which voices cause distress and social dysfunction. Previous work has relied largely on comparisons of "clinical" and "non-clinical" voice hearers, and few studies have been able to provide insight into the moment-to-moment relationships between appraisals and outcomes. The current study examines longitudinal data provided through ecological momentary assessment and passive sensors of 465 individuals who experience cross-diagnostic AVH. Results demonstrated associations of AVH appraisals to negative affect and social functioning. Above and beyond within-individual averages, when a participant reported increased appraisals of their voices as powerful and difficult to control, they were more likely to feel increased negative affect and reduced feelings of safety. AVH power appraisals were also associated with next-day number and duration of phone calls placed, and AVH controllability appraisals were associated with increased time near speech and reduced next-day time away from primary location. These results suggest that appraisals are state-like characteristics linked with day-to-day and moment-to-moment changes in impactful affective and behavioral outcomes; intervention approaches should aim to address these domains in real-time.

mHealth-Assisted Detection of Precursors to Relapse in Schizophrenia.

Theoretical views and a growing body of empirical evidence suggest that psychiatric relapses in schizophrenia-spectrum disorders (SSDs) have measurable warning signs. However, because they are time- and resource-intensive, existing assessment approaches are not well-suited to detect these warning signs in a timely, scalable fashion. Mobile technologies deploying frequent measurements-i.e., ecological momentary assessment-could be leveraged to detect increases in symptoms that may precede relapses. The present study examined EMA measurements with growth curve models in the 100 days preceding and following 27 relapses (among n = 20 individuals with SSDs) to identify (1) what symptoms changed in the periods gradually preceding, following, and right as relapses occur, (2) how large were these changes, and (3) on what time scale did they occur. Results demonstrated that, on average, participants reported elevations in negative mood (d = 0.34), anxiety (d =0.49), persecutory ideation (d =0.35), and hallucinations (d =0.34) on relapse days relative to their average during the study. These increases emerged gradually on average from significant and steady increases (d = 0.05 per week) in persecutory ideation and hallucinations over the 100-day period preceding relapse. This suggests that brief (i.e., 1-2 item) assessments of psychotic symptoms may detect meaningful signals that precede psychiatric relapses long before they occur. These assessments could increase opportunities for relapse prevention as remote measurement-based care management platforms develop.

Expanding the Reach of Research: Quantitative Evaluation of a Web-Based Approach for Remote Recruitment of People Who Hear Voices.

BACKGROUND: Similar to other populations with highly stigmatized medical or psychiatric conditions, people who hear voices (ie, experience auditory verbal hallucinations [AVH]) are often difficult to identify and reach for research. Technology-assisted remote research strategies reduce barriers to research recruitment; however, few studies have reported on the efficiency and effectiveness of these approaches. OBJECTIVE: This study introduces and evaluates the efficacy of technology-assisted remote research designed for people who experience AVH. METHODS: Our group developed an integrated, automated and human complementary web-based recruitment and enrollment apparatus that incorporated Google Ads, web-based screening, identification verification, hybrid automation, and interaction with live staff. We examined the efficacy of that apparatus by examining the number of web-based advertisement impressions (ie, number of times the web-based advertisement was viewed); clicks on that advertisement; engagement with web-based research materials; and the extent to which it succeeded in representing a broad sample of individuals with AVH, assessed through the self-reported AVH symptom severity and demographic representativeness (relative to the US population) of the sample recruited. RESULTS: Over an 18-month period, our Google Ads advertisement was viewed 872,496 times and clicked on 11,183 times. A total amount of US $4429.25 was spent on Google Ads, resulting in 772 individuals who experience AVH providing consent to participate in an entirely remote research study (US $0.40 per click on the advertisement and US $5.73 per consented participant) after verifying their phone number, passing a competency screening questionnaire, and providing consent. These participants reported high levels of AVH frequency (666/756, 88.1% daily or more), distress (689/755, 91.3%), and functional interference (697/755, 92.4%). They also represented a broad sample of diversity that mirrored the US population demographics. Approximately one-third (264/756, 34.9%) of the participants had never received treatment for their AVH and, therefore, were unlikely to be identified via traditional clinic-based research recruitment strategies. CONCLUSIONS: Web-based procedures allow for time saving, cost-efficient, and representative recruitment of individuals with AVH and can serve as a model for future studies focusing on hard-to-reach populations.

Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II.

BACKGROUND: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. OBJECTIVE: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. METHODS: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. RESULTS: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. CONCLUSIONS: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic.

Daily perceived stress predicts less next day social interaction: Evidence from a naturalistic mobile sensing study.

Although mammals have a strong motivation to engage in social interaction, stress can significantly interfere with this desire. Indeed, research in nonhuman animals has shown that stress reduces social interaction, a phenomenon referred to as "stress-induced social avoidance." While stress and social disconnection are also intertwined in humans, to date, evidence that stress predicts reductions in social interaction is mixed, in part, because existing paradigms fail to capture social interaction naturalistically. To help overcome this barrier, we combined experience sampling and passive mobile sensing methods with time-lagged analyses (i.e., vector autoregressive modeling) to investigate the temporal impact of stress on real-world indices of social interaction. We found that, across a 2-month period, greater perceived stress on a given day predicted significantly decreased social interaction-measured by the amount of face to face conversation-the following day. Critically, the reverse pattern was not observed (i.e., social interaction did not temporally predict stress), and the effect of stress on social interaction was present while accounting for other related variables such as sleep, movement, and time spent at home. These findings are consistent with animal research on stress-induced social avoidance and lay the groundwork for creating naturalistic, mobile-sensing based human models to further elucidate the cycle between stress and real-world social interaction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predicting Early Warning Signs of Psychotic Relapse From Passive Sensing Data: An Approach Using Encoder-Decoder Neural Networks.

BACKGROUND: Schizophrenia spectrum disorders (SSDs) are chronic conditions, but the severity of symptomatic experiences and functional impairments vacillate over the course of illness. Developing unobtrusive remote monitoring systems to detect early warning signs of impending symptomatic relapses would allow clinicians to intervene before the patient's condition worsens. OBJECTIVE: In this study, we aim to create the first models, exclusively using passive sensing data from a smartphone, to predict behavioral anomalies that could indicate early warning signs of a psychotic relapse. METHODS: Data used to train and test the models were collected during the CrossCheck study. Hourly features derived from smartphone passive sensing data were extracted from 60 patients with SSDs (42 nonrelapse and 18 relapse >1 time throughout the study) and used to train models and test performance. We trained 2 types of encoder-decoder neural network models and a clustering-based local outlier factor model to predict behavioral anomalies that occurred within the 30-day period before a participant's date of relapse (the near relapse period). Models were trained to recreate participant behavior on days of relative health (DRH, outside of the near relapse period), following which a threshold to the recreation error was applied to predict anomalies. The neural network model architecture and the percentage of relapse participant data used to train all models were varied. RESULTS: A total of 20,137 days of collected data were analyzed, with 726 days of data (0.037%) within any 30-day near relapse period. The best performing model used a fully connected neural network autoencoder architecture and achieved a median sensitivity of 0.25 (IQR 0.15-1.00) and specificity of 0.88 (IQR 0.14-0.96; a median 108% increase in behavioral anomalies near relapse). We conducted a post hoc analysis using the best performing model to identify behavioral features that had a medium-to-large effect (Cohen d>0.5) in distinguishing anomalies near relapse from DRH among 4 participants who relapsed multiple times throughout the study. Qualitative validation using clinical notes collected during the original CrossCheck study showed that the identified features from our analysis were presented to clinicians during relapse events. CONCLUSIONS: Our proposed method predicted a higher rate of anomalies in patients with SSDs within the 30-day near relapse period and can be used to uncover individual-level behaviors that change before relapse. This approach will enable technologists and clinicians to build unobtrusive digital mental health tools that can predict incipient relapse in SSDs.

Using behavioral rhythms and multi-task learning to predict fine-grained symptoms of schizophrenia.

Schizophrenia is a severe and complex psychiatric disorder with heterogeneous and dynamic multi-dimensional symptoms. Behavioral rhythms, such as sleep rhythm, are usually disrupted in people with schizophrenia. As such, behavioral rhythm sensing with smartphones and machine learning can help better understand and predict their symptoms. Our goal is to predict fine-grained symptom changes with interpretable models. We computed rhythm-based features from 61 participants with 6,132 days of data and used multi-task learning to predict their ecological momentary assessment scores for 10 different symptom items. By taking into account both the similarities and differences between different participants and symptoms, our multi-task learning models perform statistically significantly better than the models trained with single-task learning for predicting patients' individual symptom trajectories, such as feeling depressed, social, and calm and hearing voices. We also found different subtypes for each of the symptoms by applying unsupervised clustering to the feature weights in the models. Taken together, compared to the features used in the previous studies, our rhythm features not only improved models' prediction accuracy but also provided better interpretability for how patients' behavioral rhythms and the rhythms of their environments influence their symptom conditions. This will enable both the patients and clinicians to monitor how these factors affect a patient's condition and how to mitigate the influence of these factors. As such, we envision that our solution allows early detection and early intervention before a patient's condition starts deteriorating without requiring extra effort from patients and clinicians.

Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study.

BACKGROUND: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. OBJECTIVE: By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? METHODS: Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. RESULTS: During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19-related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.03) were significantly associated with COVID-19-related news. CONCLUSIONS: Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods to reduce the impact of future catastrophic events on the mental health of the population.

Causal Factors of Anxiety and Depression in College Students: Longitudinal Ecological Momentary Assessment and Causal Analysis Using Peter and Clark Momentary Conditional Independence.

BACKGROUND: Across college campuses, the prevalence of clinically relevant depression or anxiety is affecting more than 27% of the college population at some point between entry to college and graduation. Stress and self-esteem have both been hypothesized to contribute to depression and anxiety levels. Although contemporaneous relationships between these variables have been well-defined, the causal relationship between these mental health factors is not well understood, as frequent sampling can be invasive, and many of the current causal techniques are not well suited to investigate correlated variables. OBJECTIVE: This study aims to characterize the causal and contemporaneous networks between these critical mental health factors in a cohort of first-year college students and then determine if observed results replicate in a second, distinct cohort. METHODS: Ecological momentary assessments of depression, anxiety, stress, and self-esteem were obtained weekly from two cohorts of first-year college students for 40 weeks (1 academic year). We used the Peter and Clark Momentary Conditional Independence algorithm to identify the contemporaneous (t) and causal (t-1) network structures between these mental health metrics. RESULTS: All reported results are significant at P<.001 unless otherwise stated. Depression was causally influenced by self-esteem (t-1 rp, cohort 1 [C1]=-0.082, cohort 2 [C2]=-0.095) and itself (t-1 rp, C1=0.388, C2=0.382) in both cohorts. Anxiety was causally influenced by stress (t-1 rp, C1=0.095, C2=0.104), self-esteem (t-1 rp, C1=-0.067, C2=-0.064, P=.002), and itself (t-1 rp, of C1=0.293, C2=0.339) in both cohorts. A causal link between anxiety and depression was observed in the first cohort (t-1 rp, C1=0.109) and only observed in the second cohort with a more liberal threshold (t-1 rp, C2=0.044, P=.03). Self-esteem was only causally influenced by itself (t-1 rp, C1=0.389, C2=0.393). Stress was only causally influenced by itself (t-1 rp, C1=0.248, C2=0.273). Anxiety had positive contemporaneous links to depression (t rp, C1=0.462, C2=0.444) and stress (t rp, C1=0.354, C2=0.358). Self-esteem had negative contemporaneous links to each of the other three mental health metrics, with the strongest negative relationship being stress (t rp, C1=-0.334, C2=-0.340), followed by depression (t rp, C1=-0.302, C2=-0.274) and anxiety (t rp, C1=-0.256, C2=-0.208). Depression had positive contemporaneous links to anxiety (previously mentioned) and stress (t rp, C1=0.250, C2=0.231). CONCLUSIONS: This paper is an initial attempt to describe the contemporaneous and causal relationships among these four mental health metrics in college students. We replicated previous research identifying concurrent relationships between these variables and extended them by identifying causal links among these metrics. These results provide support for the vulnerability model of depression and anxiety. Understanding how causal factors impact the evolution of these mental states over time may provide key information for targeted treatment or, perhaps more importantly, preventative interventions for individuals at risk for depression and anxiety.

Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects.

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that can replace a portion of treatment as usual, or as stand-alone tools accessed outside of care settings or direct to the consumer. To advance the potential public health impact of this promising line of research, multiple areas warrant further development and investigation. The Center for Technology and Behavioral Health (CTBH), a P30 Center of Excellence supported by the National Institute on Drug Abuse at the National Institutes of Health, is an interdisciplinary research center at Dartmouth College focused on the goal of harnessing existing and emerging technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. The CTBH launched a series of workshops to encourage and expand multidisciplinary collaborations among Dartmouth scientists and international CTBH affiliates engaged in research related to digital technology and behavioral health (eg, addiction science, behavioral health intervention, technology development, computer science and engineering, digital security, health economics, and implementation science). This paper summarizes a workshop conducted on the Development and Evaluation of Digital Therapeutics for Behavior Change, which addressed (1) principles of behavior change, (2) methods of identifying and testing the underlying mechanisms of behavior change, (3) conceptual frameworks for optimizing applications for mental health and addictive behavior, and (4) the diversity of experimental methods and designs that are essential to the successful development and testing of digital therapeutics. Examples were presented of ongoing CTBH projects focused on identifying and improving the measurement of health behavior change mechanisms and the development and evaluation of digital therapeutics. In summary, the workshop showcased the myriad research targets that will be instrumental in promoting and accelerating progress in the field of digital health and health behavior change and illustrated how the CTBH provides a model of multidisciplinary leadership and collaboration that can facilitate innovative, science-based efforts to address the health behavior challenges afflicting our communities.

Sensing sociability: Individual differences in young adults' conversation, calling, texting, and app use behaviors in daily life.

Sociability as a disposition describes a tendency to affiliate with others (vs. be alone). Yet, we know relatively little about how much social behavior people engage in during a typical day. One challenge to documenting social behavior tendencies is the broad number of channels over which socializing can occur, both in-person and through digital media. To examine individual differences in everyday social behavior patterns, here we used smartphone-based mobile sensing methods (MSMs) in four studies (total N = 926) to collect real-world data about young adults' social behaviors across four communication channels: conversations, phone calls, text messages, and use of messaging and social media applications. To examine individual differences, we first focused on establishing between-person variability in daily social behavior, examining stability of and relationships among daily sensed social behavior tendencies. To explore factors that may explain the observed individual differences in sensed social behavior, we then expanded our focus to include other time estimates (e.g., times of the day, days of the week) and personality traits. In doing so, we present the first large-scale descriptive portrait of behavioral sociability patterns, characterizing the degree to which young adults engaged in social behaviors and mapping these behaviors onto self-reported personality dispositions. Our discussion focuses on how the observed sociability patterns compare to previous research on young adults' social behavior. We conclude by pointing to areas for future research aimed at understanding sociability using mobile sensing and other naturalistic observation methods for the assessment of social behavior. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fusing Mobile Phone Sensing and Brain Imaging to Assess Depression in College Students.

As smartphone usage has become increasingly prevalent in our society, so have rates of depression, particularly among young adults. Individual differences in smartphone usage patterns have been shown to reflect individual differences in underlying affective processes such as depression (Wang et al., 2018). In the current study, a positive relationship was identified between smartphone screen time (e.g., phone unlock duration) and resting-state functional connectivity (RSFC) between the subgenual cingulate cortex (sgCC), a brain region implicated in depression and antidepressant treatment response, and regions of the ventromedial/orbitofrontal cortex (OFC), such that increased phone usage was related to stronger connectivity between these regions. This cluster was subsequently used to constrain subsequent analyses looking at individual differences in depressive symptoms in the same cohort and observed partial replication in a separate cohort. Similar analyses were subsequently performed on metrics of circadian rhythm consistency showing a negative relationship between connectivity of the sgCC and OFC. The data and analyses presented here provide relatively simplistic preliminary analyses which replicate and provide an initial step in combining functional brain activity and smartphone usage patterns to better understand issues related to mental health. Smartphones are a prevalent part of modern life and the usage of mobile sensing data from smartphones promises to be an important tool for mental health diagnostics and neuroscience research.

Correlates of Stress in the College Environment Uncovered by the Application of Penalized Generalized Estimating Equations to Mobile Sensing Data.

BACKGROUND: Stress levels among college students have been on the rise for the last few decades. Currently, rates of reported stress among college students are at an all-time high. Traditionally, the dominant way to assess stress levels has been through pen-and-paper surveys. OBJECTIVE: The aim of this study is to use passive sensing data collected via mobile phones to obtain a rich and potentially less-biased source of data that can be used to help better understand stressors in the college experience. METHODS: We used a mobile sensing app, StudentLife, in tandem with a pictorial mobile phone-based measure of stress, the Mobile Photographic Stress Meter, to investigate the situations and contexts that are more likely to precipitate stress. RESULTS: Using recently developed methods for handling high-dimensional longitudinal data, penalized generalized estimating equations, we identified a set of mobile sensing features (absolute values of beta >0.001 and robust z>1.96) across the domains of social activity, movement, location, and ambient noise that were predictive of student stress levels. CONCLUSIONS: By combining recent statistical methods and mobile phone sensing, we have been able to study stressors in the college experience in a way that is more objective, detailed, and less intrusive than past research. Future work can leverage information gained from passive sensing and use that to develop real-time, targeted interventions for students experiencing a stressful time.

Use of lectin-magnetic separation (LMS) for detecting Toxoplasma gondii oocysts in environmental water samples.

Proof-of-principle of lectin-magnetic separation (LMS) for isolating Toxoplasma oocysts (pre-treated with 0.5% acidified pepsin (AP)) from water for subsequent detection by microscopy or molecular methods has been shown. However, application of this technique in the routine water-analysis laboratory requires that the method is tested, modified, and optimized. The current study describes attempts to apply the LMS technique on supernatants from water samples previously analyzed for contamination with Cryptosporidium and Giardia using standard methods, and the supernatant following immunomagnetic separation (IMS) retained. Experiments on AP-treatment of Toxoplasma oocysts in situ in such samples demonstrated that overnight incubation at 37 °C was adequate, but excess AP had to be removed before continuing to LMS; neutralization in sodium hydroxide and a single wash step was found to be suitable. Mucilaginous material in post-IMS samples that had been stored at room temperature without washing, which was found to be probably an exudate from bacterial and fungal overgrowth, hampered the isolation of T. gondii oocysts by LMS beads. For detection, microscopy was successful only for clean samples, as debris occluded viewing in dirtier samples. Although qPCR was successful, for some samples non-specific inhibition occurred, as demonstrated by inhibition of an internal amplification control in the qPCR reaction. For some, but not all, samples this could be addressed by dilution. Finally, the optimized methodology was used for a pilot project in which 23 post-IMS water sample concentrates were analyzed. Of these, only 20 provided interpretable results (without qPCR inhibition) of which one sample was positive, and confirmed by sequencing of PCR product, indicating that Toxoplasma oocysts occur in Norwegian drinking water samples. In conclusion, we suggest that post-IMS samples may be suitable for analysis for Toxoplasma oocysts using LMS, only if freshly processed or washed before being refrigerated. In addition, application of AP treatment requires a neutralization step before proceeding to LMS. For detection, qPCR, rather than microscopy, is the most appropriate approach, although some inhibition may still occur, and therefore inclusion of an internal amplification control is important. Our study indicates that, despite some limitations, this approach would be appropriate for further large-scale analysis of samples of raw and treated drinking water.

Use of Multimodal Technology to Identify Digital Correlates of Violence Among Inpatients With Serious Mental Illness: A Pilot Study.

OBJECTIVE: The study examined multimodal technologies to identify correlates of violence among inpatients with serious mental illness. METHODS: Twenty-eight high-risk inpatients were provided with smartphones adapted for data collection. Participants recorded their thoughts and behaviors by using self-report software. Sensors embedded in each device (microphone and accelerometers) and throughout the inpatient unit (Bluetooth beacons) captured patients' activity and location. RESULTS: Self-reported delusions were associated with violent ideation (odds ratio [OR]=3.08), damaging property (OR=8.24), and physical aggression (OR=12.39). Alcohol and cigarette cravings were associated with violent ideation (OR=5.20 and OR=6.08, respectively), damaging property (OR=3.71 and OR=4.26, respectively), threatening others (OR=3.62 and OR=3.04, respectively), and physical aggression (OR=6.26, and OR=8.02, respectively). Drug cravings were associated with violent ideation (OR=2.76) and damaging property (OR=5.09). Decreased variability in physical activity and noisy ward conditions were associated with violent ideation (OR=.71 and OR=2.82, respectively). CONCLUSIONS: Identifiable digital correlates may serve as indicators of increased risk of violence.

CrossCheck: Integrating self-report, behavioral sensing, and smartphone use to identify digital indicators of psychotic relapse.

OBJECTIVE: This purpose of this study was to describe and demonstrate CrossCheck, a multimodal data collection system designed to aid in continuous remote monitoring and identification of subjective and objective indicators of psychotic relapse. METHOD: Individuals with schizophrenia-spectrum disorders received a smartphone with the monitoring system installed along with unlimited data plan for 12 months. Participants were instructed to carry the device with them and to complete brief self-reports multiple times a week. Multimodal behavioral sensing (i.e., physical activity, geospatials activity, speech frequency, and duration) and device use data (i.e., call and text activity, app use) were captured automatically. Five individuals who experienced psychiatric hospitalization were selected and described for instructive purposes. RESULTS: Participants had unique digital indicators of their psychotic relapse. For some, self-reports provided clear and potentially actionable description of symptom exacerbation prior to hospitalization. Others had behavioral sensing data trends (e.g., shifts in geolocation patterns, declines in physical activity) or device use patterns (e.g., increased nighttime app use, discontinuation of all smartphone use) that reflected the changes they experienced more effectively. CONCLUSION: Advancements in mobile technology are enabling collection of an abundance of information that until recently was largely inaccessible to clinical research and practice. However, remote monitoring and relapse detection is in its nascence. Development and evaluation of innovative data management, modeling, and signal-detection techniques that can identify changes within an individual over time (i.e., unique relapse signatures) will be essential if we are to capitalize on these data to improve treatment and prevention. (PsycINFO Database Record

Lectin-magnetic separation (LMS) for isolation of Toxoplasma gondii oocysts from concentrated water samples prior to detection by microscopy or qPCR.

Although standard methods for analyzing water samples for the protozoan parasites Cryptosporidium spp. and Giardia duodenalis are available and widely used, equivalent methods for analyzing water samples for Toxoplasma gondii oocysts are lacking. This is partly due to the lack of a readily available, reliable immunomagnetic separation technique (IMS). Here we investigated the use of lectin-magnetic separation (LMS) for isolating T. gondii oocysts from water sample concentrates, with subsequent detection by microscopy or molecular methods. Four different types of magnetic beads coated with wheat germ agglutinin (WGA) were tested for capture of oocysts from clean or dirty water samples. Dynabeads (Myone T1 and M-280) consistently provided mean capture efficiencies from 1 ml clean water in excess of 97%. High recoveries were also found with Tamavidin beads (in excess of 90%) when LMS was used for capture from a small (1 ml) volume. Dissociation (required for detection by microscopy) using 0.1N hydrochloric acid (HCl), as standard in IMS, was not successful, but could be achieved using a combination of acidified pepsin (AP) and N-acetyl d-glucosamine. Although simple centrifugation was as effective as LMS when concentrating high numbers of oocysts from clean water, LMS provided superior results when oocysts numbers were low or the water sample was dirty. Application of LMS integrated with qPCR enabled detection of 10 oocysts per 10 ml dirty water sample concentrate. These findings indicate that LMS with WGA coupled to magnetic beads could be an efficient isolation step in the analysis of water sample concentrates for T. gondii oocysts, with detection either by microscopy or by qPCR.