Reliability of the fMRI-based assessment of self-evaluation in individuals with internet gaming disorder.

The self-concept-defined as the cognitive representation of beliefs about oneself-determines how individuals view themselves, others, and their actions. A negative self-concept can drive gaming use and internet gaming disorder (IGD). The assessment of the neural correlates of self-evaluation gained popularity to assess the self-concept in individuals with IGD. This attempt, however, seems to critically depend on the reliability of the investigated task-fMRI brain activation. As first study to date, we assessed test-retest reliability of an fMRI self-evaluation task. Test-retest reliability of neural brain activation between two separate fMRI sessions (approximately 12 months apart) was investigated in N = 29 healthy participants and N = 11 individuals with pathological internet gaming. We computed reliability estimates for the different task contrasts (self, a familiar, and an unknown person) and the contrast (self > familiar and unknown person). Data indicated good test-retest reliability of brain activation, captured by the "self", "familiar person", and "unknown person" contrasts, in a large network of brain regions in the whole sample (N = 40) and when considering both experimental groups separately. In contrast to that, only a small set of brain regions showed moderate to good reliability, when investigating the contrasts ("self > familiar and unknown person"). The lower reliability of the contrast can be attributed to the fact that the constituting contrast conditions were highly correlated. Future research on self-evaluation should be cautioned by the findings of substantial local reliability differences across the brain and employ methods to overcome these limitations.

A Smarter Way to Use Your Smartphone: An Intervention to Limit Smartphone-Related Distractions Reduces Hyperactivity but Not Inattention Symptoms.

INTRODUCTION: Smartphones are often helpful in our everyday lives. Yet, they also tend to interrupt us during other activities. It has been argued that such distractions contribute to attention-deficit/hyperactivity disorder-like symptoms. However, since there are mostly correlational studies, the causal nature of this relationship is unclear. Our aim was to test whether reducing smartphone-related distractions might have a beneficial effect on inattention and hyperactive symptoms. METHODS: We conducted a 1-week field experiment with 37 healthy undergraduates and quasi-randomly assigned them to an intervention or control group (CG). The intervention group was given theory-based specific instructions that aimed at reducing smartphone-related distractions, whereas the CG received no intervention. The outcomes of interest were inattention level, hyperactive symptoms, and working memory accuracy. RESULTS: Compared to those in the control condition, participants who limited their smartphone use showed considerable reductions in hyperactive symptoms after 1 week - particularly those who displayed high problematic smartphone use. However, there were no group differences regarding inattention symptoms and working memory accuracy. DISCUSSION: The results give a first hint that strategically reducing smartphone-related distractions via specific but simple use modifications can mitigate hyperactive symptoms. Especially people with problematic smartphone use seem to profit from such an intervention. Remaining questions and directions are discussed.

Reconsolidation impairment of reward memory by stimulating stress response.

Research in memory reconsolidation has raised hope for new treatment options of persistent psychiatric disorders like substance dependence and post-traumatic stress disorder (PTSD). While animal research showed successful memory modification by interfering with reconsolidation, human research requires less invasive techniques. In our pilot study, we aimed to reduce appetitive memory reconsolidation of a newly acquired reward memory by exerting a stressor. Thirty healthy participants were randomly assigned to two groups performing a monetary reward paradigm at a personal computer. Day 1 was considered to allow for memory acquisition; on day 2, the experimental group was exposed to a frightening stimulus in the reconsolidation window; and day 3 again served to determine reward memory effects. Measures of reward memory were reaction times to reward announcing stimuli (ie, showing instrumental behavior), actual reward gained, and electrodermal response as a measure for reward anticipation. We found significantly smaller reaction time improvements to reward stimuli over time in the experimental group, as well as reduced achievements in monetary reward. Electrodermal response to reward announcing stimuli was lower in the experimental group after intervention, whereas it was higher in the untreated group. Thus, we argue in favor of the reconsolidation hypothesis, assuming our intervention had successfully interfered with the reconsolidation process. This points towards future treatment options that interfere with an addiction memory.

Exploring the Limitations of Event-Related Potential Measures in Moving Subjects: Pilot Studies of Four Different Technical Modifications in Ergometer Rowing.

Measuring brain activity in moving subjects is of great importance for investigating human behavior in ecological settings. For this purpose, EEG measures are applicable; however, technical modifications are required to reduce the typical massive movement artefacts. Four different approaches to measure EEG/ERPs during rowing were tested: (i) a purpose-built head-mounted preamplifier, (ii) a laboratory system with active electrodes, and a wireless headset combined with (iii) passive or (iv) active electrodes. A standard visual oddball task revealed very similar (within subjects) visual evoked potentials for rowing and rest (without movement). The small intraindividual differences between rowing and rest, in comparison to the typically larger interindividual differences in the ERP waveforms, revealed that ERPs can be measured reliably even in an athletic movement such as rowing. On the other hand, the expected modulation of the motor-related activity by force output was largely affected by movement artefacts. Therefore, for a successful application of ERP measures in movement research, further developments to differentiate between movement-related neuronal activity and movement-related artefacts are required. However, activities with small magnitudes related to motor learning and motor control may be difficult to detect because they are superimposed by the very large motor potential, which increases with force output.

Ambulatory Assessment for Physical Activity Research: State of the Science, Best Practices and Future Directions.

Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 "Physical Activity Assessment - State of the Science, Best Practices, Future Directions" where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessment that near realtime, which minimizes retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within- subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21st century such as insufficient PA and high levels of sedentary behavior.

Effectiveness of smartphone-based ambulatory assessment (SBAA-BD) including a predicting system for upcoming episodes in the long-term treatment of patients with bipolar disorders: study protocol for a randomized controlled single-blind trial.

BACKGROUND: The detection of early warning signs is essential in the long-term treatment of bipolar disorders. However, in bipolar patients' daily life and outpatient treatment the assessment of upcoming state changes faces several difficulties. In this trial, we examine the effectiveness of a smartphone based automated feedback about ambulatory assessed early warning signs in prolonging states of euthymia and therefore preventing hospitalization. This study aims to assess, whether patients experience longer episodes of euthymia, when their treating psychiatrists receive automated feedback about changes in communication and activity. With this additional information an intervention at an earlier stage in the development of mania or depression could be facilitated. We expect that the amount of time will be longer between affective episodes in the intervention group. METHODS/DESIGN: The current study is designed as a randomized, multi-center, observer-blind, active-control, parallel group trial within a nationwide research project on the topic of innovative methods for diagnostics, prevention and interventions of bipolar disorders. One hundred and twenty patients with bipolar disorder will be randomly assigned to (1) the experimental group with included automated feedback or (2) the control group without feedback. During the intervention phase, the psychopathologic state of all participants is assessed every four weeks over 18 months. Kaplan-Meier estimators will be used for estimating the survival functions, a Log-Rank test will be used to formally compare time to a new episode across treatment groups. An intention-to-treat analysis will include data from all randomized patients. DISCUSSION: This article describes the design of a clinical trial investigating the effectiveness of a smartphone-based feedback loop. This feedback loop is meant to elicit early interventions at the detection of warning signs for the prevention of affective episodes in bipolar patients. This approach will hopefully improve the chances of a timely intervention helping patients to keep a balanced mood for longer periods of time. In detail, if our hypothesis can be confirmed, clinical practice treating psychiatrists will be enabled to react quickly when changes are automatically detected. Therefore, outpatients would receive an even more individually tailored treatment concerning time and frequency of doctor's appointments. TRIAL REGISTRATION: ClinicalTrials.gov : NCT02782910 : Title: "Smartphone-based Ambulatory Assessment of Early Warning Signs (BipoLife_A3)". Registered May 25 2016. Protocol Amendment Number: 03. Issue Date: 26 March 2018. Author(s): ES.

Letter to the editor concerning the article "Effects of acoustic feedback training in elite-standard Para-Rowing" by Schaffert and Mattes (2015).

In a case study, Schaffert and Mattes reported the application of acoustic feedback (sonification) to optimise the time course of boat acceleration. The authors attributed an increased boat speed in the feedback condition to an optimised boat acceleration (mainly during the recovery phase). However, in rowing it is biomechanically impossible to increase the boat speed significantly by reducing the fluctuations in boat acceleration during the rowing cycle. To assess such a, potentially small, optimising effect experimentally, the confounding variables must be controlled very accurately (that is especially the propulsive forces must be kept constant between experimental conditions or the differences in propulsive forces between conditions must be much smaller than the effects on boat speed resulting from an optimised movement pattern). However, this was not controlled adequately by the authors. Instead, the presented boat acceleration data show that the increased boat speed under acoustic feedback was due to increased propulsive forces.

Dissociating electrophysiological correlates of subjective, objective, and correct memory in investigating the emotion-induced recognition bias.

Performance on tasks requiring discrimination of at least two stimuli can be viewed either from an objective perspective (referring to actual stimulus differences), or from a subjective perspective (corresponding to participant's responses). Using event-related potentials recorded during an old/new recognition memory test involving emotionally laden and neutral words studied either blockwise or randomly intermixed, we show here how the objective perspective (old versus new items) yields late effects of blockwise emotional item presentation at parietal sites that the subjective perspective fails to find, whereas the subjective perspective ("old" versus "new" responses) is more sensitive to early effects of emotion at anterior sites than the objective perspective. Our results demonstrate the potential advantage of dissociating the subjective and the objective perspective onto task performance (in addition to analyzing trials with correct responses), especially for investigations of illusions and information processing biases, in behavioral and cognitive neuroscience studies.

Can clouds dance? Part 2: an ERP investigation of passive conceptual expansion.

Conceptual expansion, one of the core operations in creative cognition, was investigated in the present ERP study. An experimental paradigm using novel metaphoric, nonsensical and literal phrases was employed where individual differences in conceptual knowledge organization were accounted for by using participants' responses to categorize the stimuli to each condition. The categorization was determined by their judgment of the stimuli on the two defining criteria of creativity: unusualness and appropriateness. Phrases judged as unusual and appropriate were of special interest as they are novel and unfamiliar phrases thought to passively induce conceptual expansion. The results showed a graded N400 modulation for phrases judged to be unusual and inappropriate (nonsense) or unusual and appropriate (conceptual expansion, novel metaphorical) relative to usual and appropriate (literal) phrases. The N400 is interpreted as indexing greater effort to retrieve semantic information and integrate the novel concepts presented through the phrases. Analyses of the later time-window showed an ongoing negativity that was graded in the same manner as the N400. The findings attest to the usefulness of investigating creative cognition using event-related electrophysiology.

Women with abuse-related posttraumatic stress disorder sleep more fitfully but just as long as healthy controls: an actigraphic study.

STUDY OBJECTIVES: Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. METHODS: We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 nontraumatized mentally healthy women (healthy controls, HC group). RESULTS: The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. CONCLUSIONS: Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se. SUBSET OF DATA FROM CLINICAL TRIAL: Treating Psychosocial and Neural Consequences of Childhood Interpersonal Violence in Adults (RELEASE), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000000, German Clinical Trials registration number: DRKS00005578.

Performance of ECG-based seizure detection algorithms strongly depends on training and test conditions.

OBJECTIVE: To identify non-EEG-based signals and algorithms for detection of motor and non-motor seizures in people lying in bed during video-EEG (VEEG) monitoring and to test whether these algorithms work in freely moving people during mobile EEG recordings. METHODS: Data of three groups of adult people with epilepsy (PwE) were analyzed. Group 1 underwent VEEG with additional devices (accelerometry, ECG, electrodermal activity); group 2 underwent VEEG; and group 3 underwent mobile EEG recordings both including one-lead ECG. All seizure types were analyzed. Feature extraction and machine-learning techniques were applied to develop seizure detection algorithms. Performance was expressed as sensitivity, precision, F1 score, and false positives per 24 hours. RESULTS: The algorithms were developed in group 1 (35 PwE, 33 seizures) and achieved best results (F1 score 56%, sensitivity 67%, precision 45%, false positives 0.7/24 hours) when ECG features alone were used, with no improvement by including accelerometry and electrodermal activity. In group 2 (97 PwE, 255 seizures), this ECG-based algorithm largely achieved the same performance (F1 score 51%, sensitivity 39%, precision 73%, false positives 0.4/24 hours). In group 3 (30 PwE, 51 seizures), the same ECG-based algorithm failed to meet up with the performance in groups 1 and 2 (F1 score 27%, sensitivity 31%, precision 23%, false positives 1.2/24 hours). ECG-based algorithms were also separately trained on data of groups 2 and 3 and tested on the data of the other groups, yielding maximal F1 scores between 8% and 26%. SIGNIFICANCE: Our results suggest that algorithms based on ECG features alone can provide clinically meaningful performance for automatic detection of all seizure types. Our study also underscores that the circumstances under which such algorithms were developed, and the selection of the training and test data sets need to be considered and limit the application of such systems to unseen patient groups behaving in different conditions.

Digital phenotyping: towards replicable findings with comprehensive assessments and integrative models in bipolar disorders.

BACKGROUND: Digital phenotyping promises to unobtrusively obtaining a continuous and objective input of symptomatology from patients' daily lives. The prime example are bipolar disorders, as smartphone parameters directly reflect bipolar symptomatology. Empirical studies, however, have yielded inconsistent findings. We believe that three main shortcomings have to be addressed to fully leverage the potential of digital phenotyping: short assessment periods, rare outcome assessments, and an extreme fragmentation of parameters without an integrative analytical strategy. METHODS: To demonstrate how to overcome these shortcomings, we conducted frequent (biweekly) dimensional and categorical expert ratings and daily self-ratings over an extensive assessment period (12 months) in 29 patients with bipolar disorder. Digital phenotypes were monitored continuously. As an integrative analytical strategy, we used structural equation modelling to build latent psychopathological outcomes (mania, depression) and latent digital phenotype predictors (sleep, activity, communicativeness). OUTCOMES: Combining gold-standard categorical expert ratings with dimensional self and expert ratings resulted in two latent outcomes (mania and depression) with statistically meaningful factor loadings that dynamically varied over 299 days. Latent digital phenotypes of sleep and activity were associated with same-day latent manic psychopathology, suggesting that psychopathological alterations in bipolar disorders relate to domains (latent variables of sleep and activity) and not only to specific behaviors (such as the number of declined incoming calls). The identification of latent psychopathological outcomes that dimensionally vary on a daily basis will enable to empirically determine which combination of digital phenotypes at which days prior to an upcoming episode are viable as digital prodromal predictors.

Life within a limited radius: Investigating activity space in women with a history of child abuse using global positioning system tracking.

Early experiences of childhood sexual or physical abuse are often associated with functional impairments, reduced well-being and interpersonal problems in adulthood. Prior studies have addressed whether the traumatic experience itself or adult psychopathology is linked to these limitations. To approach this question, individuals with posttraumatic stress disorder (PTSD) and healthy individuals with and without a history of child abuse were investigated. We used global positioning system (GPS) tracking to study temporal and spatial limitations in the participants' real-life activity space over the course of one week. The sample consisted of 228 female participants: 150 women with PTSD and emotional instability with a history of child abuse, 35 mentally healthy women with a history of child abuse (healthy trauma controls, HTC) and 43 mentally healthy women without any traumatic experiences in their past (healthy controls, HC). Both traumatized groups-i.e. the PTSD and the HTC group-had smaller movement radii than the HC group on the weekends, but neither spent significantly less time away from home than HC. Some differences between PTSD and HC in movement radius seem to be related to correlates of PTSD psychopathology, like depression and physical health. Yet group differences between HTC and HC in movement radius remained even when contextual and individual health variables were included in the model, indicating specific effects of traumatic experiences on activity space. Experiences of child abuse could limit activity space later in life, regardless of whether PTSD develops.

An event-related potential evoked by movement planning is modulated by performance and learning in visuomotor control.

Based on a previous exploratory study, the functionality of event-related potentials related to visuomotor processing and learning was investigated. Three pursuit tracking tasks (cursor control either mouse, joystick, or bimanually) revealed the greatest tracking error and greatest learning effect in the bimanual task. The smallest error without learning was found in the mouse task. Error reduction reflected visuomotor learning. In detail, target-cursor distance was reduced continuously, indicating a better fit to a changed direction, whereas response time remained at 300 ms. A central positive ERP component with an activity onset 100 ms after a directional change of the target and most likely generated in premotor areas could be assigned to response planning and execution. The magnitude of this component was modulated by within-and-between-task difficulty and size of the tracking error. Most importantly, the size of this component was sensitive to between-subject performance and increased with visuomotor learning.

Abnormal N400 Semantic Priming Effect May Reflect Psychopathological Processes in Schizophrenia: A Twin Study.

OBJECTIVE: Activation of semantic networks is indexed by the N400 effect. We used a twin study design to investigate whether N400 effect abnormalities reflect genetic/trait liability or are related to psychopathological processes in schizophrenia. METHODS: We employed robust linear regression to compare N400 and behavioral priming effects across 36 monozygotic twin pairs (6 pairs concordant for schizophrenia/schizoaffective disorder, 11 discordant pairs, and 19 healthy control pairs) performing a lexical decision task. Moreover, we examined the correlation between Brief Psychiatric Rating Scale (BPRS) score and the N400 effect and the influence of medication status on this effect. RESULTS: Regression yielded a significant main effect of group on the N400 effect only in the direct priming condition (p = 0.003). Indirect condition and behavioral priming effect showed no significant effect of group. Planned contrasts with the control group as a reference group revealed that affected concordant twins had significantly reduced N400 effect compared to controls, and discordant affected twins had a statistical trend for reduced N400 effect compared to controls. The unaffected twins did not differ significantly from the controls. There was a trend for correlation between reduced N400 effect and higher BPRS scores, and the N400 effect did not differ significantly between medicated and unmedicated patients. CONCLUSIONS: Reduced N400 effect may reflect disease-specific processes in schizophrenia implicating frontotemporal brain network in schizophrenia pathology.

N2 event-related potential correlates of response inhibition in an auditory Go/Nogo task.

The aim of this study was to investigate the event-related potential correlates of response inhibition in the N2 time window, specifically in the auditory modality. A paired tone Go/Nogo paradigm elicited an enhanced fronto-central negativity in the Nogo condition, which was accompanied by a concurring inferior fronto-temporal positivity. In contrast to most previous studies our data provide evidence for a fronto-central Nogo-N2 component in the auditory modality.

Exploring the Neural Basis of Avatar Identification in Pathological Internet Gamers and of Self-Reflection in Pathological Social Network Users.

Background and aims Internet gaming addiction appears to be related to self-concept deficits and increased angular gyrus (AG)-related identification with one's avatar. For increased social network use, a few existing studies suggest striatal-related positive social feedback as an underlying factor. However, whether an impaired self-concept and its reward-based compensation through the online presentation of an idealized version of the self are related to pathological social network use has not been investigated yet. We aimed to compare different stages of pathological Internet game and social network use to explore the neural basis of avatar and self-identification in addictive use. Methods About 19 pathological Internet gamers, 19 pathological social network users, and 19 healthy controls underwent functional magnetic resonance imaging while completing a self-retrieval paradigm, asking participants to rate the degree to which various self-concept-related characteristics described their self, ideal, and avatar. Self-concept-related characteristics were also psychometrically assessed. Results Psychometric testing indicated that pathological Internet gamers exhibited higher self-concept deficits generally, whereas pathological social network users exhibit deficits in emotion regulation only. We observed left AG hyperactivations in Internet gamers during avatar reflection and a correlation with symptom severity. Striatal hypoactivations during self-reflection (vs. ideal reflection) were observed in social network users and were correlated with symptom severity. Discussion and conclusion Internet gaming addiction appears to be linked to increased identification with one's avatar, evidenced by high left AG activations in pathological Internet gamers. Addiction to social networks seems to be characterized by emotion regulation deficits, reflected by reduced striatal activation during self-reflection compared to during ideal reflection.

SOA-dependent N400 and P300 semantic priming effects using pseudoword primes and a delayed lexical decision.

In a previous semantic priming study, we found a semantic distance effect on the lexical-decision-related P300 when SOA was short (150 ms) only, but no different RT and N400 priming effects between short and long (700 ms) SOAs. To investigate this further, we separated priming from lexical decision, using a delayed lexical decision in the present study. In the short SOA only, primed targets evoked an early peaking (approximately 480 ms) P300-like component, probably because the subject detected the semantic relationship implicitly. We hypothesize that in tasks requiring an immediate lexical decision, this early P300 and the later lexical decision P300 (approximately 600 ms) are additive. Secondly, we found both a direct and an indirect priming effect for both SOAs for the ERP amplitude of the N400 time window. However the N400 component itself was considerably larger in the long SOA than in the short SOA. We interpreted this finding as an ERP correlate for deeper semantic processing in the long SOA, due to increased attention that was provoked by the use of pseudoword primes. In contrast, in the short SOA, subjects might have used a shallowed semantic processing. N400, P300, and RTs are sensitive to semantic priming-but the modulation patterns are not consistent. This raises the question as to which variable reflects an immediate physiological correlate of semantic priming, and which variable reflects co-occurring processes associated with semantic priming.

Analyzing a complex visuomotor tracking task with brain-electrical event related potentials.

Non-invasive techniques such as neuroimaging and event-related potential (ERP) methods have dramatically enhanced our understanding of the human brain. According to the requirements of the applied method, it is useful to simplify tasks for methodological reasons. In the present study we tested whether ERP measures are also suitable for analyzing complex tasks. In order to do this, we developed an analysis strategy based on the post hoc analysis of the behavioural data. We applied this method to a pursuit-tracking task of 25 s trial duration, consisting of repeated and non-repeated waveforms, where subjects had to track a target cross with a mouse-controlled cursor cross. An EEG was recorded from 62 channels. Response-locked ERPs were computed for two types of error correction: the correction of errors induced externally by the change of target direction and of internal errors generated by the subject itself. We found several ERP components that could be assigned to different feedback and feedforward controlled processing steps in the frontoparietal circuitry underlying visuomotor control, such as movement planning, movement execution (motor potential), reafferent activity, visuospatial analysis, and attentional (P300) processes. Our results support newer models that propose a role for the posterior parietal cortex in integrating multimodal sensory information. In addition, fast (about 180 ms and probably facilitated by anticipation) and slow (about 230-260 ms) error corrections could be differentiated by the time course of ERP activity. Our results show that complex (motor) tasks can be investigated with ERPs. This opens fruitful perspectives for future research on motor control in an ecological setting.

Improving motor activity assessment in depression: which sensor placement, analytic strategy and diurnal time frame are most powerful in distinguishing patients from controls and monitoring treatment effects.

BACKGROUND: Abnormalities in motor activity represent a central feature in major depressive disorder. However, measurement issues are poorly understood, limiting the use of objective measurement of motor activity for diagnostics and treatment monitoring. METHODS: To improve measurement issues, especially sensor placement, analytic strategies and diurnal effects, we assessed motor activity in depressed patients at the beginning (MD; n=27) and after anti-depressive treatment (MD-post; n=18) as well as in healthy controls (HC; n=16) using wrist- and chest-worn accelerometers. We performed multiple analyses regarding sensor placements, extracted features, diurnal variation, motion patterns and posture to clarify which parameters are most powerful in distinguishing patients from controls and monitoring treatment effects. RESULTS: Whereas most feature-placement combinations revealed significant differences between groups, acceleration (wrist) distinguished MD from HC (d=1.39) best. Frequency (vertical axis chest) additionally differentiated groups in a logistic regression model (R2=0.54). Accordingly, both amplitude (d=1.16) and frequency (d=1.04) showed alterations, indicating reduced and decelerated motor activity. Differences between MD and HC in gestures (d=0.97) and walking (d=1.53) were found by data analysis from the wrist sensor. Comparison of motor activity at the beginning and after MD-treatment largely confirms our findings. LIMITATIONS: Sample size was small, but sufficient for the given effect sizes. Comparison of depressed in-patients with non-hospitalized controls might have limited motor activity differences between groups. CONCLUSIONS: Measurement of wrist-acceleration can be recommended as a basic technique to capture motor activity in depressed patients as it records whole body movement and gestures. Detailed analyses showed differences in amplitude and frequency denoting that depressed patients walked less and slower.