Mobile health monitoring to characterize depression symptom trajectories in primary care.
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Date
2015-02-24
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Abstract
BACKGROUND Classification of depression severity can guide treatment decisions This study examined whether using repeated mobile health assessments to determine symptom trajectories is a potentially useful method for classifying depression severity METHODS 344 primary care patients with depression were identified and recruited as part of a program of mobile health symptom monitoring and self management support Depression symptoms were measured weekly via interactive voice response IVR calls using the Patient Health Questionnaire PHQ 9 Trajectory analysis of weekly IVR PHQ 9 scores from baseline through week 6 was used to subgroup patients according to similar trajectories Multivariable linear regression was used to determine whether the trajectories predicted 12 week PHQ 9 scores after adjusting for baseline and 6 week PHQ 9 scores RESULTS The optimal trajectory analysis model included 5 non intersecting trajectories The subgroups of patients assigned to each trajectory had mean baseline PHQ 9s of 19 7 14 5 9 5 5 0 and 2 0 and respective mean decreases in PHQ 9s over six weeks of 3 2 0 3 6 2 3 and 1 9 In regression analyses each trajectory significantly predicted 12 week PHQ 9 scores using the modal trajectory as a reference after adjusting for both baseline and 6 week PHQ 9 scores LIMITATIONS Treatment history was unknown findings may not be generalizable to new episodes of treatment CONCLUSIONS Depression symptom trajectories based on mobile health assessments are predictive of future depression outcomes even after accounting for typical assessments at baseline and a single follow up time point Approaches to classify patients disease status that involve multiple repeated assessments may provide more accurate and useful information for depression management compared to lower frequency monitoring