New Tools for New Research in Psychiatry: A Scalable and Customizable Platform to Empower Data Driven Smartphone Research

Background A longstanding barrier to progress in psychiatry, both in clinical settings and research trials, has been the persistent difficulty of accurately and reliably quantifying disease phenotypes. Mobile phone technology combined with data science has the potential to offer medicine a wealth of additional information on disease phenotypes, but the large majority of existing smartphone apps are not intended for use as biomedical research platforms and, as such, do not generate research-quality data. Objective Our aim is not the creation of yet another app per se but rather the establishment of a platform to collect research-quality smartphone raw sensor and usage pattern data. Our ultimate goal is to develop statistical, mathematical, and computational methodology to enable us and others to extract biomedical and clinical insights from smartphone data. Methods We report on the development and early testing of Beiwe, a research platform featuring a study portal, smartphone app, database, and data modeling and analysis tools designed and developed specifically for transparent, customizable, and reproducible biomedical research use, in particular for the study of psychiatric and neurological disorders. We also outline a proposed study using the platform for patients with schizophrenia. Results We demonstrate the passive data capabilities of the Beiwe platform and early results of its analytical capabilities. Conclusions Smartphone sensors and phone usage patterns, when coupled with appropriate statistical learning tools, are able to capture various social and behavioral manifestations of illnesses, in naturalistic settings, as lived and experienced by patients. The ubiquity of smartphones makes this type of moment-by-moment quantification of disease phenotypes highly scalable and, when integrated within a transparent research platform, presents tremendous opportunities for research, discovery, and patient health.

[1]  J. Ainsworth,et al.  Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: a qualitative study , 2013, BMC Psychiatry.

[2]  Heyoung Lee,et al.  The SAMS: Smartphone Addiction Management System and Verification , 2013, Journal of Medical Systems.

[3]  Jim van Os,et al.  Size of burden of schizophrenia and psychotic disorders , 2005, European Neuropsychopharmacology.

[4]  M Knapp,et al.  Economic outcomes and costs in the treatment of schizophrenia. , 1997, Clinical therapeutics.

[5]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[6]  G. Hogarty,et al.  The limited effects of antipsychotic medication on schizophrenia relapse and adjustment and the contributions of psychosocial treatment , 1998 .

[7]  Vincent D. Blondel,et al.  A survey of results on mobile phone datasets analysis , 2015, EPJ Data Science.

[8]  Mika Gissler,et al.  Web-Based Versus Traditional Paper Questionnaires: A Mixed-Mode Survey With a Nordic Perspective , 2013, Journal of medical Internet research.

[9]  P. Jørgensen,et al.  Schizophrenic delusions: the detection of warning signals , 1998, Schizophrenia Research.

[10]  J. McGrath,et al.  Schizophrenia: a concise overview of incidence, prevalence, and mortality. , 2008, Epidemiologic reviews.

[11]  Michael F. Green,et al.  Functional impairment in people with schizophrenia: Focus on employability and eligibility for disability compensation , 2012, Schizophrenia Research.

[12]  Lucy Yardley,et al.  Opportunities and challenges for smartphone applications in supporting health behavior change , 2013 .

[13]  Dhavan V. Shah,et al.  A smartphone application to support recovery from alcoholism: a randomized clinical trial. , 2014, JAMA psychiatry.

[14]  Patrick C. Staples,et al.  Realizing the Potential of Mobile Mental Health: New Methods for New Data in Psychiatry , 2015, Current Psychiatry Reports.

[15]  Hongshik Ahn,et al.  Concurrent measurement of "real-world" stress and arousal in individuals with psychosis: assessing the feasibility and validity of a novel methodology. , 2010, Schizophrenia bulletin.

[16]  J. Kane,et al.  Treatment strategies to prevent relapse and encourage remission. , 2007, The Journal of clinical psychiatry.

[17]  D. Lazer,et al.  The Parable of Google Flu: Traps in Big Data Analysis , 2014, Science.

[18]  C. Depp,et al.  A Pilot Study of Mood Ratings Captured by Mobile Phone Versus Paper-and-Pencil Mood Charts in Bipolar Disorder , 2012, Journal of dual diagnosis.

[19]  Jeremy Ginsberg,et al.  Detecting influenza epidemics using search engine query data , 2009, Nature.

[20]  Lorie A. Kloda,et al.  The diagnostic accuracy of the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-8 (PHQ-8), and Patient Health Questionnaire-9 (PHQ-9) for detecting major depression: protocol for a systematic review and individual patient data meta-analyses , 2014, Systematic Reviews.

[21]  Ronan E. O'Carroll,et al.  Cognitive impairment in schizophrenia , 2000 .

[22]  M. Keshavan,et al.  Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics , 2014, JMIR mental health.

[23]  H. Reis,et al.  The relationship context of human behavior and development. , 2000, Psychological bulletin.

[24]  Jari Saramäki,et al.  Persistence of social signatures in human communication , 2012, Proceedings of the National Academy of Sciences.

[25]  T. Insel,et al.  Wesleyan University From the SelectedWorks of Charles A . Sanislow , Ph . D . 2010 Research Domain Criteria ( RDoC ) : Toward a New Classification Framework for Research on Mental Disorders , 2018 .

[26]  S. Shiffman,et al.  Ecological momentary assessment. , 2008, Annual review of clinical psychology.

[27]  G. Hogarty,et al.  The limitations of antipsychotic medication on schizophrenia relapse and adjustment and the contributions of psychosocial treatment. , 1998, Journal of psychiatric research.

[28]  C. Melville,et al.  Relapse in schizophrenia. , 1980, The American journal of psychiatry.

[29]  Albert-László Barabási,et al.  Understanding individual human mobility patterns , 2008, Nature.

[30]  Tasha Glenn,et al.  Privacy in the Digital World: Medical and Health Data Outside of HIPAA Protections , 2014, Current Psychiatry Reports.

[31]  A-L Barabási,et al.  Structure and tie strengths in mobile communication networks , 2006, Proceedings of the National Academy of Sciences.

[32]  Konrad Paul Kording,et al.  Mobile Phone Sensor Correlates of Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study , 2015, Journal of medical Internet research.

[33]  A. Barabasi,et al.  Analysis of a large-scale weighted network of one-to-one human communication , 2007, physics/0702158.

[34]  Jukka-Pekka Onnela,et al.  Geographic Constraints on Social Network Groups , 2010, PloS one.

[35]  Cathryn M. Delude.  Deep phenotyping: The details of disease , 2015, Nature.

[36]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[37]  M. Sigman,et al.  Automated analysis of free speech predicts psychosis onset in high-risk youths , 2015, npj Schizophrenia.

[38]  R. Emsley,et al.  The nature of relapse in schizophrenia , 2013, BMC Psychiatry.

[39]  D. Gustafson,et al.  Predictive modeling of addiction lapses in a mobile health application. , 2014, Journal of substance abuse treatment.

[40]  John Torous,et al.  Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder , 2015, JMIR mental health.

[41]  J. Olivares,et al.  Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review , 2013, Annals of General Psychiatry.

[42]  A. Awad,et al.  The burden of schizophrenia on caregivers: a review. , 2008, PharmacoEconomics.

[43]  Tanzeem Choudhury,et al.  Passive and In-Situ assessment of mental and physical well-being using mobile sensors , 2011, UbiComp '11.

[44]  R. Morriss,et al.  Training to recognise the early signs of recurrence in schizophrenia. , 2013, The Cochrane database of systematic reviews.

[45]  Henry A. Nasrallah,et al.  Schizophrenia, “Just the Facts”: What we know in 2008 Part 1: Overview , 2008, Schizophrenia Research.

[46]  Christine Barrowclough,et al.  A Comparison of Two Delivery Modalities of a Mobile Phone-Based Assessment for Serious Mental Illness: Native Smartphone Application vs Text-Messaging Only Implementations , 2013, Journal of medical Internet research.

[47]  Philip D. Harvey,et al.  COGNITIVE IMPAIRMENT IN SCHIZOPHRENIA , 2005, Schizophrenia Research.

[48]  M. Csíkszentmihályi,et al.  Validity and Reliability of the Experience‐Sampling Method , 1987, The Journal of nervous and mental disease.

[49]  D. Penn,et al.  Lexical Characteristics of Emotional Narratives in Schizophrenia: Relationships With Symptoms, Functioning, and Social Cognition , 2015, The Journal of nervous and mental disease.

[50]  B. Löwe,et al.  A brief measure for assessing generalized anxiety disorder: the GAD-7. , 2006, Archives of internal medicine.

[51]  D. Ben-Zeev,et al.  Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. , 2014, Schizophrenia bulletin.

[52]  Brian W. Powers,et al.  The digital phenotype , 2015, Nature Biotechnology.

[53]  Michael S. Ritsner,et al.  Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorders: I. Predictive value of disorder-related factors , 2012, Quality of Life Research.

[54]  Angus Roberts,et al.  Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method , 2015, BMJ Open.

[55]  Byron Havard,et al.  Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System , 2015, JMIR mental health.

[56]  J. Ainsworth,et al.  The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application , 2012, BMC Psychiatry.