Abstract
Late-life depression is heterogenous and patients vary in disease course over time. Most psychotherapy studies measure activity levels and symptoms solely using self-report scales, administered periodically. These scales may not capture granular changes during treatment. We introduce the potential utility of passive sensing data collected with smartphone to assess fluctuations in daily functioning in real time during psychotherapy for late life depression in elder abuse victims. To our knowledge, this is the first investigation of passive sensing among depressed elder abuse victims. We present data from three victims who received a 9-week intervention as part of a pilot randomized controlled trial and showed a significant decrease in depressive symptoms (50% reduction). Using a smartphone, we tracked participants' daily number of smartphone unlocks, time spent at home, time spent in conversation, and step count over treatment. Independent assessment of depressive symptoms and behavioral activation were collected at intake, Weeks 6 and 9. Data revealed patient-level fluctuations in activity level over treatment, corresponding with self-reported behavioral activation. We demonstrate how passive sensing data could expand our understanding of heterogenous presentations of late-life depression among elder abuse. We illustrate how trajectories of change in activity levels as measured with passive sensing and subjective measures can be tracked concurrently over time. We outline challenges and potential solutions for application of passive sensing data collection in future studies with larger samples using novel advanced statistical modeling, such as artificial intelligence algorithms.
Highlights
Major Depressive Disorder (MDD) in later life is a heterogenous condition characterized by high variability in biological and clinical features [1, 2]
While passive sensing has gained its popularity in mental health studies in youth and adult populations [8, 9], few studies examined its applicability on studying mental disorders in late life [10, 11]
We developed PROTECT, a behavioral activation and goal directed intervention for late life depression in elder abuse victims
Summary
Major Depressive Disorder (MDD) in later life is a heterogenous condition characterized by high variability in biological and clinical features [1, 2]. Real-time routine tracking of movement and activity levels in depressed older adults—especially those suffering from trauma— can inform the study of engagement in behavioral activation (BA) psychotherapies that target increasing activity levels to reduce depression severity [12, 13]. In these therapies patients are encouraged to engage in meaningful, rewarding activities, including increased time away from home, physical activity, and social interactions [13,14,15]. We discuss opportunities and challenges and provide potential solutions and recommendations for future research
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