Association Between the Severity of Depressive Symptoms and Human-Smartphone Interactions: Longitudinal Study

Abstract

Background Various behavioral sensing research studies have found that depressive symptoms are associated with human-smartphone interaction behaviors, including lack of diversity in unique physical locations, entropy of time spent in each location, sleep disruption, session duration, and typing speed. These behavioral measures are often tested against the total score of depressive symptoms, and the recommended practice to disaggregate within- and between-person effects in longitudinal data is often neglected. Objective We aimed to understand depression as a multidimensional process and explore the association between specific dimensions and behavioral measures computed from passively sensed human-smartphone interactions. We also aimed to highlight the nonergodicity in psychological processes and the importance of disaggregating within- and between-person effects in the analysis. Methods Data used in this study were collected by Mindstrong Health, a telehealth provider that focuses on individuals with serious mental illness. Depressive symptoms were measured by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult Survey every 60 days for a year. Participants’ interactions with their smartphones were passively recorded, and 5 behavioral measures were developed and were expected to be associated with depressive symptoms according to either theoretical proposition or previous empirical evidence. Multilevel modeling was used to explore the longitudinal relations between the severity of depressive symptoms and these behavioral measures. Furthermore, within- and between-person effects were disaggregated to accommodate the nonergodicity commonly found in psychological processes. Results This study included 982 records of DSM Level 1 depressive symptom measurements and corresponding human-smartphone interaction data from 142 participants (age range 29-77 years; mean age 55.1 years, SD 10.8 years; 96 female participants). Loss of interest in pleasurable activities was associated with app count (γ10=−0.14; P=.01; within-person effect). Depressed mood was associated with typing time interval (γ05=0.88; P=.047; within-person effect) and session duration (γ05=−0.37; P=.03; between-person effect). Conclusions This study contributes new evidence for associations between human-smartphone interaction behaviors and the severity of depressive symptoms from a dimensional perspective, and it highlights the importance of considering the nonergodicity of psychological processes and analyzing the within- and between-person effects separately.