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Ren X, Burkhardt HA, Areán PA, Hull TD, Cohen T. Deep Representations of First-person Pronouns for Prediction of Depression Symptom Severity. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1226-1235. [PMID: 38222407 PMCID: PMC10785936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Prior work has shown that analyzing the use of first-person singular pronouns can provide insight into individuals' mental status, especially depression symptom severity. These findings were generated by counting frequencies of first-person singular pronouns in text data. However, counting doesn't capture how these pronouns are used. Recent advances in neural language modeling have leveraged methods generating contextual embeddings. In this study, we sought to utilize the embeddings of first-person pronouns obtained from contextualized language representation models to capture ways these pronouns are used, to analyze mental status. De-identified text messages sent during online psychotherapy with weekly assessment of depression severity were used for evaluation. Results indicate the advantage of contextualized first-person pronoun embeddings over standard classification token embeddings and frequency-based pronoun analysis results in predicting depression symptom severity. This suggests contextual representations of first-person pronouns can enhance the predictive utility of language used by people with depression symptoms.
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Affiliation(s)
- Xinyang Ren
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - Hannah A Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - Patricia A Areán
- ALACRITY Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | | | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
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Imel ZE, Tanana MJ, Soma CS, Hull TD, Pace BT, Stanco SC, Creed TA, Moyers TB, Atkins DC. Mental Health Counseling From Conversational Content With Transformer-Based Machine Learning. JAMA Netw Open 2024; 7:e2352590. [PMID: 38252437 PMCID: PMC10804269 DOI: 10.1001/jamanetworkopen.2023.52590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Importance Use of asynchronous text-based counseling is rapidly growing as an easy-to-access approach to behavioral health care. Similar to in-person treatment, it is challenging to reliably assess as measures of process and content do not scale. Objective To use machine learning to evaluate clinical content and client-reported outcomes in a large sample of text-based counseling episodes of care. Design, Setting, and Participants In this quality improvement study, participants received text-based counseling between 2014 and 2019; data analysis was conducted from September 22, 2022, to November 28, 2023. The deidentified content of messages was retained as a part of ongoing quality assurance. Treatment was asynchronous text-based counseling via an online and mobile therapy app (Talkspace). Therapists were licensed to provide mental health treatment and were either independent contractors or employees of the product company. Participants were self-referred via online sign-up and received services via their insurance or self-pay and were assigned a diagnosis from their health care professional. Exposure All clients received counseling services from a licensed mental health clinician. Main Outcomes and Measures The primary outcomes were client engagement in counseling (number of weeks), treatment satisfaction, and changes in client symptoms, measured via the 8-item version of Patient Health Questionnaire (PHQ-8). A previously trained, transformer-based, deep learning model automatically categorized messages into types of therapist interventions and summaries of clinical content. Results The total sample included 166 644 clients treated by 4973 therapists (20 600 274 messages). Participating clients were predominantly female (75.23%), aged 26 to 35 years (55.4%), single (37.88%), earned a bachelor's degree (59.13%), and were White (61.8%). There was substantial variability in intervention use and treatment content across therapists. A series of mixed-effects regressions indicated that collectively, interventions and clinical content were associated with key outcomes: engagement (multiple R = 0.43), satisfaction (multiple R = 0.46), and change in PHQ-8 score (multiple R = 0.13). Conclusions and Relevance This quality improvement study found associations between therapist interventions, clinical content, and client-reported outcomes. Consistent with traditional forms of counseling, higher amounts of supportive counseling were associated with improved outcomes. These findings suggest that machine learning-based evaluations of content may increase the scale and specificity of psychotherapy research.
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Affiliation(s)
| | | | | | | | | | | | - Torrey A. Creed
- Beck Community Initiative, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Walton MA, Carter PM, Seewald L, Ngo Q, Battisti KA, Pearson C, Blow FC, Cunningham RM, Bourque C, Kidwell KM. Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: A sequential multiple assignment randomized controlled trial protocol. Contemp Clin Trials 2023; 130:107218. [PMID: 37148999 PMCID: PMC10947472 DOI: 10.1016/j.cct.2023.107218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
Alcohol use and violent behaviors among youth are associated with morbidity and mortality. An emergency department (ED) visit provides an opportunity to initiate prevention efforts. Despite promising findings from our single session SafERteens brief intervention (BI), impact is limited by modest effect sizes, with data lacking on optimal boosters to enhance effects. This paper describes the protocol for a sequential, multiple assignment, randomized trial (SMART). Adolescents and emerging adults (ages 14-20) in the ED screening positive for alcohol use and violent behaviors (physical aggression) were randomly assigned to: 1) SafERteens BI + Text Messaging (TM), or 2) SafERteens BI + remote Health Coach (HC). Participants completed weekly surveys over 8 weeks after the ED visit to tailor intervention content and measure mechanisms of change. At one-month, intervention response/non-response is determined (e.g., binge drinking or violent behaviors). Responders are re-randomized to continued intervention condition (e.g., maintenance) or minimized condition (e.g., stepped down). Non-responders are re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes were measured at 4 and 8 months, including primary outcomes of alcohol consumption and violence, with secondary outcomes of alcohol consequences and violence consequences. Although the original goal was to enroll 700 participants, COVID-19 impacts on research diminished recruitment in this trial (enrolled n = 400). Nonetheless, the proposed SMART is highly innovative by blending real-time assessment methodologies with adaptive intervention delivery among teens with comorbid alcohol misuse and violent behaviors. Findings will inform the content and timing booster interventions to alter risk behavior trajectories. Trial Registration:ClinicalTrials.govNCT03344666. University of Michigan # HUM00109156.
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Affiliation(s)
- Maureen A Walton
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109-2800, USA
| | - Laura Seewald
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109-2800, USA
| | - Quyen Ngo
- Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, Center City, MN 55012, USA
| | - Katherine A Battisti
- Department of Pediatrics, Central Michigan University and Covenant Hospital, Saginaw, MI 48602, USA
| | - Claire Pearson
- Wayne State University, Department of Emergency Medicine, and St. John Hospital, Detroit, MI 48109, USA
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109-2800, USA
| | - Carrie Bourque
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
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Song J, Litvin B, Allred R, Chen S, Hull TD, Areán PA. Comparing Message-Based Psychotherapy to Once-Weekly, Video-Based Psychotherapy for Moderate Depression: Randomized Controlled Trial. J Med Internet Res 2023; 25:e46052. [PMID: 37384392 PMCID: PMC10365600 DOI: 10.2196/46052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite the high prevalence of major depressive disorder and the related societal burden, access to effective traditional face-to-face or video-based psychotherapy is a challenge. An alternative that offers mental health care in a flexible setting is asynchronous messaging therapy. To date, no study has evaluated its efficacy and acceptability in a randomized controlled trial for depression. OBJECTIVE The aim of this study was to compare the efficacy and acceptability of message-based psychotherapy for depression to once-weekly video-based psychotherapy. METHODS In this 2-armed randomized controlled trial, individuals (N=83) with depressive symptomatology (Patient Health Questionnaire-9 ≥10) were recruited on the internet and randomly assigned to either a message-based intervention group (n=46) or a once-weekly video-based intervention group (n=37). Patients in the message-based treatment condition exchanged asynchronous messages with their therapist following an agreed-upon schedule. Patients in the video-based treatment condition met with their therapist once each week for a 45-minute video teletherapy session. Self-report data for depression, anxiety, and functional impairment were collected at pretreatment, weekly during treatment, at posttreatment, and at a 6-month follow-up. Self-reported treatment expectancy and credibility for the assigned intervention were assessed at pretreatment and therapeutic alliance at posttreatment. RESULTS Findings from multilevel modeling indicated significant, medium-to-large improvements in depression (d=1.04; 95% CI 0.60-1.46), anxiety (d=0.61; 95% CI 0.22-0.99), and functional impairment (d=0.66; 95% CI 0.27-1.05) for patients in the message-based treatment condition. Changes in depression (d=0.11; 95% CI -0.43 to 0.66), anxiety (d=-0.01; 95% CI -0.56 to 0.53), and functional impairment (d=0.25; 95% CI -0.30 to 0.80) in the message-based treatment condition were noninferior to those in the video-based treatment condition. There were no significant differences in treatment credibility (d=-0.09; 95% CI -0.64 to 0.45), therapeutic alliance (d=-0.15; 95% CI -0.75 to 0.44), or engagement (d=0.24; 95% CI -0.20 to 0.67) between the 2 treatment conditions. CONCLUSIONS Message-based psychotherapy could present an effective and accessible alternative treatment modality for patients who might not be able to engage in traditional scheduled services such as face-to-face or video-based psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov NCT05467787; https://www.clinicaltrials.gov/ct2/show/NCT05467787.
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Affiliation(s)
- Jiyoung Song
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | | | - Ryan Allred
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Griffith Fillipo IR, Pullmann MD, Hull TD, Zech J, Wu J, Litvin B, Chen S, Arean PA. Participant retention in a fully remote trial of digital psychotherapy: Comparison of incentive types. Front Digit Health 2022; 4:963741. [PMID: 36148211 PMCID: PMC9485564 DOI: 10.3389/fdgth.2022.963741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Numerous studies have found that long term retention is very low in remote clinical studies (>4 weeks) and to date there is limited information on the best methods to ensure retention. The ability to retain participants in the completion of key assessments periods is critical to all clinical research, and to date little is known as to what methods are best to encourage participant retention. To study incentive-based retention methods we randomized 215 US adults (18+ years) who agreed to participate in a sequential, multiple assignment randomized trial to either high monetary incentive (HMI, $125 USD) and combined low monetary incentive ($75 USD) plus alternative incentive (LMAI). Participants were asked to complete daily and weekly surveys for a total of 12 weeks, which included a tailoring assessment around week 5 to determine who should be stepped up and rerandomized to one of two augmentation conditions. Key assessment points were weeks 5 and 12. There was no difference in participant retention at week 5 (tailoring event), with approximately 75% of the sample completing the week-5 survey. By week 10, the HMI condition retained approximately 70% of the sample, compared to 60% of the LMAI group. By week 12, all differences were attenuated. Differences in completed measures were not significant between groups. At the end of the study, participants were asked the impressions of the incentive condition they were assigned and asked for suggestions for improving engagement. There were no significant differences between conditions on ratings of the fairness of compensation, study satisfaction, or study burden, but study burden, intrinsic motivation and incentive fairness did influence participation. Men were also more likely to drop out of the study than women. Qualitative analysis from both groups found the following engagement suggestions: desire for feedback on survey responses and an interest in automated sharing of individual survey responses with study therapists to assist in treatment. Participants in the LMAI arm indicated that the alternative incentives were engaging and motivating. In sum, while we were able to increase engagement above what is typical for such study, more research is needed to truly improve long term retention in remote trials.
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Affiliation(s)
- Isabell R. Griffith Fillipo
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
- University of Washington SMART Center, Seattle, WA, United States
| | - Thomas D. Hull
- Research and Development, Talkspace, New York, NY, United States
| | - James Zech
- Research and Development, Talkspace, New York, NY, United States
| | - Jerilyn Wu
- Research and Development, Talkspace, New York, NY, United States
| | - Boris Litvin
- Research and Development, Talkspace, New York, NY, United States
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
| | - Patricia A. Arean
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
- Correspondence: Patricia A. Areán
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