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Jover Martínez A, Lemmens LHJM, Fried EI, Roefs A. Developing a transdiagnostic Ecological Momentary Assessment protocol for psychopathology. Int J Methods Psychiatr Res 2024; 33:e2028. [PMID: 39030856 PMCID: PMC11258473 DOI: 10.1002/mpr.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/19/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVES The network approach to psychopathology posits that mental disorders emerge from dynamic interactions among psychopathology-relevant variables. Ecological Momentary Assessment (EMA) is frequently used to assess these variables in daily life. Considering the transdiagnostic nature of the network approach to psychopathology, this study describes the development of a transdiagnostic EMA protocol for psychopathology. METHODS First, 96 clinicians completed an online survey, providing three EMA constructs for up to three disorders they specialize in, and three EMA constructs relevant across disorders (transdiagnostic constructs). Second, 12 focus groups were conducted with clinical experts for specific types of diagnoses (e.g., mood disorders, anxiety disorders). Finally, a selection of items was reached by consensus. Two raters independently coded the online survey responses with an inter-rater agreement of 87.3%. RESULTS Jaccard indices showed up to 52.6% overlap in EMA items across types of diagnoses. The most frequently reported transdiagnostic constructs were mood, sleep quality, and stress. A final set of EMA items is created based on items' frequency and informativeness, ensuring completeness across diagnoses and minimizing burden. CONCLUSIONS The described procedure resulted in a feasible EMA protocol to examine psychopathology transdiagnostically. Feasibility was helped by the overlap in mentioned symptoms across disorders. Such overlap raises questions about the validity of DSM categories.
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Affiliation(s)
- Alberto Jover Martínez
- Clinical Psychological ScienceFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Lotte H. J. M. Lemmens
- Clinical Psychological ScienceFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Eiko I. Fried
- Clinical PsychologyFaculty of Social and Behavioral SciencesLeiden UniversityLeidenThe Netherlands
| | - Anne Roefs
- Clinical Psychological ScienceFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
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Pátková Daňsová P, Chvojka E, Cígler H, Lacinová L. Mild differences in the role of somatic symptoms in depression networks in pregnancy and postpartum: A comparison with women outside peripartum. J Psychiatr Res 2024; 174:165-171. [PMID: 38636153 DOI: 10.1016/j.jpsychires.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
Depression is one of the most prevalent mental ailments in pregnancy. Many authors have discussed the appropriateness of somatic symptoms for depression assessment in pregnancy and postpartum. However, no study has examined the role of somatic symptoms in networks of pregnant and postpartum women compared to women outside peripartum. Here, we show that somatic symptoms are essential to depression assessment during pregnancy and postpartum. We compared networks of the nine PHQ-9 items across pregnant women (n = 894, Mage = 29.29), women in postpartum (n = 586, Mage = 29.83) and women outside peripartum (n = 1029, Mage = 24.87). While three of the five somatic symptoms in PHQ-9 were more present in pregnant women than in those outside the peripartum, the three networks were highly similar regarding the position of the somatic symptoms and their relation to the emotional-cognitive symptoms. Most depression symptoms in pregnant women were predicted by other depression symptoms to a lesser extent than in postpartum and outside peripartum. Other external variables are therefore needed to explain these sensations in pregnancy. In addition to the incidence of somatic symptoms, practitioners should ask pregnant women about their attributions of these.
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Affiliation(s)
- Petra Pátková Daňsová
- The Psychology Research Institute, Faculty of Social Studies, Masaryk University, Czech Republic.
| | - Edita Chvojka
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Netherlands.
| | - Hynek Cígler
- The Psychology Research Institute, Faculty of Social Studies, Masaryk University, Czech Republic.
| | - Lenka Lacinová
- The Psychology Research Institute, Faculty of Social Studies, Masaryk University, Czech Republic.
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3
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Ribeiro Santiago PH, Soares GH, Quintero A, Jamieson L. Comparing the Clique Percolation algorithm to other overlapping community detection algorithms in psychological networks: A Monte Carlo simulation study. Behav Res Methods 2024:10.3758/s13428-024-02415-2. [PMID: 38693441 DOI: 10.3758/s13428-024-02415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
In psychological networks, one limitation of the most used community detection algorithms is that they can only assign each node (symptom) to a unique community, without being able to identify overlapping symptoms. The clique percolation (CP) is an algorithm that identifies overlapping symptoms but its performance has not been evaluated in psychological networks. In this study, we compare the CP with model parameters chosen based on fuzzy modularity (CPMod) with two other alternatives, the ratio of the two largest communities (CPRat), and entropy (CPEnt). We evaluate their performance to: (1) identify the correct number of latent factors (i.e., communities); and (2) identify the observed variables with substantive (and equally sized) cross-loadings (i.e., overlapping symptoms). We carried out simulations under 972 conditions (3x2x2x3x3x3x3): (1) data categories (continuous, polytomous and dichotomous); (2) number of factors (two and four); (3) number of observed variables per factor (four and eight); (4) factor correlations (0.0, 0.5, and 0.7); (5) size of primary factor loadings (0.40, 0.55, and 0.70); (6) proportion of observed variables with substantive cross-loadings (0.0%, 12.5%, and 25.0%); and (7) sample size (300, 500, and 1000). Performance was evaluated through the Omega index, Mean Bias Error (MBE), Mean Absolute Error (MAE), sensitivity, specificity, and mean number of isolated nodes. We also evaluated two other methods, Exploratory Factor Analysis and the Walktrap algorithm modified to consider overlap (EFA-Ov and Walk-Ov, respectively). The Walk-Ov displayed the best performance across most conditions and is the recommended option to identify communities with overlapping symptoms in psychological networks.
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Affiliation(s)
| | - Gustavo Hermes Soares
- Adelaide Dental School, The University of Adelaide, Level 4, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, Australia
| | - Adrian Quintero
- ICFES - Colombian Institute for Educational Evaluation, Bogotá, Colombia
| | - Lisa Jamieson
- Adelaide Dental School, The University of Adelaide, Level 4, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, Australia
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Siepe BS, Sander C, Schultze M, Kliem A, Ludwig S, Hegerl U, Reich H. Time-Varying Network Models for the Temporal Dynamics of Depressive Symptomatology in Patients With Depressive Disorders: Secondary Analysis of Longitudinal Observational Data. JMIR Ment Health 2024; 11:e50136. [PMID: 38635978 PMCID: PMC11066753 DOI: 10.2196/50136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND As depression is highly heterogenous, an increasing number of studies investigate person-specific associations of depressive symptoms in longitudinal data. However, most studies in this area of research conceptualize symptom interrelations to be static and time invariant, which may lead to important temporal features of the disorder being missed. OBJECTIVE To reveal the dynamic nature of depression, we aimed to use a recently developed technique to investigate whether and how associations among depressive symptoms change over time. METHODS Using daily data (mean length 274, SD 82 d) of 20 participants with depression, we modeled idiographic associations among depressive symptoms, rumination, sleep, and quantity and quality of social contacts as dynamic networks using time-varying vector autoregressive models. RESULTS The resulting models showed marked interindividual and intraindividual differences. For some participants, associations among variables changed in the span of some weeks, whereas they stayed stable over months for others. Our results further indicated nonstationarity in all participants. CONCLUSIONS Idiographic symptom networks can provide insights into the temporal course of mental disorders and open new avenues of research for the study of the development and stability of psychopathological processes.
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Affiliation(s)
- Björn Sebastian Siepe
- Psychological Methods Lab, Department of Psychology, University of Marburg, Marburg, Germany
| | - Christian Sander
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Martin Schultze
- Department of Psychology, Goethe University, Frankfurt, Germany
| | | | - Sascha Ludwig
- Institute for Applied Informatics, University Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
- Depression Research Center of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Hanna Reich
- German Depression Foundation, Leipzig, Germany
- Depression Research Center of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
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Bickel EA, Schellekens MPJ, Smink JG, Mul VEM, Ranchor AV, Fleer J, Schroevers MJ. Looking at individual symptoms: the dynamic network structure of depressive symptoms in cancer survivors and their preferences for psychological care. J Cancer Surviv 2024; 18:479-488. [PMID: 35976556 PMCID: PMC9382609 DOI: 10.1007/s11764-022-01246-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The majority of depressed cancer survivors do not receive psychological care, possibly because offered care does not align with their experiences and preferences. We examined (1) which depressive symptoms cancer survivors would like to receive psychological care for; (2) how distinct depressive symptoms are related to each other in the contemporaneous and temporal network of depressive symptoms; and (3) whether survivors' care needs correspond to the interconnectedness of these specific symptoms. METHOD Fifty-two cancer survivors suffering from at least mild depressive symptoms and were not receiving psychological care filled out a baseline questionnaire about their care needs for distinct depressive symptoms, followed by ecological momentary assessments (EMA) assessing depressive symptoms (14 days, five times a day). Multi-level vector autoregression analysis was used to estimate associations between distinct depressive symptoms as well as their centrality within the network. RESULTS Cancer survivors most strongly preferred to receive care for fatigue, feeling down, little enjoyment, and sleep problems. Fatigue, together with worry and lack of concentration, most strongly predicted the onset of other symptoms. Little enjoyment and feeling down were two of the most central symptoms (i.e., strongly connected to other symptoms) in the contemporaneous network and were most strongly influenced by other symptoms in the temporal network. CONCLUSIONS Clinicians can offer specific interventions that target fatigue, as these played an important role in the onset of symptoms and would align with survivors' needs. IMPLICATIONS FOR CANCER SURVIVORS Offering such symptom-specific care may increase the uptake of psychological interventions in cancer survivors.
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Affiliation(s)
- E A Bickel
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M P J Schellekens
- Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, De Bilt, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - J G Smink
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - V E M Mul
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - A V Ranchor
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sistiaga S, Tseng WL, Zhang L, Rossignol M, Bellaert N. How are irritability and anhedonia symptoms linked? A network approach. J Clin Psychol 2024. [PMID: 38497904 DOI: 10.1002/jclp.23679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Anhedonia and irritability are two prevalent symptoms of major depressive disorder (MDD) that predict greater depression severity and poor outcomes, including suicidality. Although both symptoms have been proposed to result from paradoxical reward processing dysfunctions, the interactions between these symptoms remain unclear. Anhedonia is a multifaceted symptom reflecting impairments in multiple dimensions of reward processing (e.g., pleasure, desire, motivation, and effort) across distinct reward types (e.g., food, sensory experiences, social activities, hobbies) that may differentially interact with irritability. This study investigated the complex associations between anhedonia and irritability using network analysis. METHOD Participants (N = 448, Mage = 33.29, SD = 14.58) reported their symptoms of irritability on the Brief Irritability Test (Holtzman et al., 2015) and anhedonia (i.e., pleasure, desire, motivation, and effort dimensions across four reward types) on the Dimensional Anhedonia Rating Scale (Rizvi et al., 2015). A regularized Gaussian Graphical Model was built to estimate the network structure between items. RESULTS Irritability was negatively related to willingness to expand effort to obtain food/drinks (estimate = -0.18), social activities (-0.13), and hobbies (-0.12) rewards. Irritability was positively associated with a desire for food/drinks (0.12). LIMITATIONS Only a small proportion (5.8%) of our sample was clinical and the study design was cross-sectional. CONCLUSION A specific link between irritability and the effort dimension of the hedonic response across three reward types was identified. Investigating effort expenditure deficits with experimental paradigms may help us understand the mechanisms underlying the comorbidity between irritability and anhedonia in the context of MDD.
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Affiliation(s)
- Sonia Sistiaga
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Lanting Zhang
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Mandy Rossignol
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
| | - Nellia Bellaert
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
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van den Berg JW, van Beek DJ, Bouman YHA, Janssen E, Smid WJ, Gijs L. Understanding the Risk of Sexual Reoffending in Adult Men: A Network-Based Model. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:135-157. [PMID: 36731100 DOI: 10.1177/10790632231153633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The predominant approach to understand dynamic risk factors of sexual reoffending has been referred to as the Propensities Model (Thornton, 2016). According to this model, dynamic risk factors can be conceptualized as latent constructs whose change alters the risk of sexual reoffending. Despite its strengths and contributions to research, this model does not offer answers to the question of how dynamic risk factors contribute to the risk of sexual reoffending, or of how sustained change in risk might take place. In this paper we introduce the Network-Based Model of Risk of Sexual Reoffending (NBM-RSR), which addresses several limitations and constraints of the Propensities Model and offers empirically testable propositions regarding the nature and development of the risk of sexual reoffending. The NBM-RSR considers risk of sexual reoffending to involve a self-sustaining network of causally connected dynamic risk factors. Consistent with this, an increased risk of sexual reoffending is characterized through a network that contains more and stronger interconnected dynamic risk factors with a higher strength. Sustained change in risk of sexual reoffending occurs when activity in the network exceeds a critical point resulting in a new self-sustaining network. Propositions based on the NBM-RSR are introduced and translated into testable hypotheses. These propositions revolve around (a) risk of sexual reoffending resulting from the construction of a network of causally connected dynamic risk factors, (b) network stability, sudden changes, and critical transitions, and (c) dynamic risk factors' relative influence on risk of sexual reoffending.
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Affiliation(s)
- Jan Willem van den Berg
- Transfore, Outpatient Clinic De Tender, Deventer, the Netherlands
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Belgium
| | - Daan J van Beek
- Private practice of clinical psychology, Utrecht, The Netherlands
| | | | - Erick Janssen
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Belgium
| | | | - Luk Gijs
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Belgium
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Calderon A, Baik SY, Ng MHS, Fitzsimmons-Craft EE, Eisenberg D, Wilfley DE, Taylor CB, Newman MG. Machine Learning and Bayesian Network Analyses Identifies Psychiatric Disorders and Symptom Associations with Insomnia in a national sample of 31,285 Treatment-Seeking College Students. RESEARCH SQUARE 2024:rs.3.rs-3944417. [PMID: 38464303 PMCID: PMC10925462 DOI: 10.21203/rs.3.rs-3944417/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background A better understanding of the structure of relations among insomnia and anxiety, mood, eating, and alcohol-use disorders is needed, given its prevalence among young adults. Supervised machine learning provides the ability to evaluate the discriminative accuracy of psychiatric disorders associated with insomnia. Combined with Bayesian network analysis, the directionality between symptoms and their associations may be illuminated. Methods The current exploratory analyses utilized a national sample of college students across 26 U.S. colleges and universities collected during population-level screening before entering a randomized controlled trial. Firstly, an elastic net regularization model was trained to predict, via repeated 10-fold cross-validation, which psychiatric disorders were associated with insomnia severity. Seven disorders were included: major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, post-traumatic stress disorder, anorexia nervosa, and alcohol use disorder. Secondly, using a Bayesian network approach, completed partially directed acyclic graphs (CPDAG) built on training and holdout samples were computed via a Bayesian hill-climbing algorithm to determine symptom-level interactions of disorders most associated with insomnia [based on SHAP (SHapley Additive exPlanations) values)] and were evaluated for stability across networks. Results Of 31,285 participants, 20,597 were women (65.8%); mean (standard deviation) age was 22.96 (4.52) years. The elastic net model demonstrated clinical significance in predicting insomnia severity in the training sample [R2 = .449 (.016); RMSE = 5.00 [.081]), with comparable performance in accounting for variance explained in the holdout sample [R2 = .33; RMSE = 5.47). SHAP indicated the presence of any psychiatric disorder was associated with higher insomnia severity, with major depressive disorder demonstrated to be the most associated disorder. CPDAGs showed excellent fit in the holdout sample and suggested that depressed mood, fatigue, and self-esteem were the most important depression symptoms that presupposed insomnia. Conclusion These findings offer insights into associations between psychiatric disorders and insomnia among college students and encourage future investigation into the potential direction of causality between insomnia and major depressive disorder. Trial registration Trial may be found on the National Institute of Health RePORTER website: Project Number: R01MH115128-05.
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Affiliation(s)
| | | | - Matthew H S Ng
- Nanyang Technological University, Rehabilitation Research Institute of Singapore
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Nemesure MD, Collins AC, Price GD, Griffin TZ, Pillai A, Nepal S, Heinz MV, Lekkas D, Campbell AT, Jacobson NC. Depressive symptoms as a heterogeneous and constantly evolving dynamical system: Idiographic depressive symptom networks of rapid symptom changes among persons with major depressive disorder. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2024; 133:155-166. [PMID: 38271054 PMCID: PMC11002496 DOI: 10.1037/abn0000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Major depressive disorder (MDD) is conceptualized by individual symptoms occurring most of the day for at least two weeks. Despite this operationalization, MDD is highly variable with persons showing greater variation within and across days. Moreover, MDD is highly heterogeneous, varying considerably across people in both function and form. Recent efforts have examined MDD heterogeneity byinvestigating how symptoms influence one another over time across individuals in a system; however, these efforts have assumed that symptom dynamics are static and do not dynamically change over time. Nevertheless, it is possible that individual MDD system dynamics change continuously across time. Participants (N = 105) completed ratings of MDD symptoms three times a day for 90 days, and we conducted time varying vector autoregressive models to investigate the idiographic symptom networks. We then illustrated this finding with a case series of five persons with MDD. Supporting prior research, results indicate there is high heterogeneity across persons as individual network composition is unique from person to person. In addition, for most persons, individual symptom networks change dramatically across the 90 days, as evidenced by 86% of individuals experiencing at least one change in their most influential symptom and the median number of shifts being 3 over the 90 days. Additionally, most individuals had at least one symptom that acted as both the most and least influential symptom at any given point over the 90-day period. Our findings offer further insight into short-term symptom dynamics, suggesting that MDD is heterogeneous both across and within persons over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Amanda C Collins
- Center for Technology and Behavioral Health, Geisel School of Medicine
| | - George D Price
- Center for Technology and Behavioral Health, Geisel School of Medicine
| | - Tess Z Griffin
- Center for Technology and Behavioral Health, Geisel School of Medicine
| | | | | | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine
| | - Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine
| | - Andrew T Campbell
- Center for Technology and Behavioral Health, Geisel School of Medicine
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Liang S, Huang Z, Wang Y, Wu Y, Chen Z, Zhang Y, Guo W, Zhao Z, Ford SD, Palaniyappan L, Li T. Using a longitudinal network structure to subgroup depressive symptoms among adolescents. BMC Psychol 2024; 12:46. [PMID: 38268052 PMCID: PMC10807250 DOI: 10.1186/s40359-024-01537-8] [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: 11/23/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Network modeling has been proposed as an effective approach to examine complex associations among antecedents, mediators and symptoms. This study aimed to investigate whether the severity of depressive symptoms affects the multivariate relationships among symptoms and mediating factors over a 2-year longitudinal follow-up. METHODS We recruited a school-based cohort of 1480 primary and secondary school students over four semesters from January 2020 to December 2021. The participants (n = 1145) were assessed at four time points (ages 10-13 years old at baseline). Based on a cut-off score of 5 on the 9-item Patient Health Questionnaire at each time point, the participants were categorized into the non-depressive symptom (NDS) and depressive symptom (DS) groups. We conducted network analysis to investigate the symptom-to-symptom influences in these two groups over time. RESULTS The global network metrics did not differ statistically between the NDS and DS groups at four time points. However, network connection strength varied with symptom severity. The edge weights between learning anxiety and social anxiety were prominently in the NDS group over time. The central factors for NDS and DS were oversensitivity and impulsivity (3 out of 4 time points), respectively. Moreover, both node strength and closeness were stable over time in both groups. CONCLUSIONS Our study suggests that interrelationships among symptoms and contributing factors are generally stable in adolescents, but a higher severity of depressive symptoms may lead to increased stability in these relationships.
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Affiliation(s)
- Sugai Liang
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China
| | - Zejun Huang
- Hangzhou Institute of Educational Science, 310003, Hangzhou, China
| | - Yiquan Wang
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China
| | - Yue Wu
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China
| | - Zhiyu Chen
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China
| | - Yamin Zhang
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China
| | - Wanjun Guo
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China
| | - Zhenqing Zhao
- Hangzhou Vocational & Technical College, 310018, Hangzhou, China
| | - Sabrina D Ford
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, H4H1R3, Montreal, Canada
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, H4H1R3, Montreal, Canada.
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, N6A5K8, London, Canada.
- Department of Medical Biophysics, Western University, N6A5K8, London, Canada.
| | - Tao Li
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 305 Tianmushan Road, 310013, Hangzhou, China.
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 310000, Hangzhou, China.
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, 310063, Hangzhou, China.
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11
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Koning ASCAM, Booij SH, Meijer OC, Riese H, Giltay EJ. Temporal associations between salivary cortisol and emotions in clinically depressed individuals and matched controls: A dynamic time warp analysis. Psychoneuroendocrinology 2023; 158:106394. [PMID: 37774658 DOI: 10.1016/j.psyneuen.2023.106394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
Depression can be understood as a complex dynamic system where depressive symptoms interact with one another. Cortisol is suggested to play a major role in the pathophysiology of depression, but knowledge on the temporal interplay between cortisol and depressive symptoms is scarce. We aimed to analyze the temporal connectivity between salivary cortisol and momentary affective states in depressed individuals and controls. Thirty pair-matched depressed and non-depressed participants completed questionnaires on momentary positive (PA) and negative (NA) affect and collected saliva three times a day for 30 days. The association between cortisol and affect was analyzed by dynamic time warp (DTW) analyses. These analyses involved lag-1 backward to lag-1 forward undirected analyses and lag-0 and lag-1 forward directed analyses. Large inter- and intra-individual variability in the networks were found. At the group level, with undirected analysis PA and NA were connected in the networks in depressed individuals and in controls. Directed analyses indicated that increases in cortisol preceded specific NA items in controls, but tended to follow upon specific affect items increase in depressed individuals. To conclude, at group level, changes in cortisol levels in individuals diagnosed with a depression may be a result of changes in affect, rather than a cause.
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Affiliation(s)
- Anne-Sophie C A M Koning
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne H Booij
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Onno C Meijer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium.
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12
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Schlechter P, Ford TJ, Neufeld SAS. The development of depressive symptoms in older adults from a network perspective in the English Longitudinal Study of Ageing. Transl Psychiatry 2023; 13:363. [PMID: 38007499 PMCID: PMC10676393 DOI: 10.1038/s41398-023-02659-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/27/2023] Open
Abstract
An increased understanding of the interrelations between depressive symptoms among older populations could help improve interventions. However, studies often use sum scores to understand depression in older populations, neglecting important symptom dynamics that can be elucidated in evolving depressive symptom networks. We computed Cross-Lagged Panel Network Models (CLPN) of depression symptoms in 11,391 adults from the English Longitudinal Study of Ageing. Adults aged 50 and above (mean age 65) were followed over 16 years throughout this nine-wave representative population study. Using the eight-item Center for Epidemiological Studies Depression Scale, we computed eight CLPNs covering each consecutive wave. Across waves, networks were consistent with respect to the strength of lagged associations (edge weights) and the degree of interrelationships among symptoms (centrality indices). Everything was an effort and could not get going displayed the strongest reciprocal cross-lagged associations across waves. These two symptoms and loneliness were core symptoms as reflected in strong incoming and outgoing connections. Feeling depressed was strongly predicted by other symptoms only (incoming but not strong outgoing connections were observed) and thus was not related to new symptom onset. Restless sleep had outgoing connections only and thus was a precursor to other depression symptoms. Being happy and enjoying life were the least central symptoms. This research underscores the relevance of somatic symptoms in evolving depression networks among older populations. Findings suggest the central symptoms from the present study (everything was an effort, could not get going, loneliness) may be potential key intervention targets to mitigate depression in older adults.
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Affiliation(s)
- Pascal Schlechter
- University of Cambridge, Department of Psychiatry, Cambridge, England, UK.
| | - Tamsin J Ford
- University of Cambridge, Department of Psychiatry, Cambridge, England, UK
| | - Sharon A S Neufeld
- University of Cambridge, Department of Psychiatry, Cambridge, England, UK
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13
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Mihić L, Janičić B, Marchetti I, Novović Z, Sica C, Bottesi G, Belopavlović R, Jakšić N. Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis. Clin Psychol Psychother 2023. [PMID: 37940606 DOI: 10.1002/cpp.2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.
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Affiliation(s)
- Ljiljana Mihić
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Janičić
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Igor Marchetti
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Zdenka Novović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Claudio Sica
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Radomir Belopavlović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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14
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Huang D, Susser E, Rudolph KE, Keyes KM. Depression networks: a systematic review of the network paradigm causal assumptions. Psychol Med 2023; 53:1665-1680. [PMID: 36927618 DOI: 10.1017/s0033291723000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The network paradigm for psychiatric disorder nosology was proposed based on the hypothesis that mental disorders are caused by networks of symptoms that are themselves causally related. Researchers have widely applied and integrated this paradigm to examine a variety of mental disorders, particularly depression. Existing studies generally focus on the correlation structure of symptoms, inferring causal relationships. Thus, presumption of causality may not be justified. The goal of this review was to examine the assumptions necessary for causal inference in network studies of depression. Specifically, we examined whether and how network studies address common violations of causal assumptions (i.e. no measurement error, exchangeability, and positivity). Of the 41 studies reviewed, five (12%) studies discussed sources of confounding unrelated to measurement error; none discussed positivity; and five conducted post-hoc analysis for measurement error. Depression network studies, in principle, are conducted under the assumption that symptom relationships are causal. Yet, in practice, studies seldomly discussed or adequately tested assumptions required to infer causality. Researchers continue to design studies that are unable to support the credibility of the network paradigm for the study of depression. There is a critical need to ensure scientific efforts cease to perpetuate problematic designs and findings to a potentially unsubstantiated paradigm.
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Affiliation(s)
- Debbie Huang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, New York, United States of America
| | - Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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15
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Liu Q, Joiner RJ, Trichtinger LA, Tran T, Cole DA. Dissecting the depressed mood criterion in adult depression: The heterogeneity of mood disturbances in major depressive episodes. J Affect Disord 2023; 323:392-399. [PMID: 36455714 DOI: 10.1016/j.jad.2022.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mood disturbances have historically remained a core criterion in diagnosing major depressive episode. DSMs have illustrated this criterion with depressed, hopeless, discouraged, cheerless, and irritable mood, suggesting interchangeability. Extant research has examined individual forms of mood disturbance to depression severity. Less examined is the heterogeneity in mood disturbances and its implication to their association to depression presentations and outcomes. METHOD The current study used a nationally representative sample of U.S. adults with unipolar major depressive disorder to study the association between specific forms of mood disturbances to depression severity, chronicity, or symptoms, above and beyond other forms, as well as their relations to functional impairment, suicidal outcomes, and psychiatric comorbidity via generalized linear models. RESULTS Cheerless and hopeless mood were associated with depression severity. Hopeless and irritable mood were associated with depression chronicity. Different forms of mood disturbance showed differential relations to depressive symptoms. Cheerless, hopeless, and irritable mood were associated with depression-specific functional interference, incremental to depression severity. Cheerless, hopeless, and discouraged mood were associated with passive suicidal ideation. Hopeless mood was associated with active suicidal ideation. Hopeless and irritable mood were associated with both suicide plan and suicide attempt. Different forms of mood disturbance demonstrated differential associations to comorbid psychiatric conditions. DISCUSSION The relations between different forms of mood disturbances and various aspects of depression are nuanced. Theoretically, these relations highlight the potential utility in acknowledging the complexity and heterogeneity in mood disturbances. Clinically, our results suggest potential utility in routinely monitoring mood disturbances.
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Affiliation(s)
- Qimin Liu
- Department of Psychology and Human Development, Vanderbilt University, United States of America.
| | - Raquael J Joiner
- Department of Psychology, Unviersity of California, Los Angeles, United States of America
| | - Lauren A Trichtinger
- Department of Mathematics, Computing, and Statistics, Simmons University, United States of America
| | - Tiffany Tran
- Department of Psychology and Human Development, Vanderbilt University, United States of America
| | - David A Cole
- Department of Psychology and Human Development, Vanderbilt University, United States of America
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16
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Imperiale MN, Lieb R, Calkins ME, Meinlschmidt G. Transdiagnostic symptom networks in relation to mental health service use in community youth. Clin Psychol Psychother 2023; 30:119-130. [PMID: 36059253 PMCID: PMC10087894 DOI: 10.1002/cpp.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study is to scrutinize whether psychopathology symptom networks differ between those with and without lifetime: treatment seeking, treatment and treatment of longer duration. METHODS We created non-exclusive groups of subjects with versus without lifetime treatment seeking, treatment and treatment of mid-long-term duration. We estimated Ising models and carried out network comparison tests (NCTs) to compare (a) overall connectivity and (b) network structure. Furthermore, we examined node strength. We used propensity score matching (PSM) to minimize potential confounding by indication for service use. RESULTS Based on data from 9,172 participants, there were no statistically significant differences in overall connectivity and network structure in those with versus without lifetime: treatment seeking (p = .75 and p = .82, respectively), treatment (p = .63 and p = .49, respectively) and treatment of mid-longterm duration (p = .15 and p = .62, respectively). Notably, comparing networks with versus without service use consistently revealed higher node strength in 'obsessions' and 'aggression' and lower node strength in 'elevated mood' in all networks with service use. CONCLUSIONS Findings suggest that after adjusting for potential confounding by indication for service use, there was no indication of an association in overall connectivity or network structure for lifetime treatment seeking, treatment and treatment of longer duration. However, selected structurally important symptoms differed consistently in all three comparisons. Our findings highlight the potential of network analysis methods to examine treatment mechanisms and outcomes. Specifically, more granular network characteristics on the node level may complement and enrich traditional outcomes in clinical research.
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Affiliation(s)
- Marina N Imperiale
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany.,Department of Psychosomatic Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
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17
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Piot M, Mestdagh M, Riese H, Weermeijer J, Brouwer JM, Kuppens P, Dejonckheere E, Bos FM. Practitioner and researcher perspectives on the utility of ecological momentary assessment in mental health care: A survey study. Internet Interv 2022; 30:100575. [PMID: 36193339 PMCID: PMC9526140 DOI: 10.1016/j.invent.2022.100575] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/05/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a scientific self-monitoring method to capture individuals' daily life experiences. Early on, EMA has been suggested to have the potential to improve mental health care. However, it remains unclear if and how EMA should be implemented. This requires an in-depth investigation of how practitioners and researchers view the implementation of EMA. OBJECTIVE Explore the perspectives of mental health practitioners and EMA researchers on the utility of EMA for mental health care. METHODS Practitioners (n = 89; psychiatrists, psychologists, psychiatric nurses) and EMA researchers (n = 62) completed a survey about EMA in clinical practice. This survey addressed EMA goals for practitioner and patient, requirements regarding clinical use of EMA, and (dis)advantages of EMA compared to treatment-as-usual. t-Tests were used to determine agreement with each statement and whether practitioners' and researchers' views differed significantly. Linear regression was used to explore predictors of goals and preferences (e.g., EMA experience). RESULTS Practitioners and researchers considered EMA to be a useful clinical tool for diverse stages of care. They indicated EMA to be most useful for gaining insight into the context specificity of symptoms (55.0 %), whereas receiving alerts when symptoms increase was rated the least useful (11.3 %, alerts is in 95 % of bootstrap iterations between rank 8 and 10). Compared to treatment-as-usual, EMA was considered easier to use (M = 4.87, t = 5.30, p < .001) and interpret (M = 4.52, t = 3.61, p < .001), but also more burdensome for the patient (M = 4.48, t = 3.17, p < .001). Although participants preferred personalization of the EMA diary, they also suggested that EMA should cost practitioners and patients limited time. The preference for creating personalized EMA was related to the level of experience with EMA. Finally, they highlighted the need for practitioner training and patient full-time access to the EMA feedback. CONCLUSIONS This survey study demonstrated that practitioners and researchers expect EMA to have added value for mental health care. Concrete recommendations for implementation of EMA are formulated. This may inform the development of specific clinical applications and user-friendly EMA software.
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Affiliation(s)
- Maarten Piot
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Corresponding author at: Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Leuven 3000, Belgium.
| | - Merijn Mestdagh
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
| | - Jeroen Weermeijer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jannie M.A. Brouwer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Department Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg, Belgium
| | - Fionneke M. Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands
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18
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Bos FM, von Klipstein L, Emerencia AC, Veermans E, Verhage T, Snippe E, Doornbos B, Hadders-Prins G, Wichers M, Riese H. A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application. JMIR Ment Health 2022; 9:e36430. [PMID: 35943762 PMCID: PMC9399881 DOI: 10.2196/36430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. OBJECTIVE This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). METHODS The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. RESULTS The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. CONCLUSIONS PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lino von Klipstein
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ando C Emerencia
- Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Erwin Veermans
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Verhage
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Grietje Hadders-Prins
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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19
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Höller I, Schreiber D, Bos F, Forkmann T, Teismann T, Margraf J. The Mereology of Depression-Networks of Depressive Symptoms during the Course of Psychotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127131. [PMID: 35742380 PMCID: PMC9222343 DOI: 10.3390/ijerph19127131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022]
Abstract
(1) Background: Research has shown that it is important to examine depressive symptoms in the light of the mereology (the ratio between one symptom and the whole disorder). The goal of this study was to examine changes in the symptom interrelations of patients undergoing cognitive behavioral therapy treatment (CBT) via network analyses. (2) Method: Outpatients with depressive symptoms (N = 401) were assessed with the Beck Depression Inventory three times (pretreatment, after 12 sessions, and post-treatment) during CBT. Gaussian graphical models were used to estimate the relationships among symptoms. (3) Results: The severity of depressive symptoms significantly decreased over the course of therapy, but connectivity in the networks significantly increased. Communities of symptoms changed during treatment. The most central and predictable symptom was worthlessness at baseline and after 12 sessions, and loss of energy and self-dislike at post-treatment. (4) Conclusion: The results indicate that the severity of depressive symptoms decreased during cognitive behavior therapy, while network connectivity increased. Furthermore, the associations among symptoms and their centrality changed during the course of therapy. Future studies may investigate individual differences and their impact on the planning of psychotherapeutic treatment.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (D.S.); (T.F.)
- Correspondence: ; Tel.: +49-201-183-6117
| | - Dajana Schreiber
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (D.S.); (T.F.)
| | - Fionneke Bos
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands;
- Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, 9401LA Assen, The Netherlands
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (D.S.); (T.F.)
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany; (T.T.); (J.M.)
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany; (T.T.); (J.M.)
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20
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Bringmann LF, Albers C, Bockting C, Borsboom D, Ceulemans E, Cramer A, Epskamp S, Eronen MI, Hamaker E, Kuppens P, Lutz W, McNally RJ, Molenaar P, Tio P, Voelkle MC, Wichers M. Psychopathological networks: Theory, methods and practice. Behav Res Ther 2021; 149:104011. [PMID: 34998034 DOI: 10.1016/j.brat.2021.104011] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 12/19/2022]
Abstract
In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bring together different points of view on psychological networks by methodologists and clinicians to give a critical overview on these challenges, and to present an agenda for addressing these challenges. In contrast to previous reviews, we especially focus on methodological issues related to temporal networks. This includes topics such as selecting and assessing the quality of the nodes in the network, distinguishing between- and within-person effects in networks, relating items that are measured at different time scales, and dealing with changes in network structures. These issues are not only important for researchers using network models on empirical data, but also for clinicians, who are increasingly likely to encounter (person-specific) networks in the consulting room.
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Affiliation(s)
- Laura F Bringmann
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - Casper Albers
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - Claudi Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Denny Borsboom
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Ceulemans
- KU Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Angélique Cramer
- RIVM National Institute for Public Health and the Environment, the Netherlands
| | - Sacha Epskamp
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Markus I Eronen
- Department of Theoretical Philosophy, University of Groningen, the Netherlands
| | - Ellen Hamaker
- Department of Methodology and Statistics, Utrecht University, the Netherlands
| | - Peter Kuppens
- KU Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Germany
| | | | - Peter Molenaar
- Department of Human Development and Family Studies, The Pennsylvania State University, USA
| | - Pia Tio
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Manuel C Voelkle
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB, Groningen, the Netherlands
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