Predicting Symptoms of Depression and Anxiety Using Smartphone and Wearable Data
Open accessAbstract
Background: Depression and anxiety are leading causes of disability worldwide but often remain undetected and untreated. Smartphone and wearable devices may offer a unique source of data to detect moment by moment changes in risk factors associated with mental disorders that overcome many of the limitations of traditional screening methods. Objective: The current study aimed to explore the extent to which data from smartphone and wearable devices could predict symptoms of depression and anxiety. Methods: A total of N = 60 adults (ages 24–68) who owned an Apple iPhone and Oura Ring were recruited online over a 2-week period. At the beginning of the study, participants installed the Delphi data acquisition app on their smartphone. The app continuously monitored participants' location (using GPS) and smartphone usage behavior (total usage time and frequency of use). The Oura Ring provided measures related to activity (step count and metabolic equivalent for task), sleep (total sleep time, sleep onset latency, wake after sleep onset and time in bed) and heart rate variability (HRV). In addition, participants were prompted to report their daily mood (valence and arousal). Participants completed self-reported assessments of depression, anxiety and stress (DASS-21) at baseline, midpoint and the end of the study. Results: Multilevel models demonstrated a significant negative association between the variability of locations visited and symptoms of depression (beta = −0.21, p = 0.037) and significant positive associations between total sleep time and depression (beta = 0.24, p = 0.023), time in bed and depression (beta = 0.26, p = 0.020), wake after sleep onset and anxiety (beta = 0.23, p = 0.035) and HRV and anxiety (beta = 0.26, p = 0.035). A combined model of smartphone and wearable features and self-reported mood provided the strongest prediction of depression. Conclusion: The current findings demonstrate that wearable devices may provide valuable sources of data in predicting symptoms of depression and anxiety, most notably data related to common measures of sleep.
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Written from the paper’s full text.
TL;DR
In a 30-day observational study of 55 adults using an iPhone and Oura Ring during COVID-19 restrictions, smartphone GPS and wearable sleep/HRV data predicted depression and anxiety symptoms in multilevel models. A combined model of passive sensing plus daily self-reported mood best predicted depression, while EMA-only models were strongest for anxiety and stress.
Key findings
- Location variance was negatively associated with depression (beta = −0.21, p = 0.037); no other GPS features were significantly associated with depression, anxiety, or stress.
- Wearable sleep/HRV measures predicted symptoms: total sleep time (beta = 0.24, p = 0.023) and time in bed (beta = 0.26, p = 0.020) were positively associated with depression; wake after sleep onset (beta = 0.23, p = 0.035) and HRV (beta = 0.26, p = 0.035) were positively associated with anxiety.
- EMA valence was related to depression (beta = −0.39, p = 0.001), anxiety (beta = −0.30, p = 0.014), and stress (beta = −0.39, p < 0.001); the combined EMA plus digital phenotyping model had the strongest prediction of depression, while EMA-only models were strongest for anxiety and stress.
- Baseline DASS-21 scores were depression M = 3.78, SD = 3.48; anxiety M = 2.73, SD = 2.68; stress M = 6.00, SD = 3.82, with 67.3% normal depression, 70.9% normal anxiety, and 65.5% normal stress.
Methods
- Longitudinal observational study with repeated measurements over 30 days; N = 60 recruited online (55 in final analysis), ages 24–68, mean age 42.8 (SD 11.6), required to own an iPhone and Oura Ring.
- Data sources: Delphi smartphone app continuously monitored GPS and smartphone usage; Oura Ring measured activity (steps, MET), sleep (TST, SOL, WASO, TIB), and HRV; EMA mood was prompted 3 times daily (valence and arousal); DASS-21 was completed at baseline, day 16, and day 31.
- Analysis: Spearman correlations with cluster-wise Bonferroni-Holm adjustment; multilevel models with random intercepts and slopes, z-standardized predictors, multiple imputation (20 datasets, 15 iterations), and likelihood ratio tests for combined models.
Limitations
- Stated: observational design cannot establish causality or direction; pooling data prevented examining high-frequency processes and temporal precedence; small sample likely underpowered for small effects; sample was skewed toward white, employed, educated, iOS-using, non-clinical participants; no pre-pandemic movement data were available to confirm restricted movement.
- Stated: missingness occurred in DASS-21 (10%) and sensing variables (9.1%), assumed missing at random and handled with multiple imputation.
- Evident: the results text states no significant relationship between arousal and depression, anxiety, or stress, but tables report arousal in the combined depression model and the EMA stress model, indicating inconsistent reporting.
Model-written summary. Check it against the paper before relying on it.
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Cites
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Claims the paper makes
0 of 30 cited sources checked · 0 supported · 0 flagged
- Findingown data
No significant association was found between the other GPS-derived features (total distance, location entropy, normalized location entropy and time at home) and symptoms of depression, anxiety or stress.
“No significant association between the other GPS-derived features (total distance, location entropy, normalized location entropy and time at home) and symptoms of depression, anxiety or stress were found.”
Quote in the paperNot a substantial claim - Findingown data
Depression could be predicted by EMA and smartphone and wearable data.
“Depression could be predicted by EMA and smartphone and wearable data.”
Quote in the paperSubstantial claim - Findingown data
For anxiety and stress, EMA-only data models were the strongest predictors.
“For anxiety and stress, EMA-only data models were the strongest predictors (see Tables 4, 5).”
Quote in the paperSubstantial claim - Findingown data
A multi-level model predicting daily distance traveled (Finland vs. other) revealed no significant difference between the average daily distance traveled between participants from Finland and those from other countries (β = −922.9 [in meters], p = 0.943).
“A multi-level model predicting the daily distance traveled (using categorized country Finland vs. other as predictor) revealed no significant distance between the average daily distance traveled between participants from Finland and those from other countries (β = −922.9 [in meters], p = 0.943).”
Quote in the paperNot a substantial claim - Findingown data
Time in bed had a significant positive association with depression (beta = 0.26, SE = 0.11, t(59) = 2.39, p = 0.020).
“time in bed and depression (beta = 0.26, p = 0.020)”
- Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
“time in bed and depression [beta = 0.26, SE = 0.11, t(59) = 2.39, p = 0.020]”
Quote in the paperSubstantial claim - Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
- Findingown data
There was no significant relationship between arousal and depression, anxiety or stress.
“There was no significant relationship between arousal and depression, anxiety or stress.”
Quote in the paperNot a substantial claim - Findingown data
No significant relationship was found between smartphone usage duration or smartphone usage frequency and symptoms of depression, anxiety and stress.
“we found no significant relationship between smartphone usage duration or smartphone usage frequency and symptoms of depression, anxiety and stress.”
Quote in the paperNot a substantial claim - Findingown data
EMA valence was significantly related to anxiety (beta = −0.30, SE = 0.12, t(57) = −2.54, p = 0.014).
“anxiety [beta = −0.30, SE = 0.12, t(57) = −2.54, p = 0.014]”
Quote in the paperSubstantial claim - Findingown data
GPS data (location variance) and wearable device data (total sleep time and time in bed for depression; wake after sleep onset and HRV for anxiety) were able to predict mental health symptoms.
“We found that GPS (location variance on depression) and wearable device data (total sleep time and time in bed on depression; wake after sleep onset and HRV on anxiety), were able to predict mental health.”
Quote in the paperSubstantial claim - Findingown data
Heart rate variability had a significant positive association with anxiety (beta = 0.26, SE = 0.12, t(71) = 2.15, p = 0.035).
“HRV and anxiety (beta = 0.26, p = 0.035)”
- Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
“HRV and anxiety [beta = 0.26, SE = 0.12, t(71) = 2.15, p = 0.035]”
Quote in the paperNot a substantial claim - Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
- Findingown data
None of the wearable or smartphone usage features were associated with mental health symptom severity in the correlation analysis (p>0.05).
“In contrast, none of the wearable or smartphone usage features were associated with mental health symptom severity in the correlation analysis (p>0.05).”
Quote in the paperSubstantial claim - Findingown data
Location variance had a negative association with subsequent depressive symptom severity (beta = −0.21, SE = 0.10, t(81) = −2.13, p = 0.037).
“Multilevel models demonstrated a significant negative association between the variability of locations visited and symptoms of depression (beta = −0.21, p = 0.037)”
- Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
“location variance had a negative association with subsequent depressive symptom severity (beta = −0.21, SE = 0.10, t(81) = −2.13, p = 0.037)”
Quote in the paperSubstantial claim - Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
- Findingown data
Wake after sleep onset had a significant positive association with anxiety (beta = 0.23, SE = 0.11, t(90) = 2.13, p = 0.035).
“wake after sleep onset and anxiety (beta = 0.23, p = 0.035)”
- Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
“WASO and anxiety [beta = 0.23, SE = 0.11, t(90) = 2.13, p = 0.035]”
Quote in the paperSubstantial claim - Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
- Findingown data
No significant association was found between physical activity measures (MET and steps) and depression, anxiety, and stress.
“The analyses of wearable device data showed no significant association between any of the physical activity measures (MET and steps) and depression, anxiety, and stress.”
Quote in the paperNot a substantial claim - Findingown data
For all three mental health outcomes, significant small-to-medium correlations with the obtained EMA data (valence and arousal) were found.
“For all three mental health outcomes, significant small-to-medium correlations with the obtained EMA data – valance and arousal - were found (see Table 2).”
Quote in the paperSubstantial claim - Findingown data
Location variance had no significant relationship with symptoms of anxiety or stress.
“but no significant relationship with symptoms of anxiety or stress”
Quote in the paperNot a substantial claim - Findingown data
For GPS features, only location variance and entropy showed a significant correlation with depression.
“Also, for GPS features only the location variance and the entropy showed a significant correlation with depression.”
Quote in the paperNot a substantial claim - Findingown data
EMA valence was significantly related to stress (beta = −0.39, SE = 0.11, t(74) = −3.64, p < 0.001).
“stress [beta = −0.39, SE = 0.11, t(74) = −3.64, p < 0.001]”
Quote in the paperNot a substantial claim - Findingown data
A combined model of GPS and wearable data significantly increased the ability to predict symptoms of depression and anxiety compared to GPS data alone.
“Furthermore, a combined model of GPS and wearable data significantly increased the ability to predict symptoms of depression and anxiety compared to GPS data alone.”
Quote in the paperSubstantial claim - Findingown data
Total sleep time had a significant positive association with depression (beta = 0.24, SE = 0.11, t(73) = 2.33, p = 0.023).
“significant positive associations between total sleep time and depression (beta = 0.24, p = 0.023)”
- Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
“we found a significant relationship between total sleep time and depression [beta = 0.24, SE = 0.11, t(73) = 2.33, p = 0.023]”
Quote in the paperSubstantial claim - Also stated in: § Predicting Symptom Severity From Smartphone and Wearable Data · plain
- Findingown data
None of the sleep measures were significantly related to stress.
“None of the sleep measures were significantly related to stress.”
Quote in the paperNot a substantial claim - Findingown data
EMA valence was significantly related to depression (beta = −0.39, SE = 0.11, t(55) = −3.43, p = 0.001).
“valence was significantly related to depression [beta = −0.39, SE = 0.11, t(55) = −3.43, p = 0.001]”
Quote in the paperSubstantial claim - Findingown data
No significant relationship was found between the other smartphone features (total distance, location entropy, normalized location entropy and time spent at home) and mental health measures.
“However, contrary to previous findings (19, 67–69), we did not find a significant relationship between the other smartphone features (total distance, location entropy, normalized location entropy and time spent at home) and mental health measures.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [19] Saeb, 2015, Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: An exploratory study, J Med Internet Res. source
Not checked in the free run.
- cites [67] Farhan, 2016, Behavior vs. introspection: refining prediction of clinical depression via smartphone sensing data source
Not checked in the free run.
- cites [68] Saeb, 2016, The relationship between mobile phone location sensor data and depressive symptom severity, PeerJ. source
Not checked in the free run.
- cites [69] Ben-Zeev, 2015, Next-Generation psychiatric assessment: using smartphone sensors to monitor behavior and mental health, Psychiatr Rehabil J. source
Not checked in the free run.
- Findingreasoning
Longer periods of wakefulness after falling asleep significantly predicted symptoms of anxiety.
“The additional finding that longer periods of wakefulness after falling asleep significantly predicted symptoms of anxiety may be explained by the hyper-vigilance or hyperarousal characteristic of anxiety disorders causing individuals to wake up more frequently during their sleep (70).”
Quote in the paperSubstantial claim - Findingown data
Total sleep time and time in bed were significant predictors of depressive symptom severity.
“From the physiological data derived from the wearable device, we found total sleep time and time in bed to be significant predictors of depressive symptom severity.”
Quote in the paperSubstantial claim - Findingown data
Adding smartphone and wearable data to EMA data had the highest predictive power of all models in the analysis.
“our finding that adding smartphone and wearable data to EMA data had the highest predictive power of all models in the analysis”
Quote in the paperSubstantial claim - Findingcitation
Greater diversity in visited locations predicted lower depression severity.
“The finding that greater diversity in visited locations predicted lower depression severity supports previous research demonstrating that participants who move about more through geographic space are less depressed (19, 67).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19] Saeb, 2015, Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: An exploratory study, J Med Internet Res. source
Not checked in the free run.
- cites [67] Farhan, 2016, Behavior vs. introspection: refining prediction of clinical depression via smartphone sensing data source
Not checked in the free run.
- Findingown data
Over 25% of participants had at least mild-to-moderate depression severity.
“Although participants scored highly on the depression subscale in particular (over 25% of participants had at least mild-to-moderate depression severity), clinical diagnosis was not an inclusion criterion.”
Quote in the paperNot a substantial claim - Interpretationown data
The current findings demonstrate that wearable devices may provide valuable sources of data in predicting symptoms of depression and anxiety, most notably data related to common measures of sleep.
“The current findings demonstrate that wearable devices may provide valuable sources of data in predicting symptoms of depression and anxiety, most notably data related to common measures of sleep.”
Quote in the paperSubstantial claim - Study design and conductown data
Missingness only occurred in the DASS-21 assessment (10%) and the sensing variables (9.1%).
“Missingness only occurred in the DASS-21 assessment (10%) and the sensing variables (9.1%)”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missingness in the DASS-21 assessment and sensing variables was missing at random (MAR), meaning missingness depended on observed data.
- Study design and conductcitation
The Oura Ring has been shown to have high agreement with polysomnography (PSG) in the whole night estimation of total sleep time (TST), sleep onset latency (SOL) and wake after sleep onset (WASO).
“The Oura Ring has been shown to have high agreement with polysomnography (PSG; the gold-standard for measuring sleep) in the whole night estimation of total sleep time (TST), sleep onset latency (SOL) and wake after sleep onset (WASO) (47).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [47] de Zambotti, 2019, The sleep of the ring: comparison of the OURA sleep tracker against polysomnography, Behav Sleep Med. source
Not checked in the free run.
- Premisecitation
Rohani et al. meta-analytic review revealed that the association between time spent at home and depressive symptoms was the most consistently significant finding of any smartphone-derived feature.
“Rohani et al. (15) revealed that the association between time spent at home and depressive symptoms was the most consistently significant finding of any smartphone-derived feature in the analysis.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Rohani, 2018, Correlations between objective behavioral features collected from mobile and wearable devices and depressive mood symptoms in patients with affective disorders: systematic review, J Med Internet Res. source
Not checked in the free run.
- Study design and conductnone given
The data was not normally distributed.
“Correlations were calculated using the Spearman's correlation coefficient, since the data was not normally distributed.”
Quote in the paperSubstantial claim - Study design and conductcitation
The Oura Ring has been shown to have high agreement (r2 = 0.98) with ECG for measuring HRV.
“the device has been shown to have high agreement (r2 = 0.98) with ECG (the gold standard for measuring HRV) (48).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Kinnunen, 2020, Feasible assessment of recovery and cardiovascular health: accuracy of nocturnal HR and HRV assessed via ring PPG in comparison to medical grade ECG, Physiol Meas. source
Not checked in the free run.
- Study design and conductown data
Intra-class correlations (ICC) underlined the necessity of a multilevel model (all ICC > 0.05).
“Intra-class correlations (ICC) underlined the necessity of a MLM (all ICC > 0.05).”
Quote in the paperSubstantial claim - Interpretationown data
Despite limited movement and social interaction, GPS may still provide a valuable source of data for the identification of individuals at risk of developing mental disorders.
“Furthermore, it indicates that, despite limited movement and social interaction, GPS may still provide a valuable source of data for the identification of individuals at risk of developing mental disorders.”
Quote in the paperSubstantial claim- Rests on an assumption: Participants' movement was indeed more limited during the study period than before the pandemic.
- Study design and conductreasoning
Participants were a non-clinical sample recruited from the general population.
“Forth, participants were a non-clinical sample recruited from the general population.”
Quote in the paperSubstantial claim - Premisecitation
Insomnia has been identified as a precursor to the development of full clinical syndromes.
“and that insomnia has been identified as a precursor to the development of full clinical syndromes (71)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [71] Li, 2016, Insomnia and the risk of depression: a meta-analysis of prospective cohort studies, BMC Psychiatry. source
Not checked in the free run.
- Interpretationown data
A combination of passive sensing and active assessment may provide the greatest predictive power in identifying people suffering from symptoms of depression and anxiety.
“suggests that a combination of passive sensing and active assessment may provide the greatest predictive power in identifying people suffering from symptoms of depression and anxiety.”
Quote in the paperSubstantial claim - Study design and conductnone given
The sample was heavily skewed toward white, employed individuals who were more educated than the general population.
“The sample was heavily skewed toward white, employed individuals who were more educated than the general population.”
Quote in the paperNot a substantial claim - Interpretationown data
The current study provides promising indications of digital phenotyping data derived from consumer wearable devices for the identification of individuals suffering from or at risk of developing a mental health condition.
“Notwithstanding these limitations, the current study provides promising indications of digital phenotyping data derived from consumer wearable devices for the identification of individuals suffering from or at risk of developing a mental health condition.”
Quote in the paperSubstantial claim - Premisecitation
Sleep disturbances are transdiagnostic.
“Given the transdiagnostic nature of sleep disturbances (30)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Harvey, 2011, Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms, Clin Psychol Rev. source
Not checked in the free run.
- Premisenone given
This is the first study to use validated consumer wearable devices to provide sleep data in real-life settings.
“however this is the first study to use validated consumer wearable devices to provide sleep data in real-life settings.”
Quote in the paperNot a substantial claim - Premisecitation
Participants who move about more through geographic space are less depressed.
“supports previous research demonstrating that participants who move about more through geographic space are less depressed (19, 67).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [19] Saeb, 2015, Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: An exploratory study, J Med Internet Res. source
Not checked in the free run.
- cites [67] Farhan, 2016, Behavior vs. introspection: refining prediction of clinical depression via smartphone sensing data source
Not checked in the free run.
- Interpretationown data
The superior performance of the combined GPS and wearable data model compared to the GPS-only model demonstrates the value of wearable data during times of restrictive movement such as COVID-19.
“Finally, the superior performance of the combined GPS and wearable data model compared to the GPS-only model in predicting symptoms of depression and anxiety demonstrates the value of wearable data during times of restrictive movement such as COVID-19.”
Quote in the paperSubstantial claim- Rests on an assumption: Participants' movement was indeed more limited during the study period than before the pandemic.
- Study design and conductnone given
The small sample size meant that the study was likely underpowered to find statistically significant results for a number of predictors exhibiting small effect sizes.
“Second, the small sample size meant that the study was likely underpowered to find statistically significant results for a number of predictors exhibiting small effect sizes.”
Quote in the paperNot a substantial claim
- May combine two claims. 11
- Classified as probably not a substantial claim. 18
May combine two claims.
Findingown dataEMA performed better than smartphone and wearable data models for depression, but the combination yielded the best fit.
“A combined model of smartphone and wearable features and self-reported mood provided the strongest prediction of depression.”
- Also stated in: § Combined Predictions · plain
“EMA performed better than smartphone and wearable data models, but the combination yielded the best fit (see Table 3).”
Quote in the paperSubstantial claim- Also stated in: § Combined Predictions · plain
May combine two claims.
Findingown dataAll other GPS features as well as variance and entropy for anxiety and stress were non-significant.
“All other GPS features as well as variance and entropy for anxiety and stress were non-significant (see Table 2 for more details).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe present study used methods from a previous study investigating the correlation between GPS variables and depressive symptom severity with a sample size of N = 40.
“The present study used methods from a previous study (19) investigating the correlation between GPS variables and depressive symptom severity with a sample size of N = 40.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Saeb, 2015, Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: An exploratory study, J Med Internet Res. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe DASS-21 has demonstrated high internal consistency for the three subscales of depression, anxiety, and stress in previous administrations.
“The DASS21 has demonstrated high internal consistency for the three subscales of depression, anxiety, and stress in previous administrations (42).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] Antony, 1998, Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample, Psychol Assess. source
Not checked in the free run.
May combine two claims.
Study design and conductcitationMultilevel models take into account that data is nested within persons and reduce the likelihood of Type I errors.
“MLMs take into account that data is nested within persons, i.e., the observations are not independent (56) and reduce the likelihood of Type I errors (57).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [56] Nezlek, 2001, multilevel random coefficient analyses of event- and interval-contingent data in social and personality psychology research, Personal Soc Psychol Bull. source
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- cites [57] Musca, 2011, Data with hierarchical structure: impact of intraclass correlation and sample size on type-i error, Front Psychol. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBeiwinkel et al. found that total distance traveled had a significant negative relationship with clinical manic symptoms in patients diagnosed with bipolar disorder (beta = −0.37).
“Beiwinkel et al. (20) found that the total distance traveled had a significant negative relationship with clinical manic symptoms in patients diagnosed with bipolar disorder (beta = −0.37).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Beiwinkel, 2016, Using smartphones to monitor bipolar disorder symptoms: a pilot study, JMIR Ment Heal. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataOf the 60 participants at intake, 5 dropped out (1 due to privacy concerns, 2 due to burden of self-report, and 2 for unknown reasons).
“Of the 60 participants at intake, 1 participant (1.7%) dropped out of the study due to concerns over privacy, 2 participants (3.4%) dropped out due to burden of self-report and 2 (3.4%) participants dropped out for unknown reasons.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningAdjustment for multiple testing was only performed cluster-wise to avoid overcorrection leading to false rejection of findings.
“However, p-value adjustment methods are sensitive and since the present study is of an exploratory nature, adjustment was only performed cluster-wise (e.g., separately for GPS features and wearable features) to avoid an overcorrection by p-value adjustment leading to a false-rejection of findings.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningRecruitment was continued for 2 weeks after reaching the required sample size to compensate for dropout.
“However, as dropout rates in longitudinal observation studies using digital phenotyping data are typically high, recruitment was continued for 2 weeks after reaching the required sample size to compensate for dropout.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA secure web-based dashboard was developed to monitor data collection and compliance during the study period.
“To monitor data collection and compliance during the study period, a secure web-based dashboard was developed displaying the data gathered for all participants, updated at 15-min intervals.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationP-values were adjusted for multiple testing based on the Bonferroni Holm method with a false discovery rate of 0.05.
“P-values were adjusted for multiple testing based on the Bonferroni Holm method (50) with a false discovery rate of 0.05.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] Holm, 1979, Board of the foundation of the scandinavian journal of statistics a simple sequentially rejective multiple test procedure a simple sequentially rejective multiple test procedure, Source Scand J Stat Scand J Stat.
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Classified as probably not a substantial claim.
Study design and conductreasoningMultiple imputations were used to handle missing values in the correlation and regression analysis.
“To avoid bias introduced by missingness we used multiple imputations to handle missing values in the correlation and regression analysis.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missingness in the DASS-21 assessment and sensing variables was missing at random (MAR), meaning missingness depended on observed data.
May combine two claims.
Study design and conductcitationThe imputation model took the nested structure of the data into account and followed guidelines for multilevel multiple imputations.
“The imputation model took the nested structure of the data into account and followed guidelines for multilevel multiple imputations (58).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [58] van Buuren, 2011, mice: Multivariate imputation by chained equations in R, J Stat Softw. source
Not checked in the free run.
- The authors state this as an assumption: Missingness in the DASS-21 assessment and sensing variables was missing at random (MAR), meaning missingness depended on observed data.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataOf the remaining 55 participants, 47 (85.5%) completed the midpoint questionnaire and 54 (98.2%) completed the endpoint questionnaire.
“Of the remaining 55 participants, 47 (85.5%) completed the midpoint questionnaire and 54 (98.2%) completed the endpoint questionnaire.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationConvergence was visually assessed and confirmed.
“Convergence was visually assessed and confirmed (58).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [58] van Buuren, 2011, mice: Multivariate imputation by chained equations in R, J Stat Softw. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSaeb et al. found that regularity of participants' 24-h movement patterns (r = −0.63), the variance of locations visited (r = −0.58) and the proportion of time spent at home (r = 0.49) were related to depressive symptom severity in a non-clinical population.
“Saeb et al. (19), e.g., found that regularity of participants' 24-h movement patterns (r = −0.63), the variance of locations visited (r = −0.58) and the proportion of time spent at home (r = 0.49) were related to depressive symptom severity in a non-clinical population (19).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Saeb, 2015, Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: An exploratory study, J Med Internet Res. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationTo avoid biases introduced by missing values, full information maximum likelihood was used as the estimator.
“To avoid biases introduced by missing values we used full information maximum likelihood as the estimator (51, 52).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [51] EndersCK Applied Missing Data Analysis2010
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- cites [52] RevelleW 19012653Procedures for Psychological, Psychometric, and Personality Research2020
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Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductnone givenEthical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements.
“Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductcitationPooling data prevented exploration of high-frequency processes, so temporal precedence could not be established.
“as pooling data prevented us from exploring high-frequency processes (e.g., the relationship between movement and mood), we were unable to establish temporal precedence (74).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [74] Kazdin, 2007, Mediators and mechanisms of change in psychotherapy research, Annu Rev Clin Psychol. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningAs the study commenced after the onset of the pandemic, no data comparing participants' movement before and during the study were available to confirm that their movement was more limited during the study period.
“As the study commenced after the onset of the pandemic, we were unable to provide any data comparing participants' movement before and during the study to confirm that their movement was indeed more limited during the study period.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThere are issues quantifying explained variance in multilevel models.
“Given the issues quantifying explained variance in multilevel models (86, 87)”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [86] Rights, 2019, Quantifying explained variance in multilevel models: an integrative framework for defining R-squared measures, Psychol Methods. source
Not checked in the free run.
- cites [87] LaHuis, 2014, Explained variance measures for multilevel models, Organ Res Methods. source
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe current findings do not necessarily represent a causal relationship between the behavior measured by smartphone and wearable devices and symptoms of depression and anxiety, nor can they explain the direction between them.
“thus the current findings do not necessarily represent a causal relationship between the behavior measured by smartphone and wearable devices and symptoms of depression and anxiety, nor can they explain the direction between them.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationSleep data from consumer wearables may provide valuable tools to identify early warning signs of mental disorders, thereby facilitating time-sensitive preventative measures.
“sleep data from consumer wearables may thus provide valuable tools to identify early warning signs of mental disorders, thereby facilitating time-sensitive preventative measures (72).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [72] Baglioni, 2011, Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies, J Affect Disord. source
Not checked in the free run.
May combine two claims.
PremisecitationSociodemographic status and smartphone usage behavior may differ between iOS and Android users.
“Research has shown that sociodemographic status and smartphone usage behavior may differ between iOS and Android users (75, 76).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [75] Ubhi, 2017, A comparison of the characteristics of iOS and Android users of a smoking cessation app, Transl Behav Med. source
Not checked in the free run.
- cites [76] Pryss, 2019, Ecological momentary assessment based differences between Android and iOS Users of the trackyourhearing mhealth crowdsensing platform source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study was open only to participants with an Apple (iOS) smartphone.
“Related to this, the study was open only to participants with an Apple (iOS) smartphone.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe participants provided their written informed consent to participate in this study.
“The patients/participants provided their written informed consent to participate in this study.”
Quote in the paperNot a substantial claim
The authors state this as an assumption.
Missingness in the DASS-21 assessment and sensing variables was missing at random (MAR), meaning missingness depended on observed data.
“Missingness only occurred in the DASS-21 assessment (10%) and the sensing variables (9.1%) and was assumed to be missing at random (MAR), meaning missingness depended on observed data (51, 52).”
The paper relies on this without support.
Participants' movement was indeed more limited during the study period than before the pandemic.
“we were unable to provide any data comparing participants' movement before and during the study to confirm that their movement was indeed more limited during the study period.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Smart sensing is an innovative diagnostic approach that can support mental health screening and intervention.
“One such method could be smart sensing, with the goal of achieving scalable, precise, and time-effective detection of symptoms (27–29).”
Inherent in these data sets are behavioral patterns: routines, rhythms, activities, and interactions that are useful in complementing traditional depression assessment methods, in studying the mental health of individuals, and in developing timely mental health interventions.
“Inherent in these data sets are behavioral patterns: routines, rhythms, activities, and interactions that are useful in complementing traditional depression assessment methods, in studying the mental health of individuals, and in developing timely mental health interventions [14,22,25-28].”
The findings in this study are supported by prior research that investigated the relationship between screen interactions and mental health.
“The findings in this study are also supported by prior research that investigated the relationship between screen interactions and mental health [3,27,28,33].”
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentt(81) = -2.13reported p = .037 · recomputed p = .036
“t(81) = −2.13, p = .037”
- Consistentt(73) = 2.33reported p = .023 · recomputed p = .023
“t(73) = 2.33, p = .023”
- Consistentt(59) = 2.39reported p = .02 · recomputed p = .020
“t(59) = 2.39, p = .020”
- Consistentt(90) = 2.13reported p = .035 · recomputed p = .036
“t(90) = 2.13, p = .035”
- Consistentt(71) = 2.15reported p = .035 · recomputed p = .035
“t(71) = 2.15, p = .035”
- Consistentt(55) = -3.43reported p = .001 · recomputed p = .001
“t(55) = −3.43, p = .001”
- Consistentt(57) = -2.54reported p = .014 · recomputed p = .014
“t(57) = −2.54, p = .014”
- Consistentt(74) = -3.64reported p < .001 · recomputed p < .001
“t(74) = −3.64, p < .001”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Combined model is incorrectly claimed to be strongest for anxiety
MajorThe discussion says adding sensing data to EMA had the highest predictive power for both depression and anxiety. The results instead say the EMA-only model was strongest for anxiety; Table 4 also reports a non-significant comparison of the combined model against the EMA model (p = 0.055).
“our finding that adding smartphone and wearable data to EMA data had the highest predictive power of all models in the analysis suggests that a combination of passive sensing and active assessment may provide the greatest predictive power in identifying people suffering from symptoms of depression and anxiety.”
“For anxiety and stress, EMA-only data models were the strongest predictors (see Tables 4, 5).”
Stress severe-category percentage does not match its count
MinorTable 1 lists 2 participants with severe stress and 1 with extremely severe stress. Together, 3 of the 55 participants are in these categories, or about 5.5%, not the reported 4.4%.
Reported 4.4 · recomputed 5.454545
“the mean stress level was M = 6.00, SD = 3.82 (normal: 65.5%, mild-moderate: 29.1%, severe: 4.4%).”
Two-person dropout percentages use the wrong denominator
MinorEach group of 2 dropouts represents 3.3% of the stated 60 participants at intake when rounded to one decimal place, not 3.4%.
Reported 3.4 · recomputed 3.333333
“Of the 60 participants at intake, 1 participant (1.7%) dropped out of the study due to concerns over privacy, 2 participants (3.4%) dropped out due to burden of self-report and 2 (3.4%) participants dropped out for unknown reasons.”
Stress EMA model labels its significant predictor arousal
MinorTable 5 reports a significant arousal coefficient for stress, whereas the results state that valence was significant for stress and arousal was not significant for any outcome.
“| Arousal | −0.39 | 0.11 | −3.71 | 74 | <0.001 | | | |”
“There was no significant relationship between arousal and depression, anxiety or stress.”
Correlation method is named inconsistently
MinorThe methods say the correlations used Spearman's coefficient, but the results describe Table 2 as Pearson's correlation matrices.
“Correlations were calculated using the Spearman's correlation coefficient, since the data was not normally distributed.”
“Table 2 presents Pearson's correlation matrixes of the four sets of independent variables (GPS, smartphone-usage, wearable, and EMA features) and mental health symptom severity.”
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Acceptance of smart sensing: a barrier to implementation—results from a randomized controlled trial
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Self-citationCalderone, A., Latella, D., Fauci, E. L., Puleo, R., Sergi, A., Francesco, M. D., Mauro, M., Foti, A., Salemi, L., & Calabrò, R. S. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70191 · Cited by 13 · see citing works
Tng, G. Y. Q., & Yang, H. (2023) · Behaviour and Information Technology · doi:10.1080/0144929x.2023.2196573 · Cited by 12 · see citing works
Terhorst, Y., Meßner, E.-M., Asare, K. O., Montag, C., Kannen, C., & Baumeister, H. (2024) · Journal of Medical Internet Research · doi:10.2196/55308 · Cited by 9 · see citing works
Self-citationThe relation between passively collected data and PTSD: a systematic review and meta-analysis
Zhu, N., Sarawgi, A., Bühner, M., Baumeister, H., Garatva, P., Ehring, T. W., & Terhorst, Y. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-01825-6 · Cited by 10 · see citing works
Self-citationKshirsagar, P. R., Manoharan, H., Selvarajan, S., Alterazi, H. A., Singh, D., & Lee, H.-N. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.893989 · Cited by 10 · see citing works
Onyeaka, H., Firth, J., Enemuo, V., Muoghalu, C., Naslund, J. A., Baiden, P., & Torous, J. B. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.707900 · Cited by 10 · see citing works
Machine Learning based Detection of Depression and Anxiety
Sajja, G. S. (2021) · International Journal of Computer Applications · doi:10.5120/ijca2021921856 · Cited by 11 · see citing works
Elmer, T. (2023) · EPJ Data Science · doi:10.1140/epjds/s13688-023-00434-1 · Cited by 11 · see citing works
Person-Specific Analyses of Smartphone Use and Mental Health: Intensive Longitudinal Study
Cerit, M., Lee, A. Y., Hancock, J. T., Miner, A. S., Cho, M.-J., Muise, D., Torres, A., Haber, N., Ram, N., Robinson, T. N., et al. (2025) · JMIR Formative Research · doi:10.2196/59875 · Cited by 9 · see citing works
Choi, H., Cho, Y., Min, C., Kim, K., Kim, E., Lee, S., & Kim, J. (2024) · Digital Health · doi:10.1177/20552076241256730 · Cited by 8 · see citing works
Lyfas, A Smartphone-Based Subclinical Depression Tracker
Chattopadhyay, S., & Das, R. (2021) · International Journal of Psychiatry Research · doi:10.33425/2641-4317.1120 · Cited by 8 · see citing works
Simon, L., Terhorst, Y., Cohrdes, C., Pryss, R. C., Steinmetz, L., Elhai, J. D., & Baumeister, H. (2024) · Sleep Medicine X · doi:10.1016/j.sleepx.2024.100114 · Cited by 9 · see citing works
Self-citationDigital phenotyping of depression during pregnancy using self-report data
Allen, K., Rodriguez, S. N., Hayani, L., Rothenberger, S. D., Moses‐Kolko, E. L., Simhan, H. N., & Krishnamurti, T. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.029 · Cited by 8 · see citing works
HADD: High-Accuracy Detection of Depressed Mood
Liu, Y., Kang, K., & Doe, M. J. (2022) · Technologies · doi:10.3390/technologies10060123 · Cited by 8 · see citing works
- Authors
- Moshe, I., Terhorst, Y., Opoku Asare, K., Sander, L. B., Ferreira, D., Baumeister, H., Mohr, D. C., & Pulkki-Råback, L.
- Affiliations
- University of Helsinki (FI)
- Universität Ulm (DE)
- University of Freiburg (DE)
- University of Oulu (FI)
- Northwestern University (US)
- Corresponding author
- Moshe, Isaac
- ORCID
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2021-01-28
- Volume
- 12
- Pages
- 625247-625247
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7876288
- OpenAlex
- W3126710441
- Semantic Scholar
- 5668ebac231d637ec29a731be26a949b7b73b20c
- Cited by
- 261
- References
- 83
- Citations by year
- 2026: 45 · 2025: 50 · 2024: 50 · 2023: 50 · 2022: 47 · 2021: 19
- FWCI
- 36.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Työväentutkimus Vuosikirja (submittedVersion)
- OPen Access Repositorium der Universität Ulm (OPARU) (Ulm University) (submittedVersion, other-oa)
- Universität Ulm, Kommunikations- und Informationszentrum (kiz) (cc-by)
- Funders
- Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Emotion and Mood Recognition
- Keywords
- depression, anxiety, smartphone data, wearable devices, Oura Ring, heart rate variability, sleep, GPS location data, smartphone usage behavior, mood, mental health screening, stress, DASS-21
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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