Prediction of Diagnosis and Treatment Response in Adolescents With Depression by Using a Smartphone App and Deep Learning Approaches: Usability Study
Authors: Kim Jae Sung , Wang Bohyun , Kim Meelim , Lee Jung , Kim Hyungjun , Roh Danyeul , Lee Kyung Hwa , Hong Soon-Beom , Lim Joon Shik , Kim Jae-Won , Ryan Neal 
Published: April 2023

Background
Lack of quantifiable biomarkers is a major obstacle in diagnosing and treating depression. In adolescents, increasing suicidality during antidepressant treatment further complicates the problem.

Objective
We sought to evaluate digital biomarkers for the diagnosis and treatment response of depression in adolescents through a newly developed smartphone app.

Methods
We developed the Smart Healthcare System for Teens At Risk for Depression and Suicide app for Android-based smartphones. This app passively collected data reflecting the social and behavioral activities of adolescents, such as their smartphone usage time, physical movement distance, and the number of phone calls and text messages during the study period. Our study consisted of 24 adolescents (mean age 15.4 [SD 1.4] years, 17 girls) with major depressive disorder (MDD) diagnosed with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and 10 healthy controls (mean age 13.8 [SD 0.6] years, 5 girls). After 1 week’s baseline data collection, adolescents with MDD were treated with escitalopram in an 8-week, open-label trial. Participants were monitored for 5 weeks, including the baseline data collection period. Their psychiatric status was measured every week. Depression severity was measured using the Children’s Depression Rating Scale-Revised and Clinical Global Impressions-Severity. The Columbia Suicide Severity Rating Scale was administered in order to assess suicide severity. We applied the deep learning approach for the analysis of the data. Deep neural network was employed for diagnosis classification, and neural network with weighted fuzzy membership functions was used for feature selection.

Results
We could predict the diagnosis of depression with training accuracy of 96.3% and 3-fold validation accuracy of 77%. Of the 24 adolescents with MDD, 10 responded to antidepressant treatments. We predicted the treatment response of adolescents with MDD with training accuracy of 94.2% and 3-fold validation accuracy of 76%. Adolescents with MDD tended to move longer distances and use smartphones for longer periods of time compared to controls. The deep learning analysis showed that smartphone usage time was the most important feature in distinguishing adolescents with MDD from controls. Prominent differences were not observed in the pattern of each feature between the treatment responders and nonresponders. The deep learning analysis revealed that the total length of calls received as the most important feature predicting antidepressant response in adolescents with MDD.

Conclusions
Our smartphone app demonstrated preliminary evidence of predicting diagnosis and treatment response in depressed adolescents. This is the first study to predict the treatment response of adolescents with MDD by examining smartphone-based objective data with deep learning approaches.