Frank Blaauw

Temporal dynamics of health and well-being: A crowdsourcing approach to momentary assessments and automated generation of personalized feedback

Objective Recent developments in research and mobile health enable a quantitative idiographic approach in health research. The present study investigates the potential of an electronic diary crowdsourcing study in the Netherlands for (1) large-scale automated self-assessment for individual-based health promotion and (2) enabling research at both the between-persons and within-persons level. To illustrate the latter, we examined between-persons and within-persons associations between somatic symptoms and quality of life. Methods A website provided the general Dutch population access to a 30-day (3 times a day) diary study assessing 43 items related to health and well-being, which gave participants personalized feedback. Associations between somatic symptoms and quality of life were examined with a linear mixed model. Results A total of 629 participants completed 28,430 assessments, with a mean (SD) of 45 (32) assessments per participant. Most participants (n = 517 [82%]) were women and 531 (84%) had high education. Almost 40% of the participants (n = 247) completed enough assessments (t = 68) to generate personalized feedback including temporal dynamics between well-being, health behavior, and emotions. Substantial between-person variability was found in the within-person association between somatic symptoms and quality of life. Conclusions We successfully built an application for automated diary assessments and personalized feedback. The application was used by a sample of mainly highly educated women, which suggests that the potential of our intensive diary assessment method for large-scale health promotion is limited. However, a rich data set was collected that allows for group-level and idiographic analyses that can shed light on etiological processes and may contribute to the development of empirical-based health promotion solutions.

Exploring the emotional dynamics of subclinically depressed individuals with and without anhedonia: An experience sampling study

BACKGROUND Anhedonia has been linked to worse prognosis of depression. The present study aimed to construct personalized models to elucidate the emotional dynamics of subclinically depressed individuals with versus without symptoms of anhedonia. METHODS Matched subclinically depressed individuals with and without symptoms of anhedonia (N = 40) of the HowNutsAreTheDutch sample completed three experience sampling methodology assessments per day for 30 days. For each individual, the impact of physical activity, stress experience, and high/low arousal PA/NA on each other was estimated through automated impulse response function analysis (IRF). These individual IRF associations were combined to compare anhedonic versus non-anhedonic individuals. RESULTS Physical activity had low impact on affect in both groups. In non-anhedonic individuals, stress experience increased NA and decreased PA and physical activity more strongly. In anhedonic individuals, PA high arousal showed a diminished favorable impact on affect (increasing NA/stress experience, decreasing PA/physical activity). Finally, large heterogeneity in the personalized models of emotional dynamics were found. LIMITATIONS Stress experience was measured indirectly by assessing level of distress; the timeframe in between measurements was relatively long with 6h; and only information on one of the two hallmarks of anhedonia, loss of interest, was gathered. CONCLUSIONS Our results suggest different pathways of emotional dynamics underlie depressive symptomatology. Subclinically depressed individuals with anhedonic complaints are more strongly characterized by diminished favorable impact of PA high arousal and heightened NA reactivity, whereas subclinically depressed individuals without these anhedonic complaints seem more characterized by heightened stress reactivity. The automatically generated personalized models may offer patient-specific insights in emotional dynamics, which may show clinical relevance.

A Service-Oriented Architecture for Web Applications in e-Mental Health: Two Case Studies

E-mental health applications have gained popularity recently as a result of applying developing technologies to leverage advantages over traditional care. First, e-mental health applications are inherently scalable, whereas traditional care involves one-to-one relations between patient and clinician. Second, electronic data formats can facilitate interoperability in a way that medical data on paper cannot. Third, the flexibility of a web application warrants that improvements in the care program exposed through the application will immediately benefit all applicable users. For the specific domain of e-mental health, the primary source of medical data are online questionnaires, and most applications in this domain focus on viewing, filling out, and managing these questionnaires. Many distinct such applications have been developed in recent years, most of them starting from scratch and running in isolation. In this paper, we design and propose a generic architecture for e-mental health applications from two case studies. These case studies are two e-mental health applications called HowNutsAreTheDutch and Leefplezier, and are used on a large scale with over 13,000 active users combined. By abstracting functionalities into reusable Service-Oriented Architecture interfaces, we can maximize data interoperability while minimizing application-specific code to facilitate rapid development of e-mental health applications.