PONE-D-19-24772

14-day smartphone ambulatory assessment of depression symptoms and mood dynamics in a general population sample: comparison with the PHQ-9 depression screening

PLOS ONE

Dear Dr. Burchert,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Gian Mauro Manzoni, Ph.D., Psy.D.

Academic Editor

PLOS ONE

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The authors declare that the research was conducted in the absence of any commercial or financial

relationships that could be construed as a potential conflict of interest. For the purpose of this study, Freie Universität Berlin and Aurora Health signed a formal data usage agreement. The data collection was conducted with regular users of the app. As part of the data usage agreement, Aurora Health provided the authors with a raw data export file from the app’s database. Aurora Health was not involved in the preparation of the raw data, the data analysis, the writing of this article and the interpretation the results.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This paper represents a pilot study in validating the mobile app for depression screening. For an initial pilot study, it was well-designed and used appropriate statistics. The authors were appropriately careful in the Discussion to point out the pilot nature and related limitations and future directions needed. The writing was clear and the logic was easy to follow. I have just a couple of suggestions for minor additions:

1) In terms of the Moodpath depression score, the authors acknowledge that they just chose a cutoff of 2 or higher on severity without empirical testing of whether that threshold was ideal. However, for the next criteria of the sum of all symptoms that had this “clinical significance on more than half of the ambulatory assessments” – the authors do not clarify how that criteria was chosen. Was that also just chosen without empirically determining whether ideal. For both, authors should clarify if these decisions for cut points were made a priori to inspection of the data.

2) Toward end of Discussion, the authors suggest that a structured clinical interview would be the ultimate criterion to use for future studies. I suggest they expand on that and note that longitudinal research is then needed to examine the predictive validity of important clinical outcomes such as response to treatment, relapse rate, subjective quality of life, quality of daily functioning, suicidal thoughts/attempts, etc. Ultimately, it would be the ability of the screening instrument to detect future behavior that would determine if it is "better" than a self-report measure that relies on retrospective recall. I agree that a first step for future research is to match to SCID diagnosis, but some discussion of further validation and potential use to predict best type of treatment and track changes during treatment would be useful too.

Reviewer #2: I have provided my detatiled comments in the uploaded document. In summary:

This paper reports on a diagnostic accuracy study which evaluates the ability of self‐reported ambulatory assessment of  depressive symptoms and mood monitoring to correctly classify participants as experiencing Major Depressive Disorder,  using the PHQ‐9 as the gold standard.  

This paper is timely as the use of ambulatory assessment and momentary monitoring of mood symptoms is gaining in use  ahead of the research evidence which should underpin it.  

The paper is fairly well written but it is long and could be shortened to improve clarity. The main concern I have is whether  there might be two papers presented as one here. Simply put, one is whether MOODPATH diagnosis agrees with a PHQ‐9  diagnosis and the other is whether mood monitoring agrees with the PHQ‐9 scores? It took me a number of times reading  through the manuscript to understand exactly what was being presented and whether they actually belonged together? I  just wonder if you are trying to achieve too much for one paper and clarity could be improved if you dealt with them  separately? Another concern is the large number of models presented and the lack of a pre‐published protocol. This needs  to be addressed.

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Reviewer #1: Yes: Jeffrey S. Bedwell, Ph.D.

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-19-24772 Review.pdf

PONE-D-19-24772R1

Screening accuracy of a 14-day smartphone ambulatory assessment of depression symptoms and mood dynamics in a general population sample: comparison with the PHQ-9 depression screening

PLOS ONE

Dear Dr. Burchert,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but some minor suggestions to further improve the manuscript remain. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

The reviewers indicated that all former comments have been addressed. However, a new reviewer suggested some minor revisions to further improve the manuscript, and I particularly agree on the need of more clarity about the recruitment pocess and that a Flow-chart would help to address this issue.

==============================

Please submit your revised manuscript by Jan 07 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Ricarda Nater-Mewes, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The reviewers indicated that all former comments have been addressed. However, a new reviewer suggested some minor revisions to further improve the manuscript, and I particularly agree on the need of more clarity about the recruitment pocess and that a Flow-chart would help to address this issue.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors were able to address my previous concerns and suggestions. It also appears that they have responded to all of the points from the other reviewer. I have no further suggestions for changes.

Reviewer #3: This is an important, novel paper which goes some way to addressing the kinds of questions associated with the surfeit of mobile apps available to people with mental health difficulties and their clinicians. The paper has described clearly and accurately the literature and does a mostly thorough job in doing so.

The study itself appears to be appropriate in terms of design and statistical analysis and the conclusions are balanced and realistic. I believe that the previous reviews have been addressed satisfactorily. I did feel there were some issues around the clarity of the methodology some of which could probably be addressed with figures rather than text.

A few comments:

Line 75: "The willingness to seek mental health information online was found to be higher among

persons who experience increased psychological distress" - Higher compared to whom?

Line 85 - poorly constructed sentence. Remove 'for' and consider changing the word obscure for something other such as opaque, complex or hard to navigate

Page5 - What are the figures for health or other app use in the general population - how does this compare to mental health app use?

Page 8 - summary of pilot study aims could be more clear for the reader - strip back to the basics here.

Page 9 - more clarity needed over recruitment and when and how were onboarded - a diagram here would be helpful to explain the process. For example its not immediately apparent when participants start the study. If they are already users - does this impact their results and feedback? Do new users show greater effect from a usage and depression point of view?

Page 10 - the app has already received a CE - does this mean the app has already undergone validation testing for safety and effectiveness?

Page 16 - Is the correction type for multiple testing enough here?

Page 18 and conclusions - Respondents were more likely to complete the tracker in the evening - how did this affect mood - changes in hormone levels, diurnal variance etc. should be considered here perhaps? could this be stratified?

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Jeffrey Bedwell

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Screening accuracy of a 14-day smartphone ambulatory assessment of depression symptoms and mood dynamics in a general population sample: comparison with the PHQ-9 depression screening

PONE-D-19-24772R2

Dear Dr. Burchert,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ricarda Nater-Mewes, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for the revised version of your manuscript. All suggestions by the reviewer have been addressed thoroughly, and I consider the manuscript suitable for being published.

Reviewers' comments: