Understanding personalized dynamics to inform precision medicine: a dynamic time warp analysis of 255 depressed inpatients

BMC Medicine, vol. 18, pp. 400

Abstract

BACKGROUND: Major depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis. METHODS: The 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2 weeks for a median of 11 weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated "DTW distances"). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level. RESULTS: The sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories. CONCLUSIONS: Symptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care.

Authors 7

1. Kaat Hebbrecht corresponding

   University of Antwerp

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium. kaat.hebbrecht@emmaus.be

   University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium. kaat.hebbrecht@emmaus.be

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium

2. Mirella Stuivenga

   University of Antwerp

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium

   University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium

3. T. Birkenhäger

   University of Antwerp · Erasmus MC

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium

   Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands

   University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium

4. Manuel Morrens

   University of Antwerp

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium

   University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium

5. Eiko I. Fried Aachen Department of Clinical Psychology

   Leiden University

   Affiliation as printed

   Department of Clinical Psychology, Leiden University, 2300 RA, Leiden, The Netherlands

6. B. Sabbe

   University of Antwerp

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium

   University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium

7. Erik J. Giltay corresponding Aachen Department of Psychiatry, Leiden University Medical Center

   University of Antwerp · Leiden University Medical Center

   Affiliation as printed

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium. E.J.Giltay@lumc.nl

   Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. E.J.Giltay@lumc.nl

   University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium. E.J.Giltay@lumc.nl

   Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium