Enrique Baca Garca Disclosure of conflict of interest - - PowerPoint PPT Presentation

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Enrique Baca Garca Disclosure of conflict of interest - - PowerPoint PPT Presentation

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Enriching Populations and Enhancing Outcomes in Studies Measuring Suicidality Ecological momentary assessment (EMA) and machine learning : Digital phenotyping in suicide behavior Enrique Baca Garca Disclosure of conflict of interest

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Enrique Baca García

Ecological momentary assessment (EMA) and machine learning : Digital phenotyping in suicide behavior

Enriching Populations and Enhancing Outcomes in Studies Measuring Suicidality

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  • E. Baca-García

Disclosure of conflict of interest

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Grants/research support AFSP NARSAD Lilly Janssen Servier Lundbeck Otsuka Founder MeMind Eb2

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FACTS & CONTROVERSIES

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nd greatest cause of mortality in people 18-35

640.300 potentially productive life years lost EU → 22€ billion in potential income loss Preventable but not predictable Safety vs trauma → hospitalisation (standard of care) Complexity vs risk stratification → personalisation Suicidality as exclusion criteria in clinical trials

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Clinical outcome measures vs Patient reported outcomes measures measures

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Clinician: “Have you ever thought that you would be better off dead or wish you were dead?” Patient: “ Have you ever felt that you no have desire to life?”

Wish to live/ Wish to die for patients r=.89 (IC 95% -0,94 -0.81) n=119 (896 observations)

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Enrique Baca-García

FROM SMARTCRISIS TO CNS CLINICAL TRIALS

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DESIGN: EMA

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EXPERIENCE:FEASIBILITY PATIENT EXPERIENCE

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OUTCOMES: MBC → PROMs & PREMs

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REAL TIME ANALYTIC

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SAFETY

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01 02 03 04
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RESEARCH DESIGN

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1 DSG

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RESEARCH DESIGN

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1 DSG

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RESEARCH DESIGN

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1 DSG

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RESEARCH DESIGN

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1 DSG

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Participative

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COLLECT DATA AND PATIENT EXPERIENCE

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Dynamic

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EXPLICIT-ACTIVE IMPLICIT-PASSIVE

Passive

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Interactive

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EMA

1 DSG

BMC Psychiatry in press

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SMARTCRISIS: DATA DENSITY

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1 DSG

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OUTCOME

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Clinical outcome measures Suicide/Suicide attempt/hospitalisation/ER Patient reported outcomes measures Wish to live/ to die Sleep Patient reported experience measures Satisfaction Movement

Passive

01

Dynamic

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Dynamic

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Participative

03

2

OUT

BMC Psychiatry in press

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Patient reported outcomes measures

MONTH 1 Question/day 4 Twice per week

*

Once each 4 days

**

Once each 2 weeks MONTH 2-3 Question/day 2 Once per week

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Once each 8 days

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Once each 4 weeks MONTH 4-6 Question/day 1-2 Once per week

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Once each 8 days

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Once each 6 weeks

Dynamic

02

2

OUT

BMC Psychiatry in press

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  • E. Baca-García

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Feasibility

1 Refused to participate 14% Not installed No upload Participating 66%

SMART CRISIS (n=189) WHODAS (n=1706)

Refused to participate 13% Not installed No upload Participating 58%

Refused to participate 16% Not installed No upload Participating 59%

UCV (n=583)

3 EXP

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High retention rate at 2 months (n=100)

Active

Log Rank (Mantel-Cox) =,411, DF=1, P=0,522

Passive

Log Rank (Mantel-Cox) =8,77 , DF=2, P=0,012

3 EXP

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180 days retention (n=199)

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3 EXP

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INTRAINDIVIDUAL VARIABLITY

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3 EXP

Wish to live Wish to die

CV=24,8 CV=22,4 Wish to live/ Wish to die for patients r=.89 (IC 95% -0,94 -0.81) n=119 (896 obs)

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SLEEP AS A SURROGATE MARKER

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3 EXP

Wish to live

Correlation stability sleep satisfaction Wish to live

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Personalisation: Indian buffet process

19 Feature 0 Feature 1 Feature 2 Feature 3 Profile 1 (1452) x Profile 2 (738)

x x

Profile 3 (142)

x x

Profile 4 (93)

x x x

Profile 5 (3)

x x

3 EXP

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Pattern of Movement: Real time analysis

4 RT

150 300 450 600

Pattern 8 Pattern 7 Pattern 6 Pattern 5 Pattern 4 Pattern 3 Pattern 2 Pattern 1

Median number of patterns per patient =2

JMIR Mhealth Uhealth 2018 | vol. 6 | iss. 12 | e197 | p.1

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STABILITY

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Detection based on movement patterns

29/6/2018 Unstable Pattern change 4/7/2018 EA Suicide Attempt

What's behind it?

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SAFE

JMIR Mhealth Uhealth 2018 | vol. 6 | iss. 12 | e197 | p.1

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CONCLUSIONS

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REAL WORLD + PERSONALISED → INTERVENTION

Access to real world with patient acceptability and minimal interference Massive sampling Assessing and analysing in real time Measures variability Sleep and movement as suicide behaviour markers

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Enrique Baca-García

Thanks

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Enrique * Baca-Garcia * Fundacion Jimenez Diaz Sofian Berrouiguet University Hopital Brest Juan Jose Carballo Beloso Hospital Gregorio Marañon Santiago Ovejero Fundacion Jimenez Diaz Raquel Alvarez García Hospital Rey Juan Carlos Laura Mata Iturralde Fundacion Jimenez Diaz Laura Muñoz Lorenzo Fundacion Jimenez Diaz Ezequiel Distasio Hospital General de V llaba Mari a Luis a Barrigon Fundacion Jimenez Diaz David Delgado Universidad Carlos III Pablo Fernandez Navarro ISCIII Jorge Lopez Castroman University Montpleir Hilario Blasco Fontecilla HU Puerta de Hierro Lucas Giner Universidad Sevilla Ana Gomez Carrillo University of London Mercedes Perez Rodriguez Mount Sinai, NY Philippe Courtet University Montpelier Maria Oquendo Columbia University