33. USING NOVEL WEARABLES AND ECOLOGICAL MOMENTARY ASSESSMENT TO TRACK PHYSIOLOGICAL BIOMARKERS IN PSYCHOTHERAPY FOR LATE-LIFE DEPRESSION

Abstract

Introduction

Late-life depression is common, debilitating, and linked with poor mental health and medical outcomes. Individuals with depression experience high baseline heart rates and sleep disturbances, including fluctuations in circadian rhythm and sleep cycles. Depression is typically measured using weekly or periodic interviewer-rated or self-reported measures. These scales are limited by recall bias and low time sensitivity and accuracy, especially among older adults. Novel wearable devices and real-time mood scales measured multiple times a day (ecological momentary assessments; EMAs) can improve the precision and accuracy of depression severity measurement. There is little work on the application of these methods in the aging population, with only a few studies examining changes during treatment for late-life depression. We aimed to examine whether wearables and EMAs are feasible and can track precisely the changes across multiple domains during psychotherapy for late-life depression

Methods

We implemented a novel wearable biometric ring (Oura Ring) and EMAs (measured twice daily) in an ongoing randomized controlled trial of psychotherapies for late-life suicidality. Three patients with major depression and suicidality completed 9 weeks of psychotherapy while wearing the Oura Ring and completing two EMA surveys a day (afternoon and evening surveys). Oura Ring data collected daily measures of average heart rate (beats per minute), heart rate variability, and hours of sleep. EMAs measured number of hours they slept, negative affect (stress, anxiety, irritability, depression, and loneliness), and positive affect (energy, motivation, excitement, interest, and satisfaction).

Results

Our preliminary results show that all three participants experienced a reduction in negative affect and an increase in positive affect during psychotherapy. There was variability in trajectories of positive affect: Patients A and C showed a pronounced increase in positive affect, while Patient B showed an initial increase followed by a decrease. Further, for all three participants, hours slept (measured by Oura Ring) and self-reported hours slept followed a similar pattern over time, indicating these two measures may be linked. Finally, Patients A and C showed a consistent increase in heart rate variability, while patient B experienced a decrease over time.

Conclusions

Our preliminary case studies suggest that integrating wearables with daily EMA self-reports can provide a feasible, precise, and granular assessment of daily changes in affect and biometrics, such as sleep and heart rate, during psychotherapy for late-life depression. The strong alignment between wearable-measured and self-reported sleep data, along with observable trends in heart rate variability and negative valence mood responses, highlights the powerful potential of these methods. This potential is particularly evident in their capacity to enable real-time, more personalized monitoring of treatment progress. Furthermore, these methods can potentially identify warning signs of deterioration or alternatively identify therapeutic gains during treatment.