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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
E. Baca-García
Disclosure of conflict of interest
2
Grants/research support
AFSP
NARSAD
Lilly
Janssen
Servier
Lundbeck
Otsuka
Founder
MeMind
Eb2
E. Baca-García
FACTS & CONTROVERSIES
3
2nd 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
E. Baca-García
Clinical outcome measures vs Patient reported outcomes measures measures
4
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)
Enrique Baca-García
FROM SMARTCRISIS TO CNS CLINICAL TRIALS
5
DESIGN: EMA1
EXPERIENCE:FEASIBILITY
PATIENT EXPERIENCE
2OUTCOMES:
MBC → PROMs & PREMs
3
REAL TIME ANALYTIC 4
SAFETY5
01
02
03
04
E. Baca-García
RESEARCH DESIGN
6
1
DSG
E. Baca-García
RESEARCH DESIGN
7
1
DSG
E. Baca-García
RESEARCH DESIGN
8
1
DSG
E. Baca-García
RESEARCH DESIGN
9
1
DSG
E. Baca-García
Participative 03
COLLECT DATA AND PATIENT EXPERIENCE
10
Dynamic02
EXPLICIT-ACTIVE
IMPLICIT-PASSIVE Passive01
Interactive04
EMA
1
DSG
BMC Psychiatry in press
Enrique Baca-García
SMARTCRISIS: DATA DENSITY
11
1
DSG
Enrique Baca-García
OUTCOME
12
Clinical outcome measures
Suicide/Suicide attempt/hospitalisation/ER
Patient reported outcomes measures
Wish to live/ to die
Sleep
Patient reported experience measures
Satisfaction
Movement Passive01
Dynamic02
Dynamic02
Participative 03
2OUT
BMC Psychiatry in press
E. Baca-García13
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 *
Once each 8 days **Once each 4 weeks
MONTH 4-6
Question/day 1-2
Once per week *
Once each 8 days **Once each 6 weeks
Dynamic022
OUT
BMC Psychiatry in press
E. Baca-García14
Feasibility1
Refused to participate
14%
Not installed
No upload
Participating66%
SMART CRISIS (n=189) WHODAS (n=1706)
Refused to participate
13%
Not installed
No upload
Participating58%
Refused to participate
16%
Not installed
No upload
Participating59%
UCV (n=583)
3
EXP
E. Baca-García15
High retention rate at 2 months (n=100)
ActiveLog Rank (Mantel-Cox) =,411, DF=1, P=0,522
PassiveLog Rank (Mantel-Cox) =8,77 , DF=2, P=0,012
3
EXP
Enrique Baca-García
180 days retention (n=199)
16
3
EXP
Enrique Baca-García
INTRAINDIVIDUAL VARIABLITY
17
3
EXP
Wish to live Wish to die
CV=24,8CV=22,4
Wish to live/ Wish to die for patients r=.89 (IC 95% -0,94 -0.81) n=119 (896 obs)
Enrique Baca-García
SLEEP AS A SURROGATE MARKER
18
3
EXP
Wish to live
Correlation stability
sleep satisfaction
Wish to live
Enrique Baca-García
Personalisation: Indian buffet process
19
Feature 0 Feature 1 Feature 2 Feature 3
Profile 1 (1452) xProfile 2 (738) x xProfile 3 (142) x xProfile 4 (93) x x xProfile 5 (3) x x
3
EXP
E. Baca-García20
5Pattern of Movement: Real time
analysis4
RT
0
150
300
450
600Pattern 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
E. Baca-García
STABILITY
21
Detection based on movement patterns
29/6/2018
Unstable
Pattern change
4/7/2018
EA Suicide Attempt
What's behind it?
5SAFE
JMIR Mhealth Uhealth 2018 | vol. 6 | iss. 12 | e197 | p.1
E. Baca-García22
CONCLUSIONS5
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
Enrique Baca-García
Thanks
23
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 GarcíaHospital Rey Juan
Carlos
Laura Mata Iturralde Fundacion Jimenez Diaz
LauraMuñoz
LorenzoFundacion Jimenez Diaz
Ezequiel DistasioHospital General de
V llaba
Mari
a
Luis
a
Barrigon Fundacion Jimenez Diaz
David Delgado Universidad Carlos III
Pablo Fernandez Navarro ISCIII
JorgeLopez
CastromanUniversity Montpleir
Hilario Blasco Fontecilla HU Puerta de Hierro
Lucas Giner Universidad Sevilla
Ana Gomez Carrillo University of London
MercedesPerez
RodriguezMount Sinai, NY
Philippe Courtet University Montpelier
Maria Oquendo Columbia University