Unlocking the Potential of Wear Time of a Wearable Device to Enhance Postpartum Depression Screening and Detection: Cross-Sectional Study

BACKGROUND: Postpartum depression (PPD) is a mood disorder affecting 1 in 7 women after childbirth that is often underscreened and underdetected. If not diagnosed and treated, PPD is associated with long-term developmental challenges in the child and maternal morbidity. Wearable technologies, such as smartwatches and fitness trackers (eg, Fitbit), offer continuous and longitudinal digital phenotyping for mood disorder diagnosis and monitoring, with device wear time being an important yet understudied aspect. OBJECTIVE: We aimed to suggest that wear time of a wearable device may provide additional information about perinatal mental health to facilitate screening and early detection of PPD. We proposed that wear time of a wearable device may also be valuable for managing other mental health disorders. METHODS: Using the All of Us Research Program dataset, we identified females who experienced childbirth with and without PPD using computational phenotyping. We compared the percentage of days and number of hours per day females with and without PPD wore Fitbit devices during prepregnancy, pregnancy, postpartum, and PPD periods, determined by electronic health records. Comparisons between females with and without PPD were conducted using linear regression models. We also assessed the correlation between Fitbit wear time consistency (measured as the maximum number of consecutive days the Fitbit was worn) during prepregnancy and PPD periods in females with and without PPD using the Pearson correlation. All analyses were run with Bonferroni correction. RESULTS: Our findings showed a strong trend, although nonsignificant after multiple testing correction, that females in the PPD cohort wore their Fitbits more than those in non-PPD cohort during the postpartum (PPD cohort: mean 69.9%, 95% CI 42.7%-97%; non-PPD cohort: mean 50%, 95% CI 25.5%-74.4%; P=.02) and PPD periods (PPD cohort: mean 66.6%, 95% CI 37.9%-95.3%; non-PPD cohort: mean 46.4%, 95% CI 20.5%-72.2%; P=.02). We found no difference in the number of hours per day females in the PPD and non-PPD cohorts wore their Fitbit during any period of pregnancy. Finally, there was no relationship between the consistency of Fitbit wear time during prepregnancy and PPD periods (r=-0.05, 95% CI -0.46 to 0.38; P=.84); however, there was a trend, though nonsignificant, in Fitbit wear time consistency among females without PPD (r=0.25, 95% CI -0.02 to 0.49; P=.07). CONCLUSIONS: We hypothesize that increased Fitbit wear time among females with PPD may be attributed to hypervigilance, given the common co-occurrence of anxiety symptoms. Future studies should assess the link between PPD, hypervigilance, and wear time patterns. We envision that wear time patterns of a wearable device combined with digital biomarkers such as sleep and physical activity could enhance early PPD detection using machine learning by alerting clinicians to potential concerns and facilitating timely screenings, which may have implications for other mental health disorders.

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