Modeling Short-Term Symptom Changes and Behavioral Subtypes of Depression and Anxiety in the General Population: Observational Study Using Smartphone Data (Preprint)

Background: Smartphone-based digital phenotyping has emerged as a promising approach for monitoring mental health using passive behavioral data. Prior studies have linked smartphone-derived features to depression and anxiety severity; however, knowledge regarding whether short-term changes in symptoms can be captured using passive smartphone data in general population samples remains limited, as does the understanding of how such findings should be interpreted vis-à-vis behavioral patterns and demographic variability. Objective: This study aimed to model short-term changes in depression and anxiety severity using passive smartphone data, examine model performance across demographic subgroups, and identify behavioral patterns associated with symptom changes. Methods: We collected 2 weeks of smartphone usage data from 95 adults in the general population and assessed depressive and anxiety symptoms using the clinician-rated Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, respectively. Behavioral features-including physical activity, app use, and screen usage metrics-were extracted and compressed using an autoencoder and principal component analysis. The resulting features-along with age, sex, and baseline Hamilton scores-were used to train random forest classifiers predicting symptom score changes (increase, decrease, or unchanged). Additionally, we examined whether model performance differed across demographic subgroups and whether models excluding baseline scores retained predictive performance, as baseline severity was expected to be a strong predictor. To add explanatory value beyond prediction, behavioral subtypes associated with symptom changes were identified by applying unsupervised clustering. Results: The model exhibited moderate performance in predicting changes in the Hamilton Depression Rating Scale (mean accuracy=0.70, mean area under the receiver operating characteristic curve=0.74) and Hamilton Anxiety Rating Scale (mean accuracy=0.65, mean area under the receiver operating characteristic curve=0.69) scores. Performance varied according to demographics, with reduced accuracy among younger adults and females, although these differences were not significant in permutation tests. Excluding baseline Hamilton scores diminished performance substantially, suggesting that baseline symptom severity accounted for a substantial proportion of the predictive performance. Clustering revealed 4 distinct behavioral subtypes according to smartphone usage patterns. A cluster characterized by structured, daytime-focused smartphone use and lower temporal entropy demonstrated greater improvement in depressive symptoms, whereas clusters with lower and irregular usage patterns exhibited minimal improvement or worsening. Conclusions: Passive smartphone-derived behavioral data demonstrated moderate ability to model short-term symptom changes in this predominantly nonclinical sample. However, a substantial proportion of the predictive performance was attributable to baseline symptom severity, underscoring that passive smartphone data may provide modest supplementary information rather than robust stand-alone predictive value. Nevertheless, clustering analyses indicated that passive data may still assist in identifying behaviorally distinct subtypes associated with different depressive symptom trajectories. These findings reflect a practical contribution to digital phenotyping research by elucidating both the potential and constraints of passive smartphone data for short-term symptom monitoring in small general population samples.

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