Accepted for/Published in: JMIR Mental Health
Date Submitted: Nov 5, 2019
Date Accepted: Dec 13, 2019
Web-based graphic representation of the life course of mental health: A cross-sectional study across the spectrum of mood, anxiety, eating, and substance use disorders.
ABSTRACT
Background:
Although patient history is essential for informing mental health assessment, diagnosis, and prognosis, there is a dearth of standardized instruments measuring time-dependent factors relevant to psychiatric disorders. Previous research has demonstrated the potential utility of graphical representations termed “life charts” for depicting the complexity of the course of mental illness. However, the implementation of these assessments is limited by the exclusive focus on specific mental illnesses (i.e., bipolar disorder) and the lack of intuitive graphical interfaces for data collection and visualization.
Objective:
This study aimed to develop and test the utility of the Tulsa Life Chart (TLC) as a web-based, structured approach for obtaining and graphically representing historical information on psychosocial and mental health events relevant across a spectrum of psychiatric disorders.
Methods:
The TLC interview was completed at baseline by 499 participants of the Tulsa 1000, a longitudinal study of individuals with depression, anxiety, substance use, and/or eating disorders, and healthy comparisons. All data were entered electronically and a one-page, electronic and interactive graphical representation was developed using the Google Visualization Application Programming Interface. For eight distinct life epochs, the TLC assessed the following: school attendance, hobbies, jobs, social support, substance use, mental health treatment, family structure changes, negative and positive events, and epoch and event-related mood ratings. We used general linear mixed models (GLMMs) to evaluate trajectories of each domain over time and by sex, age, and diagnosis, using case examples and web-based interactive graphs to visualize data.
Results:
GLMM analyses revealed epoch and/or diagnosis effects for all domains. Epoch by diagnosis interactions were identified for mood ratings and number of negative-versus-positive events (Ps < .001), with all psychiatric groups reporting worse mood and greater negative-versus-positive events than healthy comparisons. These differences were most robust at different epochs depending on diagnosis. There were also diagnosis and epoch main effects for substance use, mental health treatment received, social support, and hobbies (P < .001). User experience ratings (each on a 1-5 scale) revealed that participants found the TLC pleasant to complete (M = 3.07, SD = 1.26), useful for understanding their mental health (M = 3.07, SD = 1.26), and that they were likely to recommend it to others (M = 3.42, SD = 0.85).
Conclusions:
The TLC provides a structured, web-based transdiagnostic assessment of psychosocial history relevant for the diagnosis and treatment of psychiatric disorders. Interactive, one-page graphical representations of the TLC allow for the efficient communication of historical life information that would be useful for clinicians, patients, and family members. Clinical Trial: ClinicalTrials.gov # NCT02450240
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.