JMIR Publications

ABSTRACT

Background:

Postpartum depression (PPD) is a mood disorder affecting one in seven women after childbirth that is often under-screened and under-detected. 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 (e.g., Fitbit), offer continuous and longitudinal digital phenotyping for mood disorder diagnosis and monitoring, with device wear time being an important yet understudied aspect.

Objective:

The primary aim of this study is to suggest that wearable device wear time may provide additional information about perinatal mental health to facilitate screening and early detection. We propose wearable device wear time may also be valuable to other mental health disorders.

Methods:

Using the All of Us Research Program dataset, we identified women who experienced childbirth with and without PPD using computational phenotyping. We compared the 1) percentage of days and 2) number of hours per day women with and without PPD wore Fitbit devices during pre-pregnancy, pregnancy, postpartum, and PPD periods, determined by electronic health records. Analyses between women 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 pre-pregnancy and PPD time periods in women with and without PPD by calculating the Pearson correlation.

Results:

Our findings showed a strong trend that women in the PPD cohort wore their Fitbits more those without PPD during the postpartum (PPD: mean=72.9%, standard error [SE]=13.8%; non-PPD: mean=58.9%, SE=12.2%, P=.09) and PPD time periods (PPD: mean=70.7%, SE=14.5%; non-PPD: mean=55.6%, SE=12.9%, P=.08). Interestingly, there was no difference in the number of hours per day women in the PPD and non-PPD cohorts wore their Fitbit during the postpartum (PPD: mean=16.5, SE=1.00; non-PPD: mean=17.2, SE=.84, P=.29), or PPD periods (PPD: mean=17.4, SE=.97; non-PPD: mean=17.8, SE=.84, P=.53). Lastly, there was no relationship between the consistency of Fitbit wear time during pre-pregnancy and the consistency during PPD (r=-.05, P=.84); however, there was a strong trend among women without PPD (r=.25, P=.07).

Conclusions:

We hypothesize increased Fitbit wear time among women 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 patterns of wearable device wear time with digital biomarkers like sleep and physical activity could enhance early PPD detection using machine learning by alerting clinicians to potential concerns facilitating timely screenings, which may have implications for other mental health disorders.