Development and Clinical Application of a Novel Autonomic Transient Response-Based Screening System for Major Depressive Disorder Using a Fingertip Photoplethysmographic Sensor

Abstract

Over 350 million people across the world suffer from major depressive disorder (MDD). More than 10% of MDD patients have suicide intent, while it has been reported that more than 40% patients did not consult their doctors for MDD. In order to increase consultation rate of potential MDD patients, we developed a novel MDD screening system which can be used at home without help of health-care professionals. Using a fingertip photoplethysmograph (PPG) sensor as a substitute of electrocardiograph (ECG), the system discriminates MDD patients from healthy subjects using autonomic nerve transient responses induced by a mental task (random number generation) via logistic regression analysis. The nine logistic regression variables are averages of heart rate (HR), high frequency (HF) component of heart rate variability (HRV), and the low frequency (LF)/HF ratio of HRV before, during, and after the mental task. We conducted a clinical test of the proposed system. Participants were 6 MDD patients (4 females and 2 males, aged 23–60 years) from Shizuoka Saiseikai General Hospital psychiatry outpatient unit and 14 healthy volunteers from University of Electro-Communications (6 females and 8 males, aged 21–63 years). The average PPG- and ECG (as a reference)-derived HR, HF and LF/HF were significantly correlated with each other (HR; r = 1.00, p < 0.0001, HF; r = 0.98, p < 0.0001, LF/HF; r = 0.98, p < 0.0001). Leave-one-out cross validation (LOOCV) revealed 83% sensitivity and 93% specificity. The proposed system appears promising for future MDD self-screening at home and are expected to encourage psychiatric visits for potential MDD patients.

Photoplethysmographic Waveform Analysis for Autonomic Reactivity Assessment in Depression

“…In [14], MDD patients showed a reduced high frequency component of the pulse rate variability (PRV) compared to healthy control subjects during a stressful stimuli. Similar results were reported by [15], where HRV indices derived from a PPG signal were studied before, during, and after executing a mental task.…”

Heart Rate Variability (HRV) and Pulse Rate Variability (PRV) for the Assessment of Autonomic Responses

“…One of the main avenues which has been explored widely by researches is extraction of PRV information from PPG signals (Georgiou et al, 2018 ). PRV has been derived from PPG for the analysis of ANS changes under different conditions, such as the presence of mental (Dagdanpurev et al, 2018 ; Can et al, 2019 ) or somatic diseases (Bolea et al, 2017 ; Lan et al, 2018 ), during sleep (Lázaro et al, 2014 ; Garde et al, 2019 ), or for evaluating the effects of pharmacological drugs (Sluyter et al, 2016 ). Nonetheless, although PRV has been treated as a valid surrogate of HRV, their relationship is not entirely clear, and PRV has been found to significantly differ from HRV under certain circumstances (Schäfer and Vagedes, 2013 ).…”

Sex-Specific Differences in Severity of Depressive Symptoms, Heart Rate Variability, and Neurocognitive Profiles of Depressed Young Adults: Exploring Characteristics for Mild Depression

“…Photoplethysmography (PPG) waveforms can easily be recorded from the finger and then digitized to compute reliable estimates of HRV (32). PPG-derived HRV data can provide a user-friendly self-monitoring system for MDD screening (33), and PPG-based methods can be used for short-term estimation of HRV as well as long-term monitoring of patients for diagnostic and prognostic purposes (32). 3.…”