Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Hilary P. Blumberg


Irregularities in rest and activity patterns are being increasingly recognized to play important roles in symptoms of major mood disorders, such as bipolar disorder (BD) and major depressive disorder (MDD). Passive measures obtained from digital wearable actigraph devices have potential to provide scalable methods sensitive to behavioral and symptom changes that could be informative in identifying worsening and assessing effects of interventions. Use in younger individuals can be particularly helpful for identifying targets for early detection, allowing for potential reduction of disorder progression. Through this investigation, we aimed to assess changes in actigraphic measures of rest and activity patterns and mood disorder symptoms in adolescents and young adults with and at familial risk for a mood disorder receiving a telehealth social rhythm therapy (SRT) that provides individuals strategies to regularize their daily routines. Further, we aimed to assess for any associations between these changes in symptoms and actigraphic measures. Seven adolescents and young adults with and at risk for a mood disorder, ages 14- 29 years, participated in a protocol that included measures of behaviors and clinical symptoms (i.e., social rhythm stability, depressive symptoms, and suicide propensity), actigraphic recording generating measures of daily rest and activity patterns (i.e. interdaily stability [IS] and relative amplitude [RA]), and a 12-week telehealth SRT intervention through the Brain Emotion circuitry targeted Self-Monitoring and Regulation Therapy for daily rhythm regularization (BE-SMART-DR). Daily rhythm stability was assessed using the self-administered Brief Social Rhythm Scale (BSRS), as well as the BSRS items exclusively pertaining to stability of sleep and wake times (BSRS4). Symptoms of depression were assessed by the investigator-rated Hamilton Depression Rating Scale (HAMD), and suicide propensity was assessed using the self- reported Concise Health Risk Tracking Scale (CHRT). Actigraphic recording was done using GENEActiv actigraphy watch-like devices during the first two and last two weeks of BE-SMART-DR. The GGIR RStudio processing package was used to collect data on IS and RA. Changes in symptom and behavioral ratings and actigraphy measures pre- and post-BE-SMART-DR intervention, and associations among these changes were assessed. It was hypothesized that participants would show improvement in social rhythm stability, depression, and suicide propensity, as well as actigraphic measures of IS and RA. Further, it was also hypothesized that improvements in actigraphy measures would be associated with those in behaviors and symptoms. Namely, improvements in RA and IS would be associated with improvement in depression, and improvement in IS would be associated with improvement in BSRS4. Following intervention with BE-SMART-DR, participants showed significant improvements in BSRS (p<0.05), HAMD (p<0.01), and CHRT (p<0.05). There were improvements in BSRS4, IS, and RA over the intervention, but these did not reach statistical significance. While associations did not reach statistical significance in this sample, associations of percent increases in IS and percent decrease in HAMD were of strong (Pearson correlation r = -0.65), and of medium effect size with percent decrease in BSRS4 (Pearson correlation r = -0.34). The findings of this preliminary investigation suggest that telehealth-administered SRT, BE-SMART-DR, can reduce social rhythm irregularities, depressive symptoms, and suicide propensity in adolescents and young adults with and at risk for mood disorders. Actigraphic measures of daily rest and activity pattern stability may provide a way to collect data in a passive and scalable way about pattern regularity that may also reflect improvements in depression. While findings of this study in this modest sample did not reach significance, effect sizes suggest promise in this ongoing investigation.


This is an Open Access Thesis.

Open Access

This Article is Open Access