Validating Lyfas as a reliable mental health screening and monitoring instrument: a step towards mobile health application during COVID-19 Pandemic
Main Article Content
Abstract
COVID-19 has disturbed mental health to a great extent. Lockdowns, re-infections in fully vaccinated people, frequent mutations of the virus, working from home, shutting of school colleges, contradictory information flying in the air, and so on are some serious predisposing factors in deteriorating the mental health. The Indian Govt. has granted the telemedicine model of healthcare in the country. Mobile health (mHealth) adds to it effectively and Lyfas is such a smartphone-based instrument that works using the principle of arterial photoplethysmography and photochromatography. It captures short (120 sec) heart rate variability (HRV) and the allied optical biomarkers that surrogate for the cardiovascular autonomic modulation, which is influenced by mental health issues. The study aims to validate Lyfas optical biomarkers (SD1/SD2, LF/HF, pNN50, and HRVscores) and a set of physical parameters e.g., age, HR, BP – systolic and diastolic, and serum cortisol in addressing the mental health state. A total of RTPCR positive 1130 adults (Male 541, Female 589) within the age group of 27-68 yrs. participated in the study. Till the participants became RTPCR negative (average time of 14 days), the Depression-Anxiety-Stress Screening-21 (DASS-21) and Covid Screening Scale (CSS)-based monitoring is done once daily to note the distress levels, and Lyfas tests are taken thrice daily simultaneously. The average of all scores constructs the experimental data. Internal consistency (Cronbach’s α), normality test (Shapiro Wilkis test), and Spearman’s correlations (ρ) and their respective statistical significance (p<0.05, CI: 95%) are computed. The study concludes that Lyfas biomarkers show strong correlations with that of the DASS-21 and CSS scores. Physical parameters are also corroborative to the result.
Keywords:
COVID-19, Lyfas, Optical biomarkers, Depression Anxiety Stress Scale-21, Stress Scale (CSS), Shapiro Wilkis test, Cronbach’s alpha, Spearman’s correlation, Bland Altman’s reliability assessment
Article Details
How to Cite
CHATTOPADHYAY, Subhagata; DAS, Rupam.
Validating Lyfas as a reliable mental health screening and monitoring instrument: a step towards mobile health application during COVID-19 Pandemic.
Medical Research Archives, [S.l.], v. 10, n. 3, mar. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2704>. Date accessed: 24 dec. 2024.
doi: https://doi.org/10.18103/mra.v10i3.2704.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Chattopadhyay S, Shinha P. Understanding factors impacting covid vaccination in India: A preliminary report. Quantum Journal of Medical and Health Sciences. 2021; 1(3): 18-31.
2. Karayürek F, Çebi AT, Gülses A, Ayna M. The Impact of COVID-19 Vaccination on AnxietyLevels of Turkish Dental Professionals and Their Attitude in Clinical Care: A Cross-Sectional Study. Int J Environ Res Public Health. 2021; 18(19): 10373.
3. Xiao Y, Becerik-Gerber B, Lucas G, Roll SC. Impacts of Working From Home During COVID-19 Pandemic on Physical and Mental Well-Being of Office Workstation Users. J Occup Environ Med. 2021; 63(3): 181–190. doi: 10.1097/JOM.0000000000002097.
4. Cosci F, Guidi J. The Role of Illness Behavior in the COVID-19 Pandemic. Psychother Psychosom. January 2021; 90: 156–159.
5. Ministry of Health and Family Welfare Govt. of India. [Online].; 2020 [cited 2022 January 12. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf.
6. https://www.lyfas.com/. [Online].; 2021 [cited 2021 September 27. Available from: https://www.lyfas.com/.
7. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety & Stress Scales. (2nd Ed.) Sydney: Psychology Foundation; 1995.
8. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson G. Development and initial validation of the COVID Stress Scales.. Journal of Anxiety Disorders. 2020; 72: 102232. https://doi.org/10.1016/j.janxdis.2020.102232.
9. cdsco.gov.in. [Online]. [cited 2021 December 30. Available from: https://cdsco.gov.in/opencms/opencms/en/Clinical-Trial/Ethics-Committee/Ethics-Committee-Registration/.
10. DECLARATION OF HELSINKI Medical Research Involving Human Subjects. [Online]. [cited 2021 December 30. Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/.
11. Saad M, Ray LB, Bradley-Garcia M, Palamarchuk IS, Gholamrezaei A, Douglass A, et al. Autonomic Modulation of Cardiac Activity Across Levels of Sleep Depth in Individuals With Depression and Sleep Complaints. Psychosomatic Medicine. 2020; 82(2): 172-180. doi: 10.1097/PSY.0000000000000766.
12. Chattopadhyay S, Das R. Lyfas, A Smartphone-based Subclinical Depression Tracker. International Journal of Psychiatry Research. 2021; 4(6): 1-9. DOI: 10.33425/2641-4317.1120.
13. Chattopadhyay S, Das R. Comparing Heart Rate Variability with Polar H10 Sensor and Pulse Rate Variability with LYFAS: A Novel Study. Journal of Biomedical Engineering and Technology. 2021; 9(1): 1-9.
14. Solmi M, Radua J, Olivola M, Croce E, Soardo L, de Pablo GS, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. June 2021; 2021: https://doi.org/10.1038/s41380-021-01161-7.
15. WHO. [Online]. [cited 2022 January 07. Available from: https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/gender-and-women-s-mental-health.
16. Wang L, Li N, Heizhati M, Li M, Yang Z, Wang Z, et al. Association of Depression with Uncontrolled Hypertension in Primary Care Setting: A Cross-Sectional Study in Less-Developed Northwest China. International Journal of Hypertension. March 2021; 2021: https://doi.org/10.1155/2021/6652228.
17. Heart Palpitations and Anxiety. [Online].; 2021 [cited 2022 January 07. Available from: https://my.clevelandclinic.org/health/diseases/21677-heart-palpitations-and-anxiety.
18. McNiff S. Cortisol: What It Does And Why It Matters for Mental Health. [Online]. [cited 2022 January 07. Available from: https://www.psycom.net/cortisol.
19. Pizzoli SFM, Marzorati C, Gatti D, Monzani D, Mazzocco K, Pravettoni G. A meta-analysis on heart rate variability biofeedback and depressive symptoms. Scientific Reports. 2021; 11(6650).
20. von Rosenberg W CT, Adjei T, Jaffer U, Goverdovsky V, Mandic DP. Resolving ambiguities in the LF/HF ratio: LF-HF scatter plots for the categorization of mental and physical stress from HRV. Frontiers of Physiology. June 2017; 8: 360.
21. Francis JL, Weinstein AA, Krantz DS, Haigney MC, Stein PK, Stone PH, et al. Association between Symptoms of Depression and Anxiety with Heart Rate Variability in Patients with Implantable Cardioverter Defibrillators. Psychosomatic Medicine. 2009; 71(8): 821–827.
22. Deepa HS, Das R. EVALUATION OF NON-INVASIVE SMARTPHONE BASED DIGITAL BIOMARKER TOOL LYFAS IN DETECTING SLEEP DEFICIENCY AND ITS EFFECTS: A RETROSPECTIVE OBSERVATIONAL STUDY. Indian Journal of Applied Research. 2021; 11(1): 46-47.
23. Spangler DP, Dunn EJ, Aldao A, Feeling NR, Free ML, Gillie BI, et al. Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect. Frontiers of Neuroscience. 2021; 15(612566).
24. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. September 1951; 16: 297–334.
25. Goforth C. University of Virgina Research Data Services+Sciences. Using and Interpreting Cronbach's alpha. November 2015.
26. Chattopadhyay AK, Chattopadhyay S. VIRDOCD: A VIRtual DOCtor to predict dengue fatality. Expert Systems. 2021; e12796.: 1-17. DOI: 10.1111/exsy.12796.
27. Chattopadhyay S, Chattopadhyay AK, Aifantis EC. Predicting Case Fatality of Dengue Epidemic: Statistical Machine Learning Towards a Virtual Doctor. Journal of Nanotechnology in Diagnosis and Treatment. 2021; 7: 10-24.
28. Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples. Biometrika. 1965; 52(3/4): 591-611.
29. Spearman C. The proof and measurement of association between two things. American Journal of Psychology. 1904; 15(1): 72–101. doi:10.2307/1412159. JSTOR 1412159.
30. Shi H, Yang L, Zhao L, Su Z, Mao X, Zhang L, et al. Differences of Heart Rate Variability Between Happiness and Sadness Emotion States: A Pilot Study. Journal of Medical and Biological Engineering. 2017; 37(4): 527-539. DOI: 10.1007/s40846-017-0238-0.
31. Chattopadhyay S. Is oestrogen a 'biological neuroleptic'? Indian Journal of Psychiatry. 2003; 45(4): 205-7.
32. Salavera C, Usán P. Relationship between Social Skills and Happiness: Differences by Gender. Int J Environ Res Public Health. 2021 ; 18(15): 7929. doi: 10.3390/ijerph18157929.
33. Mrad ,IB, Mrad ,MB, Besbes B, Zairi I, Kahla NB, Kamoun S, et al. Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Behcet’s Disease. Int J Gen Med. August 2021; 14: 4877–4886. doi: 10.2147/IJGM.S326549.
34. Martens A, Greenberg J, Allen JJB, Hayes J, Schimel J, Johns M. Self-esteem and autonomic physiology: Self-esteem levels predict cardiac vagal tone. Journal of Research in Personality. 2010; 44(5): 573-584. https://doi.org/10.1016/j.jrp.2010.07.001.
35. Batabyal A, Bhattacharya A, Thaker M, Mukherjee S. A longitudinal study of perceived stress and cortisol responses in an undergraduate student population from India. PloS One. June 2021; 2021: https://doi.org/10.1371/journal.pone.0252579.
36. Spangler DP, Dunn EJ, Aldao A, Feeling AR, Free ML, Gillie BL, et al. Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect. Front. Neurosci. May 2021; 15; https://doi.org/10.3389/fnins.2021.612566.
37. Ioannou S, Morris P, Terry S, Baker M, Gallese V, Reddy V. Sympathy Crying: Insights from Infrared Thermal Imaging on a Female Sample. PloS One. 2016; 11(10): e0162749. https://doi.org/10.1371/journal.pone.0162749.
38. Caswell TA, Bosson J, Vandello JA, Sellers JG. Testosterone and Men's Stress Responses to Gender Threats. Psychology of Men & Masculinity. 2017; 15(1): 4. DOI: 10.1037/a0031394.
39. Kredlow MA, Fenster M, Laurent ES, Ressler KJ, Phelps EA. Prefrontal cortex, amygdala, and threat processing: implications for PTSD. Neuropsychopharmacology. September 2021; 47: 247–259. https://doi.org/10.1038/s41386-021-01155-7.
40. Agarwal R, Kolkhof P, Bakris G, Bauersachs J, Haller H, Wada T, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J.. 2021; 42(2): 152–161. doi: 10.1093/eurheartj/ehaa736.
2. Karayürek F, Çebi AT, Gülses A, Ayna M. The Impact of COVID-19 Vaccination on AnxietyLevels of Turkish Dental Professionals and Their Attitude in Clinical Care: A Cross-Sectional Study. Int J Environ Res Public Health. 2021; 18(19): 10373.
3. Xiao Y, Becerik-Gerber B, Lucas G, Roll SC. Impacts of Working From Home During COVID-19 Pandemic on Physical and Mental Well-Being of Office Workstation Users. J Occup Environ Med. 2021; 63(3): 181–190. doi: 10.1097/JOM.0000000000002097.
4. Cosci F, Guidi J. The Role of Illness Behavior in the COVID-19 Pandemic. Psychother Psychosom. January 2021; 90: 156–159.
5. Ministry of Health and Family Welfare Govt. of India. [Online].; 2020 [cited 2022 January 12. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf.
6. https://www.lyfas.com/. [Online].; 2021 [cited 2021 September 27. Available from: https://www.lyfas.com/.
7. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety & Stress Scales. (2nd Ed.) Sydney: Psychology Foundation; 1995.
8. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson G. Development and initial validation of the COVID Stress Scales.. Journal of Anxiety Disorders. 2020; 72: 102232. https://doi.org/10.1016/j.janxdis.2020.102232.
9. cdsco.gov.in. [Online]. [cited 2021 December 30. Available from: https://cdsco.gov.in/opencms/opencms/en/Clinical-Trial/Ethics-Committee/Ethics-Committee-Registration/.
10. DECLARATION OF HELSINKI Medical Research Involving Human Subjects. [Online]. [cited 2021 December 30. Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/.
11. Saad M, Ray LB, Bradley-Garcia M, Palamarchuk IS, Gholamrezaei A, Douglass A, et al. Autonomic Modulation of Cardiac Activity Across Levels of Sleep Depth in Individuals With Depression and Sleep Complaints. Psychosomatic Medicine. 2020; 82(2): 172-180. doi: 10.1097/PSY.0000000000000766.
12. Chattopadhyay S, Das R. Lyfas, A Smartphone-based Subclinical Depression Tracker. International Journal of Psychiatry Research. 2021; 4(6): 1-9. DOI: 10.33425/2641-4317.1120.
13. Chattopadhyay S, Das R. Comparing Heart Rate Variability with Polar H10 Sensor and Pulse Rate Variability with LYFAS: A Novel Study. Journal of Biomedical Engineering and Technology. 2021; 9(1): 1-9.
14. Solmi M, Radua J, Olivola M, Croce E, Soardo L, de Pablo GS, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. June 2021; 2021: https://doi.org/10.1038/s41380-021-01161-7.
15. WHO. [Online]. [cited 2022 January 07. Available from: https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/gender-and-women-s-mental-health.
16. Wang L, Li N, Heizhati M, Li M, Yang Z, Wang Z, et al. Association of Depression with Uncontrolled Hypertension in Primary Care Setting: A Cross-Sectional Study in Less-Developed Northwest China. International Journal of Hypertension. March 2021; 2021: https://doi.org/10.1155/2021/6652228.
17. Heart Palpitations and Anxiety. [Online].; 2021 [cited 2022 January 07. Available from: https://my.clevelandclinic.org/health/diseases/21677-heart-palpitations-and-anxiety.
18. McNiff S. Cortisol: What It Does And Why It Matters for Mental Health. [Online]. [cited 2022 January 07. Available from: https://www.psycom.net/cortisol.
19. Pizzoli SFM, Marzorati C, Gatti D, Monzani D, Mazzocco K, Pravettoni G. A meta-analysis on heart rate variability biofeedback and depressive symptoms. Scientific Reports. 2021; 11(6650).
20. von Rosenberg W CT, Adjei T, Jaffer U, Goverdovsky V, Mandic DP. Resolving ambiguities in the LF/HF ratio: LF-HF scatter plots for the categorization of mental and physical stress from HRV. Frontiers of Physiology. June 2017; 8: 360.
21. Francis JL, Weinstein AA, Krantz DS, Haigney MC, Stein PK, Stone PH, et al. Association between Symptoms of Depression and Anxiety with Heart Rate Variability in Patients with Implantable Cardioverter Defibrillators. Psychosomatic Medicine. 2009; 71(8): 821–827.
22. Deepa HS, Das R. EVALUATION OF NON-INVASIVE SMARTPHONE BASED DIGITAL BIOMARKER TOOL LYFAS IN DETECTING SLEEP DEFICIENCY AND ITS EFFECTS: A RETROSPECTIVE OBSERVATIONAL STUDY. Indian Journal of Applied Research. 2021; 11(1): 46-47.
23. Spangler DP, Dunn EJ, Aldao A, Feeling NR, Free ML, Gillie BI, et al. Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect. Frontiers of Neuroscience. 2021; 15(612566).
24. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. September 1951; 16: 297–334.
25. Goforth C. University of Virgina Research Data Services+Sciences. Using and Interpreting Cronbach's alpha. November 2015.
26. Chattopadhyay AK, Chattopadhyay S. VIRDOCD: A VIRtual DOCtor to predict dengue fatality. Expert Systems. 2021; e12796.: 1-17. DOI: 10.1111/exsy.12796.
27. Chattopadhyay S, Chattopadhyay AK, Aifantis EC. Predicting Case Fatality of Dengue Epidemic: Statistical Machine Learning Towards a Virtual Doctor. Journal of Nanotechnology in Diagnosis and Treatment. 2021; 7: 10-24.
28. Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples. Biometrika. 1965; 52(3/4): 591-611.
29. Spearman C. The proof and measurement of association between two things. American Journal of Psychology. 1904; 15(1): 72–101. doi:10.2307/1412159. JSTOR 1412159.
30. Shi H, Yang L, Zhao L, Su Z, Mao X, Zhang L, et al. Differences of Heart Rate Variability Between Happiness and Sadness Emotion States: A Pilot Study. Journal of Medical and Biological Engineering. 2017; 37(4): 527-539. DOI: 10.1007/s40846-017-0238-0.
31. Chattopadhyay S. Is oestrogen a 'biological neuroleptic'? Indian Journal of Psychiatry. 2003; 45(4): 205-7.
32. Salavera C, Usán P. Relationship between Social Skills and Happiness: Differences by Gender. Int J Environ Res Public Health. 2021 ; 18(15): 7929. doi: 10.3390/ijerph18157929.
33. Mrad ,IB, Mrad ,MB, Besbes B, Zairi I, Kahla NB, Kamoun S, et al. Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Behcet’s Disease. Int J Gen Med. August 2021; 14: 4877–4886. doi: 10.2147/IJGM.S326549.
34. Martens A, Greenberg J, Allen JJB, Hayes J, Schimel J, Johns M. Self-esteem and autonomic physiology: Self-esteem levels predict cardiac vagal tone. Journal of Research in Personality. 2010; 44(5): 573-584. https://doi.org/10.1016/j.jrp.2010.07.001.
35. Batabyal A, Bhattacharya A, Thaker M, Mukherjee S. A longitudinal study of perceived stress and cortisol responses in an undergraduate student population from India. PloS One. June 2021; 2021: https://doi.org/10.1371/journal.pone.0252579.
36. Spangler DP, Dunn EJ, Aldao A, Feeling AR, Free ML, Gillie BL, et al. Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect. Front. Neurosci. May 2021; 15; https://doi.org/10.3389/fnins.2021.612566.
37. Ioannou S, Morris P, Terry S, Baker M, Gallese V, Reddy V. Sympathy Crying: Insights from Infrared Thermal Imaging on a Female Sample. PloS One. 2016; 11(10): e0162749. https://doi.org/10.1371/journal.pone.0162749.
38. Caswell TA, Bosson J, Vandello JA, Sellers JG. Testosterone and Men's Stress Responses to Gender Threats. Psychology of Men & Masculinity. 2017; 15(1): 4. DOI: 10.1037/a0031394.
39. Kredlow MA, Fenster M, Laurent ES, Ressler KJ, Phelps EA. Prefrontal cortex, amygdala, and threat processing: implications for PTSD. Neuropsychopharmacology. September 2021; 47: 247–259. https://doi.org/10.1038/s41386-021-01155-7.
40. Agarwal R, Kolkhof P, Bakris G, Bauersachs J, Haller H, Wada T, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J.. 2021; 42(2): 152–161. doi: 10.1093/eurheartj/ehaa736.