{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:39:36Z","timestamp":1791923976109,"version":"4.3.4"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n Importance<\/jats:title>\n Given its recurrent nature and burden, major depressive disorder (MDD) warrants reliable methods of relapse prediction.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether actigraphy-derived parameters, measured over 1 to 2 years, are associated with relapse.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was an observational cohort study with data collection from July 2016 to January 2019. The setting was multicentric. A referred sample of participants from outpatient psychiatric and primary care clinics across Canada were followed up for 1 to 2 years. Participants had a diagnosis of MDD and Montgomery-\u00c5sberg Depression Rating Scale (MADRS) score less than or equal to 14 at baseline.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Actigraphy-derived parameters measured over 1 to 2 years.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n The primary outcome was relapse, defined as any of the following: MADRS score greater than or equal to 22 for 2 consecutive weeks, psychiatric hospitalization, emergence of suicidal intent or behavior, or antidepressant treatment escalation\u2014all adjudicated by an independent panel. Continuous actigraphy data were averaged every 2 weeks.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From a referred sample of 102 adults, 93 participants (mean [SD] age, 39.1 [12.7] years; 58 female [62%]) contributed\u2009approximately 32\u202f000 complete actigraphy days (median, 46 weeks). In Cox models adjusted for age, sex, season, and baseline MADRS score, baseline lower sleep regularity (hazard ratio [HR],\u20090.46; 95% CI, 0.28-0.74;\n P<\/jats:italic>\n \u2009=\u2009.002), lower relative amplitude (RA; HR,\u20090.45; 95% CI, 0.29-0.70;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), lower sleep efficiency (HR,\u20090.57; 95% CI, 0.38-0.85;\n P<\/jats:italic>\n \u2009=\u2009.005), higher wake after sleep onset (HR,\u20091.77; 95% CI, 1.12-2.80;\n P<\/jats:italic>\n \u2009=\u2009.01), and higher nighttime activity (HR,\u20091.86; 95% CI, 1.32-2.62;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) were associated with relapse. In time-varying models, greater composite phase deviation (HR,\u20091.76; 95% CI, 1.04-2.98;\n P<\/jats:italic>\n \u2009=\u2009.04) and lower RA (HR,\u20090.45; 95% CI, 0.21-0.97;\n P<\/jats:italic>\n \u2009=\u2009.046) were associated with relapse, with RA remaining significant even after adjusting for concurrent MADRS scores (HR,\u20090.60; 95% CI, 0.36-0.98;\n P<\/jats:italic>\n \u2009=\u2009.04). Actigraphy significantly differentiated individuals experiencing relapse from those with an ultrastable (MADRS score &amp;lt;14 throughout) and unstable (transient MADRS score, 14-22 without relapse) clinical course.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Actigraphy measures of sleep phase variability and daily activity amplitude were associated with depressive relapse, supporting actigraphy as a potential scalable biomarker to identify high-risk individuals and enable timely, personalized relapse prevention in MDD.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2025.4453","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T16:30:40Z","timestamp":1770827440000},"page":"379","source":"Crossref","is-referenced-by-count":11,"title":["One-Year Actigraphy Study of Sleep and Rest-Activity Rhythms as Markers of Relapse in Depression"],"prefix":"10.1001","volume":"83","author":[{"given":"Andre C.","family":"Tonon","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada"},{"name":"Women\u2019s Health Concerns Clinic, St Joseph\u2019s Healthcare Hamilton, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adile","family":"Nexha","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmyn E. 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