Examining smartphone-assessed executive function metrics and intrinsic resting-state functional connectivity in depression

<title>Abstract</title> Major Depressive Disorder (MDD) is a common and costly mental health condition that is often associated with deficits in executive function. Smartphone applications (“apps”) have emerged as promising methods for assessing mental health-related outcomes in individuals’ daily lives that can detect changes that unfold over time. Although smartphone apps have been used to evaluate executive functioning in individuals with neurological conditions and in other mental health disorders, few studies have examined this in MDD. The present study tested whether smartphone-assessed executive function is (1) impaired in individuals with current MDD (cMDD; n=30) relative to healthy controls (HC; n=43) and (2) related to resting-state functional connectivity within cognitive control-related neural networks. For two weeks, participants completed a set-shifting (Trail Making Test, TMT-B) task on their smartphone. Participants with cMDD had significantly lower TMT accuracy (β=-.24, p=.044) and greater variability in TMT accuracy (β=.25, p=.049) compared to HC. Resting-state analyses revealed that the association between TMT accuracy and connectivity between nodes of the dorsal attention network (bilateral intraparietal sulcus) was greater in HC than cMDD. The results extend previous laboratory-based findings by demonstrating that individuals with cMDD exhibit poorer mean-level smartphone assessed set-shifting performance and greater variability, along with altered set-shifting-related functional connectivity within the dorsal attention network. Smartphone-based assessments may offer a scalable and accessible approach for identifying executive function deficits in individuals with depression, which could potentially be integrated in monitoring treatment effects over time.