Review Activity monitoring in patients with depression: A systematic review Christopher Burton a,n , Brian McKinstry a , Aurora Szentagotai T˘ atar b , Antoni Serrano-Blanco c , Claudia Pagliari a , Maria Wolters a a University of Edinburgh, Centre for Population Health Sciences, Doorway 1, Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK b Babes-Bolyai University, RO-400084, Cluj-Napoca, Romania c Parc Sanitari Sant Joan de De ´u, Barcelona, Spain article info Article history: Received 30 May 2012 Received in revised form 1 July 2012 Accepted 1 July 2012 Available online 4 August 2012 Keywords: Depressive disorder Actigraphy Telemonitoring abstract Background: Altered physical activity is an important feature of depression. It is manifested in psychomotor retardation, agitation and withdrawal from engagement in normal activities. Modern devices for activity monitoring (actigraphs) make it possible to monitor physical activity unobtrusively but the validity of actigraphy as an indicator of mood state is uncertain. We carried out a systematic review of digital actigraphy in patients with depression to investigate the associations between measured physical activity and depression. Methods: Systematic review and meta-analysis. Studies were identified from Medline, EMBASE and Psycinfo databases and included if they were either case control or longitudinal studies of actigraphy in adults aged between 18 and 65 diagnosed with a depressive disorder. Outcomes were daytime and night-time activity and actigraphic measures of sleep. Results: We identified 19 eligible papers from 16 studies (412 patients). Case control studies showed less daytime activity in patients with depression (standardised mean difference  0.76, 95% confidence intervals 1.05 to 0.47). Longitudinal studies showed moderate increase in daytime activity (0.53, 0.20 to 0.87) and a reduction in night-time activity (  0.36, 0.65 to 0.06) over the course of treatment. Limitations: All study participants were unblinded. Only seven papers included patients treated in the community. Conclusions: Actigraphy is a potentially valuable source of additional information about patients with depression. However, there are no clear guidelines for use of actigraphy in studies of patients with depression. Further studies should investigate patients treated in the community. Additional work to develop algorithms for differentiating behaviour patterns is also needed. & 2012 Elsevier B.V. All rights reserved. Contents 1. Introduction ....................................................................................................... 22 2. Methods .......................................................................................................... 22 2.1. Eligibility ................................................................................................... 22 2.2. Search strategy ............................................................................................... 22 2.3. Study selection ............................................................................................... 22 2.4. Choice of outcomes ........................................................................................... 23 2.5. Data analysis ................................................................................................ 23 3. Results ........................................................................................................... 23 3.1. Search results ................................................................................................ 23 3.2. Study characteristics .......................................................................................... 23 3.3. Study design, risk of bias and confounding......................................................................... 23 3.4. Daytime activity .............................................................................................. 25 3.5. Sleep and night-time activity ................................................................................... 25 3.6. Variability ................................................................................................... 25 Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders 0165-0327/$ - see front matter & 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2012.07.001 n Corresponding author. Tel.: þ44 0131 650 9240. E-mail address: chris.burton@ed.ac.uk (C. Burton). Journal of Affective Disorders 145 (2013) 21–28