The development of precision psychiatry is largely based on multi-module measurements from the molecular, cellular, and behavioral levels, which are integrated to assess neurocognitive performances and clinically observed psychopathology. Nevertheless, quantifying mental activities and functions accurately and continuously has been a major difficulty within this field. This article reviews the latest efforts that utilize mobile apps to collect human–smartphone interaction data and contribute towards digital biomarkers of mental illnesses. The fundamental principles underlying a behavioral analysis with mobile apps were introduced, such as ways to monitor smartphone use under different circumstances and construct long-term patterns and trend changes. Examples were also provided to illustrate the potential applications of mobile apps that gain further insights into traditional research topics in occupational health and sleep medicine. We suggest that, with an optimized study design and analytical approach that accounts for technical challenges and ethical considerations, mobile apps will enhance the systemic understanding of mental illnesses.

The protective effect on self-harm may vary across different antipsychotics. Further studies are needed to replicate the findings.

to indication bias related to a decreased propensity for clinicians to prescribe lithium, with its narrow therapeutic index, to patients at risk for suicide. Randomized clinical trials are considered the most rigorous method by which to control for and to mitigate this limitation. Our findings are consistent with those from a meta-analysis of randomized clinical trials that found no significant effect of lithium on nonfatal deliberate self-harm. 2 Manchia et al expressed concern about the duration of study treatment and about the exclusion of patients with 6 or more previous suicide attempts. The veterans affairs data used for planning this study demonstrated that the reattempt rate declined from 15% in the first year after an attempt to 6% in the second. Lengthening the study was judged to be inefficient and costly. The data also showed that reattempts in veterans increased with the number of previous attempts, plateauing at 25% to 30% for 6 or more, but none of those with multiple previous attempts died from suicide within the next 2 years. These patients were excluded because, for them, the associations between suicidal behavior and risk of death from suicide was attenuated.Manchia et al noted that the participants had complicated clinical presentations with depression and bipolar disorder and mental health or substance use comorbidities, and that a substantial number had decreased adherence with lithium levels below the target range. These characteristics are typical of the real-world patients in the Veterans Health Care System.It may not be possible to infer from this or any study focused on nonfatal suicide-related outcomes whether lithium can prevent deaths from suicide. Given the low rates of deaths from suicide, the sample sizes required would be beyond what is possible for a clinical trial. Given the possibility of indication bias, the answer is unlikely to come from simple naturalistic or epidemiological studies. However, more sophisticated designs (eg, propensity matching 3 ) or meta-analyses of randomized clinical trials may be informative. 2,4 The primary conclusion for our study was that simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events in veterans who are actively being treated for mood disorders and substantial comorbidities. We believe our findings should be considered in planning treatment for realworld patients who have survived an episode of suiciderelated behavior.

IntroductionTreatment-resistant depression (TRD) is one of the primary causes of disability and a major risk for suicide among patients living in the community. However, the suicide risks and care needs for safety among patients with TRD during the community reintegration process appear to be underestimated. This study aimed to investigate the association between community integration and suicide risks among patients with treatment-resistant depression (TRD) with sub-analysis by gender.MethodsPatients diagnosed with major depressive disorder were recruited upon psychiatrists' referral in two general hospitals in northern Taiwan during 2018–2019. The participants who experienced more than two failed treatments of antidepressants with partial remission were defined as TRD. A structured questionnaire was used to collect socio-demographic, suicidality, and psychosocial information.ResultsIn a total of 125 participants, gender difference was identified in certain community integration aspects such as home integration, productivity, and electronic social networking. The male participants appeared to have better involvement in social contact with internet but slightly less video link than women, while women had higher level of home integration in the past month. The participants who performed worse in the social integration and better home-based activity or productivity levels had higher suicide risks including suicide ideation and overall suicide risks.ConclusionsCommunity integration levels of home, social, and productivity were associated with suicidality in terms of overall suicide risk and recent suicide ideation. Facilitation of community integration at home and life arrangements might reduce suicide risks in TRD patients.