Association of Daily Step Count With Depressive Symptoms in Patients With Major Depressive Disorder Using a...

The benefits of physical activity (PA) for both physical and mental health, including major depressive disorder (MDD), are well established. Mobile devices, such as smartphones, offer a scalable way to monitor PA and its relationship with depressive symptoms in daily life.

This study aimed to investigate the association between passive smartphone-recorded step counts and current depressive symptoms in individuals with and without a lifetime diagnosis of MDD, using a naturalistic bring-your-own-device approach.

We used the Remote Monitoring Application in Psychiatry (ReMAP) to collect passive step count data from participants' personal smartphones. The sample included 181 individuals with a lifetime MDD diagnosis, assessed via the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition; DSM-IV), and 195 healthy controls (HCs). Current depressive symptoms were assessed using the Beck Depression Inventory. PA was operationalized as daily and weekly step counts, passively recorded via smartphone sensors. Hierarchical models were applied to examine the association between PA and depression severity.

Patients with MDD exhibited significantly lower daily step counts (mean 3454, SD 2683) compared to HCs (mean 4699, SD 3175; P<.001) and showed reduced diurnal variability (β=-0.36; P=.003). Higher daily step counts were associated with lower Beck Depression Inventory scores across the full sample (β=-0.06, 95% CI -0.09 to -0.02; P=.002), with similar trends in both MDD and HC groups. Weekly step counts also significantly predicted lower concurrent depressive symptoms (β=-0.29, 95% CI -0.43 to -0.14; P<.001), while patients with MDD displayed less variability in weekly activity levels than HCs (β=-0.75; P=.001).

These findings underscore the potential of mobile devices to be used as effective tools for monitoring PA in patients with MDD, supporting more customized and adaptive approaches to prevention and treatment. They also emphasize the importance of incorporating PA into the clinical management of depression.