Sleep, Steps and Screens: Between- and within-person effects of digital markers of daily life behaviors on smartphone-based assessments of cognitive functioning in depression

RADAR-CNS consortium

doi:10.1016/j.nsa.2026.106985

Sleep, Steps and Screens: Between- and within-person effects of digital markers of daily life behaviors on smartphone-based assessments of cognitive functioning in depression

RADAR-CNS consortium

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Cognitive impairment represents a core feature of major depressive disorder (MDD), often persisting after mood symptoms remit and not addressed by usual antidepressant treatments. Despite its relevance, cognition is typically assessed with infrequent tests in clinical settings, overlooking its contextual nature. Smartphones and wearables enable ecologically valid, repeated measurements of cognition and daily life behaviors that may impact it. We examined whether sleep duration, step count, and smartphone screen time are associated with cognitive functioning in MDD.

We conducted secondary analyses of RADAR-MDD, a multicenter study following individuals with recurrent MDD. Cognitive functioning – self-reported and performance-based – was assessed with the THINC-it® app. Sleep duration and step count were measured with Fitbit devices, and screen time with the RADAR-Base app. Cognitive assessments (outcomes) were linked to behavioral measures (predictors) from the day of and the day preceding each assessment. Two-level multilevel models estimated between-person (differences in participant means) and within-person (deviations from participant means) effects. The sample included 502 participants, further subdivided by behavior–cognitive outcome pair.

For performance-based cognitive assessments, positive associations at the between-person level were found for step count (β = 0.104, SE = 0.031, p < 0.001) and screen time (β = 0.075, SE = 0.036, p = 0.038), and sleep duration showed a quadratic negative effect (β = −0.080, SE = 0.018, p < 0.001). No within-person effects were detected. For self-reported cognitive functioning, step count showed positive associations both between (β = 0.161, SE = 0.037, p < 0.001) and within persons (β = 0.027, SE = 0.010, p = 0.005), while screen time was negatively associated within persons (β = −0.033, SE = 0.011, p = 0.002).

Our findings illustrate that smartphones and wearables can collect meaningful daily life data of MDD patients that can be used to support cognitive health. Step count emerges as a promising behavioral target as it is simple to track and is correlated with better cognitive outcomes.

Original language	English
Article number	106985
Pages (from-to)	1-10
Number of pages	10
Journal	Neuroscience Applied
Volume	5
Early online date	14 Feb 2026
DOIs	https://doi.org/10.1016/j.nsa.2026.106985
Publication status	Published - 2026
Externally published	Yes

Funding

This work is funded by Stress in Action and done in collaboration with the RADAR-CNS Consortium. The research project “Stress in Action” ( www.stress-in-action.nl ) is financially supported by the Dutch Research Council and the Dutch Ministry of Education, Culture and Science (NWO gravitation [grant number 024.005.010 ]). The RADAR- CNS project received funding from the “ Innovative Medicines Initiative 2 Joint Undertaking ” [grant agreement number 115902 ]. This Joint Undertaking received support from the European Union' s Horizon 2020 Research and Innovation Program and the EFPIA ( www.imi.europa.eu ). This work was also funded by the Spanish Ministry of Science and Innovation [grant number TED2021-131106 B-I00 ], by the European Social Fund (EU) , and by the Aragón Government (Spain) through BSICoS group [grant number T39_23R ]. The funding bodies have not been involved in the study design, data collection, data analysis, data interpretation, or writing of the report.

Funders	Funder number
European Federation of Pharmaceutical Industries and Associations
BSICoS group
Horizon 2020 Framework Programme
European Social Fund Plus
Ministerie van Onderwijs, Cultuur en Wetenschap
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	024.005.010
Innovative Medicines Initiative	115902
Ministerio de Ciencia e Innovación	TED2021-131106 B-I00
Gobierno de Aragón	T39_23R

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12936773/

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@article{00b6cb1c240a4b7bb558b68b78dc8d11,

title = "Sleep, Steps and Screens: Between- and within-person effects of digital markers of daily life behaviors on smartphone-based assessments of cognitive functioning in depression",

abstract = "Cognitive impairment represents a core feature of major depressive disorder (MDD), often persisting after mood symptoms remit and not addressed by usual antidepressant treatments. Despite its relevance, cognition is typically assessed with infrequent tests in clinical settings, overlooking its contextual nature. Smartphones and wearables enable ecologically valid, repeated measurements of cognition and daily life behaviors that may impact it. We examined whether sleep duration, step count, and smartphone screen time are associated with cognitive functioning in MDD. We conducted secondary analyses of RADAR-MDD, a multicenter study following individuals with recurrent MDD. Cognitive functioning – self-reported and performance-based – was assessed with the THINC-it{\textregistered} app. Sleep duration and step count were measured with Fitbit devices, and screen time with the RADAR-Base app. Cognitive assessments (outcomes) were linked to behavioral measures (predictors) from the day of and the day preceding each assessment. Two-level multilevel models estimated between-person (differences in participant means) and within-person (deviations from participant means) effects. The sample included 502 participants, further subdivided by behavior–cognitive outcome pair. For performance-based cognitive assessments, positive associations at the between-person level were found for step count (β = 0.104, SE = 0.031, p < 0.001) and screen time (β = 0.075, SE = 0.036, p = 0.038), and sleep duration showed a quadratic negative effect (β = −0.080, SE = 0.018, p < 0.001). No within-person effects were detected. For self-reported cognitive functioning, step count showed positive associations both between (β = 0.161, SE = 0.037, p < 0.001) and within persons (β = 0.027, SE = 0.010, p = 0.005), while screen time was negatively associated within persons (β = −0.033, SE = 0.011, p = 0.002). Our findings illustrate that smartphones and wearables can collect meaningful daily life data of MDD patients that can be used to support cognitive health. Step count emerges as a promising behavioral target as it is simple to track and is correlated with better cognitive outcomes.",

author = "Marcos Ross-Adelman and George Aalbers and Faith Matcham and Daniel Leightley and Carolin Oetzmann and Ewan Carr and Sara Siddi and Haro, \{Josep M.\} and Peter Annas and Maria Dalby and Narayan, \{Vaibhav A.\} and Matthew Hotopf and Inez Myin-Germeys and Femke Lamers and Penninx, \{Brenda W.J.H.\} and \{RADAR-CNS consortium\}",

year = "2026",

doi = "10.1016/j.nsa.2026.106985",

language = "English",

volume = "5",

pages = "1--10",

journal = "Neuroscience Applied",

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T2 - Between- and within-person effects of digital markers of daily life behaviors on smartphone-based assessments of cognitive functioning in depression

AU - Ross-Adelman, Marcos

AU - Aalbers, George

AU - Matcham, Faith

AU - Leightley, Daniel

AU - Oetzmann, Carolin

AU - Carr, Ewan

AU - Siddi, Sara

AU - Haro, Josep M.

AU - Annas, Peter

AU - Dalby, Maria

AU - Narayan, Vaibhav A.

AU - Hotopf, Matthew

AU - Myin-Germeys, Inez

AU - Lamers, Femke

AU - Penninx, Brenda W.J.H.

AU - RADAR-CNS consortium

PY - 2026

Y1 - 2026

N2 - Cognitive impairment represents a core feature of major depressive disorder (MDD), often persisting after mood symptoms remit and not addressed by usual antidepressant treatments. Despite its relevance, cognition is typically assessed with infrequent tests in clinical settings, overlooking its contextual nature. Smartphones and wearables enable ecologically valid, repeated measurements of cognition and daily life behaviors that may impact it. We examined whether sleep duration, step count, and smartphone screen time are associated with cognitive functioning in MDD. We conducted secondary analyses of RADAR-MDD, a multicenter study following individuals with recurrent MDD. Cognitive functioning – self-reported and performance-based – was assessed with the THINC-it® app. Sleep duration and step count were measured with Fitbit devices, and screen time with the RADAR-Base app. Cognitive assessments (outcomes) were linked to behavioral measures (predictors) from the day of and the day preceding each assessment. Two-level multilevel models estimated between-person (differences in participant means) and within-person (deviations from participant means) effects. The sample included 502 participants, further subdivided by behavior–cognitive outcome pair. For performance-based cognitive assessments, positive associations at the between-person level were found for step count (β = 0.104, SE = 0.031, p < 0.001) and screen time (β = 0.075, SE = 0.036, p = 0.038), and sleep duration showed a quadratic negative effect (β = −0.080, SE = 0.018, p < 0.001). No within-person effects were detected. For self-reported cognitive functioning, step count showed positive associations both between (β = 0.161, SE = 0.037, p < 0.001) and within persons (β = 0.027, SE = 0.010, p = 0.005), while screen time was negatively associated within persons (β = −0.033, SE = 0.011, p = 0.002). Our findings illustrate that smartphones and wearables can collect meaningful daily life data of MDD patients that can be used to support cognitive health. Step count emerges as a promising behavioral target as it is simple to track and is correlated with better cognitive outcomes.

AB - Cognitive impairment represents a core feature of major depressive disorder (MDD), often persisting after mood symptoms remit and not addressed by usual antidepressant treatments. Despite its relevance, cognition is typically assessed with infrequent tests in clinical settings, overlooking its contextual nature. Smartphones and wearables enable ecologically valid, repeated measurements of cognition and daily life behaviors that may impact it. We examined whether sleep duration, step count, and smartphone screen time are associated with cognitive functioning in MDD. We conducted secondary analyses of RADAR-MDD, a multicenter study following individuals with recurrent MDD. Cognitive functioning – self-reported and performance-based – was assessed with the THINC-it® app. Sleep duration and step count were measured with Fitbit devices, and screen time with the RADAR-Base app. Cognitive assessments (outcomes) were linked to behavioral measures (predictors) from the day of and the day preceding each assessment. Two-level multilevel models estimated between-person (differences in participant means) and within-person (deviations from participant means) effects. The sample included 502 participants, further subdivided by behavior–cognitive outcome pair. For performance-based cognitive assessments, positive associations at the between-person level were found for step count (β = 0.104, SE = 0.031, p < 0.001) and screen time (β = 0.075, SE = 0.036, p = 0.038), and sleep duration showed a quadratic negative effect (β = −0.080, SE = 0.018, p < 0.001). No within-person effects were detected. For self-reported cognitive functioning, step count showed positive associations both between (β = 0.161, SE = 0.037, p < 0.001) and within persons (β = 0.027, SE = 0.010, p = 0.005), while screen time was negatively associated within persons (β = −0.033, SE = 0.011, p = 0.002). Our findings illustrate that smartphones and wearables can collect meaningful daily life data of MDD patients that can be used to support cognitive health. Step count emerges as a promising behavioral target as it is simple to track and is correlated with better cognitive outcomes.

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Sleep, Steps and Screens: Between- and within-person effects of digital markers of daily life behaviors on smartphone-based assessments of cognitive functioning in depression

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