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Major depressive disorder (MDD) presents challenges in diagnosis and treatment due to its complex and heterogeneous nature. Emerging evidence indicates that reward processing abnormalities may serve as a behavioral marker for MDD. To measure reward processing, patients perform computer-based behavioral tasks that involve making choices or responding to stimulants that are associated with different outcomes. Reinforcement learning (RL) models are fitted to extract parameters that measure various aspects of reward processing to characterize how patients make decisions in behavioral tasks. Recent findings suggest the inadequacy of characterizing reward learning solely based on a single RL model; instead, there may be a switching of decision-making processes between multiple strategies. An important scientific question is how the dynamics of learning strategies in decision-making affect the reward learning ability of individuals with MDD. Motivated by the probabilistic reward task (PRT) within the EMBARC study, we propose a novel RL-HMM framework for analyzing reward-based decision-making. Our model accommodates learning strategy switching between two distinct approaches under a hidden Markov model (HMM): subjects making decisions based on the RL model or opting for random choices. We account for continuous RL state space and allow time-varying transition probabilities in the HMM. We introduce a computationally efficient EM algorithm for parameter estimation and employ a nonparametric bootstrap for inference. We apply our approach to the EMBARC study to show that MDD patients are less engaged in RL compared to the healthy controls, and engagement is associated with brain activities in the negative affect circuitry during an emotional conflict task.

Mental disorders present challenges in diagnosis and treatment due to their complex and heterogeneous nature. Electroencephalogram (EEG) has shown promise as a potential biomarker for these disorders. However, existing methods for analyzing EEG signals have limitations in addressing heterogeneity and capturing complex brain activity patterns between regions. This paper proposes a novel random effects state-space model (RESSM) for analyzing large-scale multi-channel resting-state EEG signals, accounting for the heterogeneity of brain connectivities between groups and individual subjects. We incorporate multi-level random effects for temporal dynamical and spatial mapping matrices and address nonstationarity so that the brain connectivity patterns can vary over time. The model is fitted under a Bayesian hierarchical model framework coupled with a Gibbs sampler. Compared to previous mixed-effects state-space models, we directly model high-dimensional random effects matrices without structural constraints and tackle the challenge of identifiability. Through extensive simulation studies, we demonstrate that our approach yields valid estimation and inference. We apply RESSM to a multi-site clinical trial of Major Depressive Disorder (MDD). Our analysis uncovers significant differences in resting-state brain temporal dynamics among MDD patients compared to healthy individuals. In addition, we show the subject-level EEG features derived from RESSM exhibit a superior predictive value for the heterogeneous treatment effect compared to the EEG frequency band power, suggesting the potential of EEG as a valuable biomarker for MDD.

Electroencephalogram (EEG) provides noninvasive measures of brain activity and is found to be valuable for diagnosis of some chronic disorders. Specifically, pre-treatment EEG signals in alpha and theta frequency bands have demonstrated some association with anti-depressant response, which is well-known to have low response rate. We aim to design an integrated pipeline that improves the response rate of major depressive disorder patients by developing an individualized treatment policy guided by the resting state pre-treatment EEG recordings and other treatment effects modifiers. We first design an innovative automatic site-specific EEG preprocessing pipeline to extract features that possess stronger signals compared with raw data. We then estimate the conditional average treatment effect using causal forests, and use a doubly robust technique to improve the efficiency in the estimation of the average treatment effect. We present evidence of heterogeneity in the treatment effect and the modifying power of EEG features as well as a significant average treatment effect, a result that cannot be obtained by conventional methods. Finally, we employ an efficient policy learning algorithm to learn an optimal depth-2 treatment assignment decision tree and compare its performance with Q-Learning and outcome-weighted learning via simulation studies and an application to a large multi-site, double-blind randomized controlled clinical trial, EMBARC.