Current State and Future Directions of Technology-Based Ecological Momentary Assessment and Intervention for Major Depressive Disorder: A Systematic Review

Abstract

Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are alternative approaches to retrospective self-reports and face-to-face treatments, and they make it possible to repeatedly assess patients in naturalistic settings and extend psychological support into real life. The increase in smartphone applications and the availability of low-cost wearable biosensors have further improved the potential of EMA and EMI, which, however, have not yet been applied in clinical practice. Here, we conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to explore the state of the art of technology-based EMA and EMI for major depressive disorder (MDD). A total of 33 articles were included (EMA = 26; EMI = 7). First, we provide a detailed analysis of the included studies from technical (sampling methods, duration, prompts), clinical (fields of application, adherence rates, dropouts, intervention effectiveness), and technological (adopted devices) perspectives. Then, we identify the advantages of using information and communications technologies (ICTs) to extend the potential of these approaches to the understanding, assessment, and intervention in depression. Furthermore, we point out the relevant issues that still need to be addressed within this field, and we discuss how EMA and EMI could benefit from the use of sensors and biosensors, along with recent advances in machine learning for affective modelling.

Three Questions to Consider Before Applying Ecological Momentary Interventions (EMI) in Psychiatry

“…The authors argue in favor of EMI's clinical efficacy and feasibility in treating MDD. However, the review only included four different EMI, and only two RCTs on their efficacy (5). Thus, the generalizability of these findings is questionable.…”

“…A recent systematic review of EMI applications for major depressive disorder (MDD) by Colombo et al (5) included seven EMI studies. The authors argue in favor of EMI's clinical efficacy and feasibility in treating MDD.…”

“…Phobias are particularly associated with high cardiovascular activity (38). In combination with self-reports, these and other biomarkers can predict the onset and severity of psychiatric conditions (5,39), and thus should be used to verify therapy outcomes.…”

“…The umbrella term Ecological Momentary Intervention (EMI) labels a group of methods that provide clinical treatment via mobile devices in individuals' daily lives. The development and application of EMI are continuously increasing (1)(2)(3), related to the emergence of smartphone apps and the widespread availability of the internet (4,5). Today, EMI applications are offered as treatment of various different psychological and psychiatric disorders including anxiety disorders, depression, obsessive-compulsive disorders, and posttraumatic stress disorders (2,4,6).…”

The acceptability of real‐time health monitoring among community participants with depression: A systematic review and meta‐analysis of the literature

“…), the use of ESM/EMA in a real‐time environment may provide many data useful for both researchers and clinicians, even in terms of prediction of long‐term depression severity (Peeters, Berkhof, Rottenberg, & Nicolson, 2010). The adoption of EMA by patients with depression has increased the knowledge of the clinical characteristics of depression (mainly in terms of emotion reactivity, cortisol patterns, or daily rumination; Colombo et al, 2019), the impact of treatment on daily life, the residual symptoms in remitted patients, and the clinical features of depression in pediatric populations (aan het Rot, Hogenelst, & Schoevers, 2012).…”