Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study

Abstract

Background Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective The main objective of this study was twofold: (1) to assess patients’ compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients’ data into a user-friendly format. Results Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations.

In Search of Digital Dopamine: How Apps Can Motivate Depressed Patients, a Review and Conceptual Analysis

“…Another important concern is about data security and the fact that people might not be willing to share personal information. Bos et al [ 51 ] therefore recommended that EMAs should be implemented by an interdisciplinary team (patients, clinicians, researchers, technology specialists) since although clinicians and patients recognize that EMA + EMI could be relevant for increasing self-management, they warned against high assessment burden and potential symptom worsening [ 21 ].…”

“…On the other hand, DP involves the analysis of “active” data, which involves the patient in data collection. The use of the Momentary Ecological Assessment (EMA) is the most common and practical method [ 21 ]. The patient can be interviewed regularly to gather clinical information, even automatically at scheduled times of the day or in response to changes in “passive” data.…”

Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers

“…When applied effectively, EMA technology can assist with early symptom recognition, facilitate treatment, and potentially reduce severe maternal morbidity and mortality. Recent studies on mood assessment using smartphone apps with EMA technology have reported substantial compliance with the smartphone apps [13][14][15]. In addition, EMA technology also assists in improving the awareness of patients about their mood fluctuations and their context, which, in turn, can help them manage their symptoms more efficiently and seek care [16].…”