Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults

Abstract

As mobile data capture tools for patient-reported outcomes proliferate in clinical research, a key dimension of measure performance is sensitivity to change. This study compared performance of patient-reported measures of mindfulness, depression, and anxiety symptoms using traditional paper-and-pencil forms versus real-time, ambulatory measurement of symptoms via ecological momentary assessment (EMA). Sixty-seven emotionally distressed older adults completed paper-and-pencil measures of mindfulness, depression, and anxiety along with two weeks of identical items reported during ambulatory monitoring via EMA before and after participation in a randomized trial of Mindfulness-Based Stress Reduction (MBSR) or a health education intervention. We calculated effect sizes for these measures across both measurement approaches and estimated the Number-Needed-to-Treat (NNT) in both measurement conditions. Study outcomes greatly differed depending on which measurement method was used. When EMA was used to measure clinical symptoms, older adults who participated in the MBSR intervention had significantly higher mindfulness and significantly lower depression and anxiety than participants in the health education intervention at post-treatment. However, these significant changes in symptoms were not found when outcomes were measured with paper-and-pencil measures. The NNT for mindfulness and depression measures administered through EMA were approximately 25-50% lower than NNTs derived from paper-and-pencil administration. Sensitivity to change in anxiety was similar across administration modes. In conclusion, EMA measures of depression and mindfulness substantially outperformed paper-and-pencil measures with the same items. The additional resources associated with EMA in clinical trials would seem to be offset by its greater sensitivity to detect change in key outcome variables.

Personality Predicts Utilization of Mindfulness-Based Stress Reduction During and Post-Intervention in a Community Sample of Older Adults

“…Second, this study relied on self-reported measures of time spent engaging in home practice of MBSR techniques. Technological advancements, such as ecological momentary assessment, 35 could enable future investigations to track use of these techniques more carefully. Third, although the 60-item Revised NEO Personality Inventory has consistently been found reliable and valid across contexts and cultures, 18 the current study examined only the five broad personality domains.…”

Feasibility and Acceptability of Smartphone Assessment in Older Adults with Cognitive and Emotional Difficulties

“…Depression and anxiety questions were included because participants were selected for this study based on meeting criteria for depression or an anxiety disorder. Depression and anxiety were measured with National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) short form instruments which have been validated in prior research (Cella et al, 2007, 2010; Reeve et al, 2007) and found to have excellent internal consistency when administered via EMA (Moore, Depp, Wetherell, & Lenze, 2016). Mindfulness questions were included because we believed that mindfulness—a construct that emphasizes present moment experience—was particularly well suited for EMA data collection and relevant to the proposed mechanism underlying the RCT.…”

“…Mindfulness questions were included because we believed that mindfulness—a construct that emphasizes present moment experience—was particularly well suited for EMA data collection and relevant to the proposed mechanism underlying the RCT. Mindfulness was measured using items from the Cognitive Affective Mindfulness Scale-Revised (CAMS-R) which has been validated in prior research (Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007) and found to have adequate internal consistency equivalent to that of paper-and-pencil administration (Moore et al, 2016). …”

Older Adults' Perspectives on Clinical Research: A Focus Group and Survey Study

“…This standard scale can be supplemented by patient-reported outcomes, including psychological well-being. Mobile technology in clinical research is increasingly feasible and acceptable to older adults; 34 it can carry out more accurate assessments 35 or even fully mobile clinical trials, 36 but researchers need to be cognizant of security concerns and perceived burden of answering assessments. For any technology-based assessment, Computer Adaptive Testing can reduce the amount of items needed, which reduces burden on participants and potentially individualizes the measure to their specific concerns.…”