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Kivelä LMM, Fiß F, van der Does W, Antypa N. Examination of Acceptability, Feasibility, and Iatrogenic Effects of Ecological Momentary Assessment (EMA) of Suicidal Ideation. Assessment 2024; 31:1292-1308. [PMID: 38098238 PMCID: PMC11292966 DOI: 10.1177/10731911231216053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.
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Affiliation(s)
| | - F. Fiß
- Leiden University, The Netherlands
| | - W. van der Does
- Leiden University, The Netherlands
- Leiden University Treatment and Expertise Centre (LUBEC), The Netherlands
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Lateef TM, Dey D, Leroux A, Cui L, Xiao M, Zipunnikov V, Merikangas KR. Association Between Electronic Diary-Rated Sleep, Mood, Energy, and Stress With Incident Headache in a Community-Based Sample. Neurology 2024; 102:e208102. [PMID: 38266217 DOI: 10.1212/wnl.0000000000208102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to examine the diurnal links between average and changes in average levels of prospectively rated mood, sleep, energy, and stress as predictors of incident headache in a community-based sample. METHODS This observational study included structured clinical diagnostic assessment of both headache syndromes and mental disorders and electronic diaries that were administered 4 times per day for 2 weeks yielding a total of 4,974 assessments. The chief outcomes were incident morning (am) and later-day (pm) headaches. Generalized linear mixed-effects models were used to evaluate the average and lagged values of predictors including subjectively rated mood, anxiety, energy, stress, and sleep quality and objectively measured sleep duration and efficiency on incident am and pm headaches. RESULTS The sample included 477 participants (61% female), aged 7 through 84 years. After adjusting for demographic and clinical covariates and emotional states, incident am headache was associated with lower average (ß = -0.206*; confidence intervals: -0.397 to -0.017) and a decrease in average sleep quality on the prior day (ß = -0.172*; confidence interval: -0.305, -0.039). Average stress and changes in subjective energy levels on the prior day were associated with incident headaches but with different valence for am (decrease) (ß = -0.145* confidence interval: -0.286, -0.005) and pm (increase) (ß = 0.157*; confidence interval: 0.032, 0.281) headache. Mood and anxiety disorders were not significantly associated with incident headache after controlling for history of a diagnosis of migraine. DISCUSSION Both persistent and acute changes in arousal states manifest by subjective sleep quality and energy are salient precursors of incident headaches. Whereas poorer sleep quality and decreased energy on the prior day were associated with incident morning headache, an increase in energy and greater average stress were associated with headache onsets later in the day. Different patterns of predictors of morning and later-day incident headache highlight the role of circadian rhythms in the manifestations of headache. These findings may provide insight into the pathophysiologic processes underlying migraine and inform clinical intervention and prevention. Tracking these systems in real time with mobile technology provides a valuable ancillary tool to traditional clinical assessments.
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Affiliation(s)
- Tarannum M Lateef
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Debangan Dey
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew Leroux
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lihong Cui
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mike Xiao
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Vadim Zipunnikov
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathleen R Merikangas
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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3
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Pieters LE, Deenik J, de Vet S, Delespaul P, van Harten PN. Combining actigraphy and experience sampling to assess physical activity and sleep in patients with psychosis: A feasibility study. Front Psychiatry 2023; 14:1107812. [PMID: 36911128 PMCID: PMC9996223 DOI: 10.3389/fpsyt.2023.1107812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Sleep disorders and reduced physical activity are common in patients with psychosis and can be related to health-related outcomes such as symptomatology and functioning. Mobile health technologies and wearable sensor methods enable continuous and simultaneous monitoring of physical activity, sleep, and symptoms in one's day-to-day environment. Only a few studies have applied simultaneous assessment of these parameters. Therefore, we aimed to examine the feasibility of the simultaneous monitoring of physical activity, sleep, and symptoms and functioning in psychosis. METHODS Thirty three outpatients diagnosed with a schizophrenia or other psychotic disorder used an actigraphy watch and experience sampling method (ESM) smartphone app for 7 consecutive days to monitor physical activity, sleep, symptoms, and functioning. Participants wore the actigraphy watch during day and night and completed multiple short questionnaires (eight daily, one morning, and one evening) on their phone. Hereafter they completed evaluation questionnaires. RESULTS Of the 33 patients (25 male), 32 (97.0%) used the ESM and actigraphy during the instructed timeframe. ESM response was good: 64.0% for the daily, 90.6% for morning, and 82.6% for evening questionnaire(s). Participants were positive about the use of actigraphy and ESM. CONCLUSION The combination of wrist-worn actigraphy and smartphone-based ESM is feasible and acceptable in outpatients with psychosis. These novel methods can help both clinical practice and future research to gain more valid insight into physical activity and sleep as biobehavioral markers linked to psychopathological symptoms and functioning in psychosis. This can be used to investigate relationships between these outcomes and thereby improve individualized treatment and prediction.
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Affiliation(s)
- Lydia E Pieters
- Psychiatric Center GGz Central, Research Department, Amersfoort, Netherlands.,Faculty of Health Medicine and Life Sciences, Department of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Jeroen Deenik
- Psychiatric Center GGz Central, Research Department, Amersfoort, Netherlands.,Faculty of Health Medicine and Life Sciences, Department of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sabine de Vet
- Psychiatric Center GGz Central, Research Department, Amersfoort, Netherlands
| | - Philippe Delespaul
- Faculty of Health Medicine and Life Sciences, Department of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Mondriaan Mental Health Center, Heerlen, Netherlands
| | - Peter N van Harten
- Psychiatric Center GGz Central, Research Department, Amersfoort, Netherlands.,Faculty of Health Medicine and Life Sciences, Department of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
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Winkler CD, Koval P, Phillips LJ, Felmingham KL. Does prediction error during exposure relate to clinical outcomes in cognitive behavior therapy for social anxiety disorder? A study protocol. Front Psychiatry 2022; 13:1000686. [PMID: 37082515 PMCID: PMC10111196 DOI: 10.3389/fpsyt.2022.1000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven't been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.
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Affiliation(s)
- Christopher D. Winkler
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Deakin E, Ng F, Young E, Thorpe N, Newby C, Coupland C, Craven M, Slade M. Design decisions and data completeness for experience sampling methods used in psychosis: systematic review. BMC Psychiatry 2022; 22:669. [PMID: 36307752 PMCID: PMC9617456 DOI: 10.1186/s12888-022-04319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The experience sampling method (ESM) is an intensive longitudinal research method. Participants complete questionnaires at multiple times about their current or very recent state. The design of ESM studies is complex. People with psychosis have been shown to be less adherent to ESM study protocols than the general population. It is not known how to design studies that increase adherence to study protocols. A lack of typology makes it is hard for researchers to decide how to collect data in a way that allows for methodological rigour, quality of reporting, and the ability to synthesise findings. The aims of this systematic review were to characterise the design choices made in ESM studies monitoring the daily lives of people with psychosis, and to synthesise evidence relating the data completeness to different design choices. METHODS A systematic review was conducted of published literature on studies using ESM with people with psychosis. Studies were included if they used digital technology for data collection and reported the completeness of the data set. The constant comparative method was used to identify design decisions, using inductive identification of design decisions with simultaneous comparison of design decisions observed. Weighted regression was used to identify design decisions that predicted data completeness. The review was pre-registered (PROSPERO CRD42019125545). RESULTS Thirty-eight studies were included. A typology of design choices used in ESM studies was developed, which comprised three superordinate categories of design choice: Study context, ESM approach and ESM implementation. Design decisions that predict data completeness include type of ESM protocol used, length of time participants are enrolled in the study, and if there is contact with the research team during data collection. CONCLUSIONS This review identified a range of design decisions used in studies using ESM in the context of psychosis. Design decisions that influence data completeness were identified. Findings will help the design and reporting of future ESM studies. Results are presented with the focus on psychosis, but the findings can be applied across different mental health populations.
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Affiliation(s)
- Emilia Deakin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK. .,Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK. .,Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | - Fiona Ng
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU UK
| | - Emma Young
- grid.439378.20000 0001 1514 761XNottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Naomi Thorpe
- grid.439378.20000 0001 1514 761XNottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Christopher Newby
- grid.4563.40000 0004 1936 8868School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- grid.4563.40000 0004 1936 8868School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Craven
- grid.4563.40000 0004 1936 8868Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK ,grid.4563.40000 0004 1936 8868Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK ,grid.4563.40000 0004 1936 8868Institute of Mental Health, NIHR MindTech MedTech Co-Operative, University of Nottingham, Nottingham, UK
| | - Mike Slade
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU UK ,grid.4563.40000 0004 1936 8868Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK ,grid.465487.cNord University, Postboks 474, 7801 Namsos, Norway
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Moore RC, Parrish EM, Van Patten R, Paolillo E, Filip TF, Bomyea J, Lomas D, Twamley EW, Eyler LT, Depp CA. Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study. J Med Internet Res 2022; 24:e36665. [PMID: 35904876 PMCID: PMC9377465 DOI: 10.2196/36665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/29/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. OBJECTIVE The aim of this study is to develop a Health Insurance Portability and Accountability Act-compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. METHODS A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. RESULTS The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. CONCLUSIONS Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Emma M Parrish
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Ryan Van Patten
- Psychiatry and Human Behavior, Brown University, Providence, RI, United States
- Providence VA Medical Center, Providence, RI, United States
| | - Emily Paolillo
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Tess F Filip
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jessica Bomyea
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Derek Lomas
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
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Kivelä L, van der Does WAJ, Riese H, Antypa N. Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research. Front Digit Health 2022; 4:876595. [PMID: 35601888 PMCID: PMC9120419 DOI: 10.3389/fdgth.2022.876595] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 01/13/2023] Open
Abstract
Suicide and suicide-related behaviors are prevalent yet notoriously difficult to predict. Specifically, short-term predictors and correlates of suicide risk remain largely unknown. Ecological momentary assessment (EMA) may be used to assess how suicidal thoughts and behaviors (STBs) unfold in real-world contexts. We conducted a systematic literature review of EMA studies in suicide research to assess (1) how EMA has been utilized in the study of STBs (i.e., methodology, findings), and (2) the feasibility, validity and safety of EMA in the study of STBs. We identified 45 articles, detailing 23 studies. Studies mainly focused on examining how known longitudinal predictors of suicidal ideation perform within shorter (hourly, daily) time frames. Recent studies have explored the prospects of digital phenotyping of individuals with suicidal ideation. The results indicate that suicidal ideation fluctuates substantially over time (hours, days), and that individuals with higher mean ideation also have more fluctuations. Higher suicidal ideation instability may represent a phenotypic indicator for increased suicide risk. Few studies succeeded in establishing prospective predictors of suicidal ideation beyond prior ideation itself. Some studies show negative affect, hopelessness and burdensomeness to predict increased ideation within-day, and sleep characteristics to impact next-day ideation. The feasibility of EMA is encouraging: agreement to participate in EMA research was moderate to high (median = 77%), and compliance rates similar to those in other clinical samples (median response rate = 70%). More individuals reported suicidal ideation through EMA than traditional (retrospective) self-report measures. Regarding safety, no evidence was found of systematic reactivity of mood or suicidal ideation to repeated assessments of STBs. In conclusion, suicidal ideation can fluctuate substantially over short periods of time, and EMA is a suitable method for capturing these fluctuations. Some specific predictors of subsequent ideation have been identified, but these findings warrant further replication. While repeated EMA assessments do not appear to result in systematic reactivity in STBs, participant burden and safety remains a consideration when studying high-risk populations. Considerations for designing and reporting on EMA studies in suicide research are discussed.
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Affiliation(s)
- Liia Kivelä
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Willem A. J. van der Does
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
- Leiden University Treatment Center LUBEC, Leiden, Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, The Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Universitair Medisch Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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8
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Boemo T, Socastro A, Blanco I, Martin-Garcia O, Pacheco-Romero AM, Rodríguez-Carvajal R, Sanchez-Lopez A. A Novel Experience Sampling Method Tool Integrating Momentary Assessments of Cognitive Biases: Two Compliance, Usability, and Measurement Reactivity Studies. JMIR Form Res 2022; 6:e32537. [PMID: 35343900 PMCID: PMC9002591 DOI: 10.2196/32537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Experience sampling methods (ESMs) are increasingly being used to study ecological emotion dynamics in daily functioning through repeated assessments taken over several days. However, most of these ESM approaches are only based on self-report assessments, and therefore, studies on the ecological trajectories of their underlying mechanisms are scarce (ie, cognitive biases) and require evaluation through experimental tasks. We developed a novel ESM tool that integrates self-report measures of emotion and emotion regulation with a previously validated app-based cognitive task that allows for the assessment of underlying mechanisms during daily functioning. OBJECTIVE The objective of the study is to test this new tool and study its usability and the possible factors related to compliance with it in terms of latency and missing responses. Among the compliance predictors, we considered psychological and time-related variables, as well as usability, measurement reactivity, and participants' satisfaction with the tool. METHODS We conducted 2 extensive ESM studies-study 1 (N=84; a total of 3 assessments per day for 5 days) and study 2 (N=135; a total of 3 assessments per day for 10 days). RESULTS In both studies, participants found the tool highly usable (average usability score >81). By using mixed regression models, we found both common and specific results for the compliance predictors. In both study 1 and study 2, latency was significantly predicted by the day (P<.001 and P=.003, respectively). Participants showed slower responses to the notification as the days of the study progressed. In study 2 but not in study 1, latency was further predicted by individual differences in overload with the use of the app, and missing responses were accounted for by individual differences in stress reactivity to notifications (P=.04). Thus, by using a more extensive design, participants who experienced higher overload during the study were characterized by slower responses to notifications (P=.01), whereas those who experienced higher stress reactivity to the notification system were characterized by higher missing responses. CONCLUSIONS The new tool had high levels of usability. Furthermore, the study of compliance is of enormous importance when implementing novel ESM methods, including app-based cognitive tasks. The main predictors of latency and missing responses found across studies, specifically when using extensive ESM protocols (study 2), are methodology-related variables. Future research that integrates cognitive tasks in ESM designs should take these results into consideration by performing accurate estimations of participants' response rates to facilitate the optimal quality of novel eHealth approaches, as in this study.
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Affiliation(s)
| | | | - Ivan Blanco
- Autonoma University of Madrid, Madrid, Spain
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9
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Krohn H, Guintivano J, Frische R, Steed J, Rackers H, Meltzer-Brody S. App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study. JMIR Form Res 2022; 6:e28081. [PMID: 35319483 PMCID: PMC8987954 DOI: 10.2196/28081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 01/23/2023] Open
Abstract
Background Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic.
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Affiliation(s)
- Holly Krohn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rachel Frische
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jamie Steed
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hannah Rackers
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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10
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Narkhede SM, Luther L, Raugh IM, Knippenberg AR, Esfahlani FZ, Sayama H, Cohen AS, Kirkpatrick B, Strauss GP. Machine Learning Identifies Digital Phenotyping Measures Most Relevant to Negative Symptoms in Psychotic Disorders: Implications for Clinical Trials. Schizophr Bull 2022; 48:425-436. [PMID: 34915570 PMCID: PMC8886590 DOI: 10.1093/schbul/sbab134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Digital phenotyping has been proposed as a novel assessment tool for clinical trials targeting negative symptoms in psychotic disorders (PDs). However, it is unclear which digital phenotyping measurements are most appropriate for this purpose. AIMS Machine learning was used to address this gap in the literature and determine whether: (1) diagnostic status could be classified from digital phenotyping measures relevant to negative symptoms and (2) the 5 negative symptom domains (anhedonia, avolition, asociality, alogia, and blunted affect) were differentially classified by active and passive digital phenotyping variables. METHODS Participants included 52 outpatients with a PD and 55 healthy controls (CN) who completed 6 days of active (ecological momentary assessment surveys) and passive (geolocation, accelerometry) digital phenotyping data along with clinical ratings of negative symptoms. RESULTS Machine learning algorithms classifying the presence of a PD diagnosis yielded 80% accuracy for cross-validation in H2O AutoML and 79% test accuracy in the Recursive Feature Elimination with Cross Validation feature selection model. Models classifying the presence vs absence of clinically significant elevations on each of the 5 negative symptom domains ranged in test accuracy from 73% to 91%. A few active and passive features were highly predictive of all 5 negative symptom domains; however, there were also unique predictors for each domain. CONCLUSIONS These findings suggest that negative symptoms can be modeled from digital phenotyping data recorded in situ. Implications for selecting the most appropriate digital phenotyping variables for use as outcome measures in clinical trials targeting negative symptoms are discussed.
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Affiliation(s)
- Sayli M Narkhede
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | | | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, NY, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada, Reno School of Medicine, Reno, NV, USA
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11
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Klein A, Clucas J, Krishnakumar A, Ghosh SS, Van Auken W, Thonet B, Sabram I, Acuna N, Keshavan A, Rossiter H, Xiao Y, Semenuta S, Badioli A, Konishcheva K, Abraham SA, Alexander LM, Merikangas KR, Swendsen J, Lindner AB, Milham MP. Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study. J Med Internet Res 2021; 23:e22369. [PMID: 34762054 PMCID: PMC8663601 DOI: 10.2196/22369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 01/23/2023] Open
Abstract
Background Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform’s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users’ data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser–based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health–related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population.
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Affiliation(s)
- Arno Klein
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | - Jon Clucas
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Computational Neuroimaging Lab, Child Mind Institute, New York, NY, United States
| | - Anirudh Krishnakumar
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France.,ETH Library Lab, ETH Zurich and Citizen Science Centre, Zurich, Switzerland
| | - Satrajit S Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Cambridge, MA, United States
| | | | - Benjamin Thonet
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France
| | - Ihor Sabram
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | - Nino Acuna
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | - Anisha Keshavan
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Octave Bioscience, Menlo Park, CA, United States
| | - Henry Rossiter
- Computational Engineering, University of Texas at Austin, Austin, TX, United States
| | - Yao Xiao
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States
| | - Sergey Semenuta
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | | | - Kseniia Konishcheva
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France
| | - Sanu Ann Abraham
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Lindsay M Alexander
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States
| | | | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux, EPHE PSL University, Bordeaux, France
| | - Ariel B Lindner
- Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France
| | - Michael P Milham
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States.,Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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12
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Ganzach Y, Bulmash B, Noor M. The effect of serial day on the measurement of positivity and emotional complexity in diary studies. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/ejsp.2809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yoav Ganzach
- Tel Aviv Business Administration Tel Aviv Israel
| | | | - Masi Noor
- Liverpool John Moores University Liverpool John Moores University Tom Reilly building Bryom Street Liverpool Merseyside United Kingdom of Great Britain and Northern Ireland
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13
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Jones SE, Moore RC, Pinkham AE, Depp CA, Granholm E, Harvey PD. A cross-diagnostic study of Adherence to Ecological Momentary Assessment: Comparisons across study length and daily survey frequency find that early adherence is a potent predictor of study-long adherence. ACTA ACUST UNITED AC 2021; 29-30. [PMID: 34541425 DOI: 10.1016/j.pmip.2021.100085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Ecological momentary assessment (EMA) offers a highly valid strategy to assess everyday functioning in people with severe mental illness. Adherence is generally good, but several questions regarding the impact of study length, daily density of sampling, and symptom severity on adherence remain. Methods EMA adherence in two separate studies was examined. One sampled participants with schizophrenia (n=106) and healthy controls (n=76) 7 times per day for 7 days and the other sampled participants with schizophrenia (n=104) and participants with bipolar illness (n=76) 3 times per day for 30 days. Participants were asked where they were, who they were with, what they were doing and how they were feeling in both studies. The impact of rates of very early adherence on eventual adherence was investigated across the samples, and adherence rates were examined for associations with mood state and most common location when answering surveys. Results Median levels of adherence were over 80% across the samples, and the 10th percentile for adherence was approximately 45% of surveys answered. Early adherence predicted study-long adherence quite substantially in every sample. Mood states did not correlate with adherence in the patient samples and being home correlated with adherence in only the bipolar sample. Implications Adherence was quite high and was not correlated with the length of the study or the density of sampling per study day. There was a tendency for bipolar participants who were more commonly away from home to answer fewer surveys but overall adherence for the bipolar patients was quite high. These data suggest that early nonadherence is a potential predictor of eventual nonadherence and study noncompletion.
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Affiliation(s)
- Sara E Jones
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX.,University of Texas Southwestern Medical Center, Dallas TX
| | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center La Jolla, CA
| | - Eric Granholm
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center La Jolla, CA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL.,Bruce W. Carter VA Medical Center, Miami, FL
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14
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Lopez-Morinigo JD, Barrigón ML, Porras-Segovia A, Ruiz-Ruano VG, Escribano Martínez AS, Escobedo-Aedo PJ, Sánchez Alonso S, Mata Iturralde L, Muñoz Lorenzo L, Artés-Rodríguez A, David AS, Baca-García E. Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study. J Med Internet Res 2021; 23:e26548. [PMID: 34309576 PMCID: PMC8367186 DOI: 10.2196/26548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/10/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients’ behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on “being user versus nonuser” (acceptability), which was the main outcome measure. Results Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. Trial Registration ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Departamento de Psiquiatria, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Psiquiatria, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - María Luisa Barrigón
- Departamento de Psiquiatria, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Psiquiatria, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Porras-Segovia
- Departamento de Psiquiatria, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Psiquiatria, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Verónica González Ruiz-Ruano
- Departamento de Psiquiatria, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Psiquiatria, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adela Sánchez Escribano Martínez
- Departamento de Psiquiatria, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Psiquiatria, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | | | - Antonio Artés-Rodríguez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departamento de Teoría de Señal y de la Comunicación, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Evidence-Based Behavior, Leganés, Madrid, Spain
| | - Anthony S David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Enrique Baca-García
- Departamento de Psiquiatria, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Psiquiatria, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departamento de Psiquiatria, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.,Universidad Católica del Maule, Talca, Chile.,Departamento de Psiquiatría, Hospital Universitario Central de Villalba, Madrid, Spain.,Departamento de Psiquiatría, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain.,Université de Nîmes, Nimes, France
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15
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Villain M, Sibon I, Renou P, Poli M, Swendsen J. Depression and routinization following stroke. Rev Neurol (Paris) 2021; 177:964-968. [PMID: 34215428 DOI: 10.1016/j.neurol.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Post-stroke depression is a frequent complication of stroke that has detrimental consequences for quality of life and functional outcomes. Daily life routines may increase feelings of security for some individuals confronted with age-related health concerns, but little information is available concerning their role following stroke. The aim of this investigation was to examine the association of depression and other psychological variables at hospitalization for stroke and behavioral routines and mood symptoms three months later using Ecological Momentary Assessment (EMA). METHODS Forty-four patients with minor ischemic stroke were consecutively enrolled in the study. Stroke severity, handicap, depression and anxiety symptoms were assessed at baseline. EMA data acquired three months later were coded for the repetition of specific activities or behaviors occurring within the same time period across days. RESULTS Higher baseline depression and anxiety symptom severity were significantly associated with increased behavioral routines three months after stroke. The occurrence of routines was associated with a higher level of depressive symptomatology over subsequent hours of the day. CONCLUSION The findings demonstrate a general correlation between baseline psychological vulnerability and routines three months later, but within-day analyses suggest that routines may increase the risk of negative affect in this vulnerable population.
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Affiliation(s)
- M Villain
- Service de médecine physique et réadaptation, Pitié-Salpêtrière, AP-HP, Paris, France; GRC n(o) 24, handicap moteur et cognitif & réadaptation (HaMCRe), Sorbonne université, Paris, France
| | - I Sibon
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France; CHU de Bordeaux, pôle de neurosciences cliniques, hôpital Pellegrin, 33076 Bordeaux, France
| | - P Renou
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France
| | - M Poli
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France
| | - J Swendsen
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France; École pratique des Hautes Études, Paris, France.
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16
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Raugh IM, James SH, Gonzalez CM, Chapman HC, Cohen AS, Kirkpatrick B, Strauss GP. Digital phenotyping adherence, feasibility, and tolerability in outpatients with schizophrenia. J Psychiatr Res 2021; 138:436-443. [PMID: 33964681 PMCID: PMC8192468 DOI: 10.1016/j.jpsychires.2021.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
Digital phenotyping has potential for use as an objective and ecologically valid form of symptom assessment in clinical trials for schizophrenia. However, there are critical methodological factors that must be addressed before digital phenotyping can be used for this purpose. The current study evaluated levels of adherence, feasibility, and tolerability for active (i.e., signal and event contingent ecological momentary assessment surveys) and passive (i.e., geolocation, accelerometry, and ambulatory psychophysiology) digital phenotyping methods recorded from smartphone and smartband devices. Participants included outpatients diagnosed with schizophrenia (SZ: n = 54) and demographically matched healthy controls (CN: n = 55), who completed 6 days of digital phenotyping. Adherence was significantly lower in SZ than CN for active recordings, but not markedly different for passive recordings. Some forms of passive recordings had lower adherence (ambulatory psychophysiology) than others (accelerometry and geolocation). Active digital phenotyping adherence was predicted by higher psychosocial functioning, whereas passive digital phenotyping adherence was predicted by education, positive symptoms, negative symptoms, and psychosocial functioning in people with SZ. Both groups found digital phenotyping methods tolerable and feasibility was supported by low frequency of invalid responding, brief survey completion times, and similar impediments to study completion. Digital phenotyping methods can be completed by individuals with SZ with good adherence, feasibility, and tolerability. Recommendations are provided for using digital phenotyping methods in clinical trials for SZ.
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Affiliation(s)
- Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H. James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | | | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-706-542-0307. Fax: +1-706-542-3275. University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602
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17
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Williams MT, Lewthwaite H, Fraysse F, Gajewska A, Ignatavicius J, Ferrar K. Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e17023. [PMID: 33656451 PMCID: PMC7970161 DOI: 10.2196/17023] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/01/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023] Open
Abstract
Background Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. Objective This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. Methods In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets. Results Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. Conclusions In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Hayley Lewthwaite
- Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC, Canada
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Alexandra Gajewska
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jordan Ignatavicius
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Katia Ferrar
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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18
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Maatoug R, Peiffer-Smadja N, Delval G, Brochu T, Pitrat B, Millet B. Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study. JMIR Form Res 2021; 5:e14179. [PMID: 33625367 PMCID: PMC7946583 DOI: 10.2196/14179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Redwan Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Nathan Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution, UMR 1137, University Paris Diderot, Paris, France
| | - Guillaume Delval
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Térence Brochu
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Benjamin Pitrat
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Bruno Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
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19
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Gass JC, Funderburk JS, Shepardson R, Kosiba JD, Rodriguez L, Maisto SA. The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review. Subst Abus 2021; 42:512-526. [PMID: 33617740 DOI: 10.1080/08897077.2021.1874595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Self-Monitoring (SM), the act of observing ones' own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM's effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use. Method: A literature search was conducted using MEDLINE/PubMed. Results: Out of 2,659 citations, 41 studies with 126 analyses were included. Among analyses from studies rated Moderate (n = 24) or Strong (n = 3) quality, SM was shown to have a helpful effect (e.g., reducing substance use) 29% of the time; to have no effect 63.0% of the time; and to be detrimental in 8.0% of analyses. SM's helpful effects were associated with methodological characteristics including longer monitoring and Phone/IVR and EMA/Computer methodologies compared to Paper/Pencil. SM was more helpful in non-treatment-seekers (35.0% of analyses showed SM to be helpful compared to 25.0% of analyses with treatment-seekers). Conclusions: Results of this study suggest that SM, under certain circumstances, as the potential to be a low-cost, low-risk research and early intervention strategy for substance users.
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Affiliation(s)
- Julie C Gass
- VA Center for Integrated Healthcare, Western New York VA Healthcare System, Buffalo, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Robyn Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Jesse D Kosiba
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Lauren Rodriguez
- VA Center for Integrated Healthcare, Western New York VA Healthcare System, Buffalo, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
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20
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Garrett-Ruffin S, Hindash AC, Kaczkurkin AN, Mears RP, Morales S, Paul K, Pavlov YG, Keil A. Open science in psychophysiology: An overview of challenges and emerging solutions. Int J Psychophysiol 2021; 162:69-78. [PMID: 33556468 DOI: 10.1016/j.ijpsycho.2021.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/25/2022]
Abstract
The present review is the result of a one-day workshop on open science, held at the Annual Meeting of the Society for Psychophysiological Research in Washington, DC, September 2019. The contributors represent psychophysiological researchers at different career stages and from a wide spectrum of institutions. The state of open science in psychophysiology is discussed from different perspectives, highlighting key challenges, potential benefits, and emerging solutions that are intended to facilitate open science practices. Three domains are emphasized: data sharing, preregistration, and multi-site studies. In the context of these broader domains, we present potential implementations of specific open science procedures such as data format harmonization, power analysis, data, presentation code and analysis pipeline sharing, suitable for psychophysiological research. Practical steps are discussed that may be taken to facilitate the adoption of open science practices in psychophysiology. These steps include (1) promoting broad and accessible training in the skills needed to implement open science practices, such as collaborative research and computational reproducibility initiatives, (2) establishing mechanisms that provide practical assistance in sharing of processing pipelines, presentation code, and data in an efficient way, and (3) improving the incentive structure for open science approaches. Throughout the manuscript, we provide references and links to available resources for those interested in adopting open science practices in their research.
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Affiliation(s)
- Sherona Garrett-Ruffin
- Affective Neuroscience and Mental Health Counseling, Bowling Green State University, Bowling Green, OH 43403, USA
| | - Alexandra Cowden Hindash
- VHA Advanced Fellow in Women's Health Research, San Francisco VA Medical Center, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | | | - Ryan P Mears
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD 20742, USA
| | - Katharina Paul
- Department of Differential Psychology and Psychological Assessment, University Hamburg, Von Melle Park 5, 20146 Hamburg, Germany
| | - Yuri G Pavlov
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany; Department of Psychology, Ural Federal University, Ekaterinburg 620000, Russian Federation
| | - Andreas Keil
- Department of Psychology, Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL 32611, USA.
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21
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Rumination, mood, and maladaptive eating behaviors in overweight and healthy populations. Eat Weight Disord 2021; 26:273-285. [PMID: 32072571 PMCID: PMC7895787 DOI: 10.1007/s40519-020-00857-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/24/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The literature suggests that rumination (i.e., repetitive thinking about 1 or more negative concerns that is perceived as difficult to control) is linked to impaired emotional regulation and increases negative affect. Not only individuals suffering from overweight or obesity, but also healthy individuals might use emotional eating as a coping strategy to deal with negative affect caused by rumination. The aim of the present study was to determine the link between rumination and maladaptive eating strategies in participants with normal weight and overweight/obesity using trait and ecological momentary measures. METHOD In Study 1, 88 individuals from overweight/obese (N = 33) and control group (N = 50) filled in a series of questionnaires assessing trait rumination, and eating behaviors. In Study 2 momentary affect, rumination and eating behavior of 26 participants were assessed using ecological momentary assessment (EMA) methodology. RESULTS In Study 1, the moderated mediation model revealed that emotional eating mediates the link between rumination and uncontrolled eating or snacking, but only in healthy participants and not in the participants with overweight. The results of Study 2 suggest that when both momentary rumination and sad mood are entered into the model predicting momentary daily emotional eating, only rumination remains a significant predictor of emotional eating. This relationship is not modified by the fact that the participants are from healthy controls or the overweight/obese group. DISCUSSION Study 1 provided evidence on the differential role of emotional eating in participants with normal weight and with overweight. Study 2 provided initial insights into the role of momentary mood and momentary repetitive thinking in the use of emotional eating in participants' everyday lives. The differences in group effect in trait and EMA measures indicated also the importance of considering the consciousness of using rumination and emotional eating, while studying those processes in individuals with overweight. LEVEL OF EVIDENCE Level III, case-control analytic study.
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22
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Dunster GP, Swendsen J, Merikangas KR. Real-time mobile monitoring of bipolar disorder: a review of evidence and future directions. Neuropsychopharmacology 2021; 46:197-208. [PMID: 32919408 PMCID: PMC7688933 DOI: 10.1038/s41386-020-00830-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
Rapidly accumulating data from mobile assessments are facilitating our ability to track patterns of emotions, behaviors, biologic rhythms, and their contextual influences in real time. These approaches have been widely applied to study the core features, traits, changes in states, and the impact of treatments in bipolar disorder (BD). This paper reviews recent evidence on the application of both passive and active mobile technologies to gain insight into the role of the circadian system and patterns of sleep and motor activity in people with BD. Findings of more than two dozen studies converge in demonstrating a broad range of sleep disturbances, particularly longer duration and variability of sleep patterns, lower average and greater variability of motor activity, and a shift to later peak activity and sleep midpoint, indicative of greater evening orientation among people with BD. The strong associations across the domains tapped by real-time monitoring suggest that future research should shift focus on sleep, physical/motor activity, or circadian patterns to identify common biologic pathways that influence their interrelations. The development of novel data-driven functional analytic tools has enabled the derivation of individualized multilevel dynamic representations of rhythms of multiple homeostatic regulatory systems. These multimodal tools can inform clinical research through identifying heterogeneity of the manifestations of BD and provide more objective indices of treatment response in real-world settings. Collaborative efforts with common protocols for the application of multimodal sensor technology will facilitate our ability to gain deeper insight into mechanisms and multisystem dynamics, as well as environmental, physiologic, and genetic correlates of BD.
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Affiliation(s)
- Gideon P. Dunster
- grid.416868.50000 0004 0464 0574Intramural Research Program, National Institute of Mental Health, Bethesda, MD USA
| | - Joel Swendsen
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, National Center for Scientific Research; EPHE PSL Research University, Bordeaux, France
| | - Kathleen Ries Merikangas
- Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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23
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Jean FAM, Sibon I, Husky M, Couffinhal T, Swendsen J. Feasibility and validity of Ecological Momentary Assessment in patients with acute coronary syndrome. BMC Cardiovasc Disord 2020; 20:499. [PMID: 33246420 PMCID: PMC7694267 DOI: 10.1186/s12872-020-01774-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background In recent years, Ecological Momentary Assessment (EMA) has expanded rapidly in healthcare research but its application specifically to the field of cardiology has been limited. This study presents essential information concerning the feasibility and validity of EMA in patients with acute coronary syndrome. Methods Four months after a first-ever acute coronary syndrome, 47 patients completed EMA five times a day for seven consecutive days concerning their current activities, mood and perceived negativity or positivity of daily events. Results Compliance with the repeated electronic assessments was high, and no evidence was found for time-dependent biases such as fatigue or practice effects. The resulting EMA data were found to have high internal validity, high reliability when considering average scores, and low reliability when considering within-person variance. Conclusions We found evidence for the feasibility and intrinsic validity of EMA in patients with acute coronary syndrome. Research examining daily life experiences, symptoms and therapeutic adherence in this population can be reinforced through the use of mobile technologies.
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Affiliation(s)
- François A M Jean
- Department of Psychiatry, Dr Jean Eric Techer Hospital, Calais, France
| | - Igor Sibon
- Centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | | | - Thierry Couffinhal
- Institut national de la sante et de la recherche medicale (U1034), Bordeaux, France
| | - Joel Swendsen
- Centre national pour la recherche scientifique (INCIA, CNRS 5287), 146 rue Léo Saignat, Bordeaux, France. .,Ecole Pratiques de Hautes Etudes, PSL University, Paris, France.
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24
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Schuster R, Schreyer ML, Kaiser T, Berger T, Klein JP, Moritz S, Laireiter AR, Trutschnig W. Effects of intense assessment on statistical power in randomized controlled trials: Simulation study on depression. Internet Interv 2020; 20:100313. [PMID: 32215257 PMCID: PMC7090342 DOI: 10.1016/j.invent.2020.100313] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/04/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
Smartphone-based devices are increasingly recognized to assess disease symptoms in daily life (e.g. ecological momentary assessment, EMA). Despite this development in digital psychiatry, clinical trials are mainly based on point assessments of psychopathology. This study investigated expectable increases in statistical power by intense assessment in randomized controlled trials (RCTs). A simulation study, based on three scenarios and several empirical data sets, estimated power gains of two- or fivefold pre-post-assessment. For each condition, data sets of various effect sizes were generated, and AN(C)OVAs were applied to the sample of interest (N = 50-N = 200). Power increases ranged from 6% to 92%, with higher gains in more underpowered scenarios and with higher number of repeated assessments. ANCOVA profited from a more precise estimation of the baseline covariate, resulting in additional gains in statistical power. Fivefold pre-post EMA resulted in highest absolute statistical power and clearly outperformed traditional questionnaire assessments. For example, ANCOVA of automatized PHQ-9 questionnaire data resulted in absolute power of 55 (for N = 200 and d = 0.3). Fivefold EMA, however, resulted in power of 88.9. Non-parametric and multi-level analyses resulted in comparable outcomes. Besides providing psychological treatment, digital mental health can help optimizing sensitivity in RCT-based research. Intense assessment appears advisable whenever psychopathology needs to be assessed with high precision at pre- and post-assessment (e.g. small sample sizes, small treatment effects, or when applying optimization problems like machine learning). First empiric studies are promising, but more evidence is needed. Simulations for various effects and a short guide for popular power software are provided for study planning.
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Affiliation(s)
| | | | - Tim Kaiser
- Department of Psychology, University of Salzburg, Austria
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Berne, Switzerland
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Austria
- Faculty of Psychology, University of Vienna, Austria
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25
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Vachon H, Viechtbauer W, Rintala A, Myin-Germeys I. Compliance and Retention With the Experience Sampling Method Over the Continuum of Severe Mental Disorders: Meta-Analysis and Recommendations. J Med Internet Res 2019; 21:e14475. [PMID: 31808748 PMCID: PMC6925392 DOI: 10.2196/14475] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown. Objective The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research. Methods ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses. Results Compliance and retention rates were lower for studies with a higher proportion of male participants (P<.001) and individuals with a psychotic disorder (P<.001). Compliance was positively associated with the use of a fixed sampling scheme (P=.02), higher incentives (P=.03), higher time intervals between successive evaluations (P=.02), and fewer evaluations per day (P=.008), while no significant associations were observed with regard to the mean age of the sample, the study duration, or other design characteristics. Conclusions The findings demonstrate that ESM studies can be carried out in mental health research, but the quality of the data collection depends upon a number of factors related to the design of ESM studies and the samples under study that need to be considered when designing such protocols.
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Affiliation(s)
- Hugo Vachon
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium.,School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Aki Rintala
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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26
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Moore E, Williams A, Bell I, Thomas N. Client experiences of blending a coping-focused therapy for auditory verbal hallucinations with smartphone-based ecological momentary assessment and intervention. Internet Interv 2019; 19:100299. [PMID: 31890641 PMCID: PMC6928322 DOI: 10.1016/j.invent.2019.100299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 01/31/2023] Open
Abstract
This study explored participants' experiences of a novel intervention blending ecological momentary assessment and intervention (EMA/I) digital technologies with four face-to-face therapy sessions to improve coping in people who experience persisting auditory verbal hallucinations (hear voices). A smartphone app was used to deliver prompts to facilitate both self-monitoring and self-management of voices. Analysis of data recorded by the app was also used in-session to develop an idiographic formulation of antecedents of and responses to voice-hearing episodes. Semi-structured interviews were conducted with 12 participants who completed the blended therapy. A thematic approach was used to analyse the data, generating four main themes, with associated subthemes: (1) Therapy experience changed by digital technology; (2) Valuing face-to-face component; (3) Preference for different phases of the digital technology; (4) Not as bothered by voices. Key findings revealed that participants perceived EMA/I technology as helping capture their experience more accurately and communicate this more effectively to the therapist, which, in combination with coping prompts developed in-session, deepened the therapeutic relationship. These findings add to the emerging literature that shows blended therapy can play an important role in the treatment of people with psychosis, and suggest potential of EMA/I as a technology for other clinical populations.
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Affiliation(s)
- Elissa Moore
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Anne Williams
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia,Living with a Disability Research Centre, La Trobe University, Melbourne, Australia
| | - Imogen Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia,Alfred Hospital, Melbourne, Australia,Corresponding author at: Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia.
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27
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Mathersul DC, Ruscio AM. Forecasting the Future, Remembering the Past: Misrepresentations of Daily Emotional Experience in Generalized Anxiety Disorder and Major Depressive Disorder. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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28
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Liu H, Lou VWQ. Developing a smartphone-based ecological momentary assessment protocol to collect biopsychosocial data with community-dwelling late-middle-aged and older adults. Transl Behav Med 2019; 9:711-719. [PMID: 30395340 DOI: 10.1093/tbm/iby096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Although ecological momentary assessment (EMA) has been used in youth and adult populations, very few of the studies provided evidence of the feasibility and utility of smartphone-based EMA protocols to collect biopsychosocial data from aging populations. This study aimed to describe the design and implementation of a smartphone-based EMA protocol, and to evaluate the feasibility and utility of this EMA protocol among community-dwelling late-middle-aged and older Chinese. A sample of 78 community-dwelling Chinese aged between 50 and 70 years was trained to participate in a 1-week EMA data collection, during which each participant carried an Android smartphone loaded with a researcher-developed EMA application and a smartphone-based electrocardiogram (ECG) monitor to provide psychosocial (e.g., daily activities, social interaction, affect) data and ECG recordings six times daily. Adherence was demonstrated with a total response rate of 91.5% of all scheduled assessments (n = 3,822) and a moderately high level of perceived feasibility. Female participants reported higher compliance to the study and rated the overall experience as more pleasant and interesting than male participants. Our study provided the first evidence of the feasibility and utility of smartphone-based EMA protocols among late-middle-aged and older Chinese. Key areas for improvement in future design and implementation of mobile-based EMA include the incorporation of usable technology, adequate and training, and timely assistance.
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Affiliation(s)
- Huiying Liu
- Department of Social Work & Social Administration, University of Hong Kong, Hong Kong, China
| | - Vivian W Q Lou
- Department of Social Work & Social Administration, University of Hong Kong, Hong Kong, China.,Department of Social Work & Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong, China
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29
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Khazanov GK, Ruscio AM, Swendsen J. The "Brightening" Effect: Reactions to Positive Events in the Daily Lives of Individuals With Major Depressive Disorder and Generalized Anxiety Disorder. Behav Ther 2019; 50:270-284. [PMID: 30824245 PMCID: PMC6494459 DOI: 10.1016/j.beth.2018.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/17/2022]
Abstract
Depressed individuals are less reactive than healthy individuals to positive stimuli in the laboratory, but accumulating evidence suggests that they are more emotionally reactive to positive events in their daily lives. The present study probed the boundaries of this curious "mood brightening" effect and investigated its specificity to major depressive disorder (MDD) vis-à-vis generalized anxiety disorder (GAD), its closest boundary condition. We used ecological momentary assessment to measure reactions to positive events over one week in individuals with MDD (n = 38), GAD (n = 36), comorbid MDD-GAD (n = 38), and no psychopathology (n = 33). Depressed individuals responded to positive events with larger changes in affect, cognition, reported withdrawal (but not approach) behavior, and symptoms than healthy controls. More severe depression assessed before the sampling week predicted greater brightening. Altered reactivity to positive events was relatively specific to MDD when compared with GAD, similar to patterns found for other positive emotional processes. The robustness, scope, and relative specificity of the brightening effect highlights the need to resolve conflicting findings across laboratory and non-laboratory studies to advance understanding of altered reactivity in emotional disorders.
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Affiliation(s)
| | - Ayelet Meron Ruscio
- Department of Psychology, University of Pennsylvania, 425 South University Avenue, Philadelphia PA 19104, United States of America
| | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux, 3 Rue Michel Ange, 75016, Paris, France.,Ecole Pratique des Hautes Etudes, La Sorbonne, Les Parios Saint-Jacques, 4-14 Rue Ferrus, 75014, Paris, France
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30
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Breevaart K, Tims M. Crafting social resources on days when you are emotionally exhausted: The role of job insecurity. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2019. [DOI: 10.1111/joop.12261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kimberley Breevaart
- Department of Experimental and Applied Psychology Group Social and Organizational Psychology VU Amsterdam The Netherlands
| | - Maria Tims
- Department of Management and Organization Faculty of Economics and Business Administration VU Amsterdam The Netherlands
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31
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Merikangas KR, Swendsen J, Hickie IB, Cui L, Shou H, Merikangas AK, Zhang J, Lamers F, Crainiceanu C, Volkow ND, Zipunnikov V. Real-time Mobile Monitoring of the Dynamic Associations Among Motor Activity, Energy, Mood, and Sleep in Adults With Bipolar Disorder. JAMA Psychiatry 2019; 76:190-198. [PMID: 30540352 PMCID: PMC6439734 DOI: 10.1001/jamapsychiatry.2018.3546] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Biologic systems involved in the regulation of motor activity are intricately linked with other homeostatic systems such as sleep, feeding behavior, energy, and mood. Mobile monitoring technology (eg, actigraphy and ecological momentary assessment devices) allows the assessment of these multiple systems in real time. However, most clinical studies of mental disorders that use mobile devices have not focused on the dynamic associations between these systems. OBJECTIVES To examine the directional associations among motor activity, energy, mood, and sleep using mobile monitoring in a community-identified sample, and to evaluate whether these within-day associations differ between people with a history of bipolar or other mood disorders and controls without mood disorders. DESIGN, SETTING, AND PARTICIPANTS This study used a nested case-control design of 242 adults, a subsample of a community-based sample of adults. Probands were recruited by mail from the greater Washington, DC, metropolitan area from January 2005 to June 2013. Enrichment of the sample for mood disorders was provided by volunteers or referrals from the National Institutes of Health Clinical Center or by participants in the National Institute of Mental Health Mood and Anxiety Disorders Program. The inclusion criteria were the ability to speak English, availability to participate, and consent to contact at least 2 living first-degree relatives. Data analysis was performed from June 2013 through July 2018. MAIN OUTCOMES AND MEASURES Motor activity and sleep duration data were obtained from minute-to-minute activity counts from an actigraphy device worn on the nondominant wrist for 2 weeks. Mood and energy levels were assessed by subjective analogue ratings on the ecological momentary assessment (using a personal digital assistant) by participants 4 times per day for 2 weeks. RESULTS Of the total 242 participants, 92 (38.1%) were men and 150 (61.9%) were women, with a mean (SD) age of 48 (16.9) years. Among the participants, 54 (22.3%) had bipolar disorder (25 with bipolar I; 29 with bipolar II), 91 (37.6%) had major depressive disorder, and 97 (40.1%) were controls with no history of mood disorders. A unidirectional association was found between motor activity and subjective mood level (β = -0.018, P = .04). Bidirectional associations were observed between motor activity (β = 0.176; P = .03) and subjective energy level (β = 0.027; P = .03) as well as between motor activity (β = -0.027; P = .04) and sleep duration (β = -0.154; P = .04). Greater cross-domain reactivity was observed in bipolar disorder across all outcomes, including motor activity, sleep, mood, and energy. CONCLUSIONS AND RELEVANCE These findings suggest that interventions focused on motor activity and energy may have greater efficacy than current approaches that target depressed mood; both active and passive tracking of multiple regulatory systems are important in designing therapeutic targets.
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Affiliation(s)
- Kathleen Ries Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Joel Swendsen
- University of Bordeaux, National Center for Scientific Research, Bordeaux, France,EPHE PSL Research University, Paris, France
| | - Ian B. Hickie
- Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Haochang Shou
- Department of Biostatistics, University of Pennsylvania, Philadelphia
| | - Alison K. Merikangas
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Femke Lamers
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nora D. Volkow
- National Institute of Drug Abuse, Bethesda, Maryland,Laboratory of Neuroimaging, National Institute of Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Griffin B, Saunders KEA. Smartphones and Wearables as a Method for Understanding Symptom Mechanisms. Front Psychiatry 2019; 10:949. [PMID: 32009990 PMCID: PMC6978281 DOI: 10.3389/fpsyt.2019.00949] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/29/2019] [Indexed: 11/13/2022] Open
Abstract
While psychological treatments have been shown to be effective in treating psychiatric disorders, the mechanism of their therapeutic effect is less well understood. An improved mechanistic understanding of psychiatric disorders and their treatments would enable refinement of existing interventions, and more targeted intervention and the development of new treatments. A major limitation in understanding the mechanism of effect in psychological treatments has been the challenge of capturing what happens outside of the clinical setting. The development of new digital technologies such as smartphones and wearables enables much more inter-session data to be collected. The rapid evolution of smartphones and wearable technologies, combined with the ubiquity of mobile networks means that is possible for patients to provide regular, longitudinal, and high-resolution data. This allows a previously inaccessible and untapped stream of a specific patient's behaviours, moods, activities, and thoughts to be quantified. Monitoring through such technologies may be of therapeutic value, improving self-awareness and promoting mentalization. Smartphones and wearable technologies can also be used to delivered therapies remotely. Digital technologies enable new insights to be gained into the lived experience of mental disorder enabling current treatments to be refined and personalised, as well as generating new targets for future treatment development. In this article we discuss how such technologies are improving our understanding of psychiatric disorder, informing psychological treatments before considering the future potential of such technologies. We will also consider the challenges and ethical concerns of such approaches.
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Affiliation(s)
| | - Kate E A Saunders
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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Bell IH, Fielding-Smith SF, Hayward M, Rossell SL, Lim MH, Farhall J, Thomas N. Smartphone-based ecological momentary assessment and intervention in a blended coping-focused therapy for distressing voices: Development and case illustration. Internet Interv 2018; 14:18-25. [PMID: 30510910 PMCID: PMC6258111 DOI: 10.1016/j.invent.2018.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Common approaches to the psychological treatment of distressing voice hearing experiences, such as cognitive behavioural therapy, aim to promote more adaptive cognitive, emotional and behavioural responses to these experiences. Digital technologies such as smartphones show promise for supporting and enhancing these treatments by linking immediate therapeutic settings to the context of daily life. Two promising technologies include ecological momentary assessment and intervention (EMA/I), which may offer a means of advanced assessment and support in daily life, and inform the tailoring of interventions to suit individual needs. In this study, a highly novel intervention approach was developed involving four face-to-face sessions with a psychologist blended with EMA/I between sessions in order to improve coping with distressing voice hearing experiences. The authors describe the background and development of this approach along-side a single case illustration, which supported feasibility and acceptability. This study details how digital technologies such as EMA/I may be used in future as clinical tools to enhance standard psychological treatments and clinical care of people with persisting and distressing experiences.
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Affiliation(s)
- Imogen H. Bell
- Centre for Mental Health, Swinburne University of Technology, Australia
| | | | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK
- School of Psychology, University of Sussex, UK
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia
- Department of Psychiatry, St. Vincent's Hospital, Australia
| | - Michelle H. Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia
- North Western Mental Health, Melbourne Health, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia
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Janssens KAM, Bos EH, Rosmalen JGM, Wichers MC, Riese H. A qualitative approach to guide choices for designing a diary study. BMC Med Res Methodol 2018; 18:140. [PMID: 30445926 PMCID: PMC6240196 DOI: 10.1186/s12874-018-0579-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Electronic diaries are increasingly used in diverse disciplines to collect momentary data on experienced feelings, cognitions, behavior and social context in real life situations. Choices to be made for an effective and feasible design are however a challenge. Careful and detailed documentation of argumentation of choosing a particular design, as well as general guidelines on how to design such studies are largely lacking in scientific papers. This qualitative study provides a systematic overview of arguments for choosing a specific diary study design (e.g. time frame) in order to optimize future design decisions. Methods During the first data assessment round, 47 researchers experienced in diary research from twelve different countries participated. They gave a description of and arguments for choosing their diary design (i.e., study duration, measurement frequency, random or fixed assessment, momentary or retrospective assessment, allowed delay to respond to the beep). During the second round, 38 participants (81%) rated the importance of the different themes identified during the first assessment round for the different diary design topics. Results The rationales for diary design choices reported during the first round were mostly strongly related to the research question. The rationales were categorized into four overarching themes: nature of the variables, reliability, feasibility, and statistics. During the second round, all overarching themes were considered important for all diary design topics. Conclusions We conclude that no golden standard for the optimal design of a diary study exists since the design depends heavily upon the research question of the study. The findings of the current study are helpful to explicate and guide the specific choices that have to be made when designing a diary study. Electronic supplementary material The online version of this article (10.1186/s12874-018-0579-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin A M Janssens
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. .,Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands.
| | - Elisabeth H Bos
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Judith G M Rosmalen
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marieke C Wichers
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Herrewegh A, Vork L, Eurelings E, Leue C, Kruimel J, van Koeveringe G, Vrijens D. The development of a patient-reported outcome measure for real-time symptom assessment in a population with functional urologic complaints-A focus group study. Neurourol Urodyn 2018; 37:2893-2903. [PMID: 30187953 DOI: 10.1002/nau.23808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022]
Abstract
AIMS In the current diagnostic process for overactive bladder syndrome (OAB), biased retrospective questionnaires are often used. There is a need for a new assessment tool that embraces the heterogeneity of the OAB complex. A momentary assessment tool, the Experience Sampling Method (ESM) is promising, capturing random repetitive measurements during the day in the context of daily life and is capable to measure potential contextual triggers and psychological aspects. A focus group study was set up to evaluate which items should be implemented in a urological ESM. METHODS Focus group interviews were arranged, to assess the suitability and comprehensibility of a newly developed urological patient-reported outcome measurement (PROM), "Uromate." "Uromate" was created based on ESM literature. A multidisciplinary expert meeting was conducted to gain consensus on item relevance. RESULTS The initial ESM questionnaire contained 58 items, but was eventually reduced to 39 items after focus group sessions and expert meeting. Thirty-seven items are repeated questions, including three gender-dependent items. Two items are one-time questions about the use of incontinence material. Additionally, a morning questionnaire was included. Depending on the symptom pattern, a minimum of 26 items and a maximum of 36 items will be repeatedly assessed with "Uromate." CONCLUSION There is a need for a modern assessment tool for OAB which overcomes the limitations of today's retrospective questionnaires. Therefore, a urological ESM tool, the "Uromate," is being developed as a PROM, following the FDA PROM development guidelines, to measure real-time symptoms in the context of daily life.
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Affiliation(s)
- Alexandra Herrewegh
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lisa Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Eline Eurelings
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Carsten Leue
- Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Psychiatry and Medical Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Joanna Kruimel
- Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands
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Effects of anxiety and mood disorders on craving and substance use among patients with substance use disorder: An ecological momentary assessment study. Drug Alcohol Depend 2018; 187:242-248. [PMID: 29684892 DOI: 10.1016/j.drugalcdep.2018.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite recognition of the negative impact of psychiatric comorbidity on addictive disorders, the mechanisms underlying this association remain poorly understood. The present investigation applied mobile technologies to examine the effect of comorbid mood or anxiety disorders on craving intensity and substance use within the natural conditions of daily life. METHODS A total of 159 participants were recruited from a French outpatient addiction clinic and completed two weeks of computerized ambulatory monitoring of daily life experiences using Ecological Momentary Assessment (EMA). Patients described in real-time their emotional states, craving intensity, and substance use. Current mood and/or anxiety disorders were diagnosed according to DSM-IV criteria. The main substances of dependence were alcohol (n = 48), tobacco (n = 43), cannabis (n = 35), or opiates (n = 33). RESULTS Craving intensity strongly predicted substance use reported over subsequent hours of the day both in groups with (OR = 1.13, p = .009, n = 95) and without (OR = 1.20, p = .002, n = 64) current comorbid psychiatric disorders. Current comorbid mood and/or anxiety disorders were associated with higher craving intensity (γ coef = 0.632, SE = 0.254, p = .014) and consequently more frequent substance use (γ coef = 0.162, SE = 0.052, p = .003). A portion of increased substance use associated with current mood and/or anxiety disorders was independent of increases in craving intensity. CONCLUSIONS Attention to craving management is particularly important for patients with substance use disorders and comorbid mood and/or anxiety disorders, but additional interventions are also needed that address other mechanisms through which these disorders lead to an increase in substance use frequency, independently from craving.
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Paolillo EW, Tang B, Depp CA, Rooney AS, Vaida F, Kaufmann CN, Mausbach BT, Moore DJ, Moore RC. Temporal Associations Between Social Activity and Mood, Fatigue, and Pain in Older Adults With HIV: An Ecological Momentary Assessment Study. JMIR Ment Health 2018; 5:e38. [PMID: 29759960 PMCID: PMC5972192 DOI: 10.2196/mental.9802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Social isolation is associated with an increased risk for mental and physical health problems, especially among older persons living with HIV (PLWH). Thus, there is a need to better understand real-time temporal associations between social activity and mood- and health-related factors in this population to inform possible future interventions. OBJECTIVE This study aims to examine real-time relationships between social activity and mood, fatigue, and pain in a sample of older PLWH. METHODS A total of 20 older PLWH, recruited from the University of California, San Diego HIV Neurobehavioral Research Program in 2016, completed smartphone-based ecological momentary assessment (EMA) surveys 5 times per day for 1 week. Participants reported their current social activity (alone vs not alone and number of social interactions) and levels of mood (sadness, happiness, and stress), fatigue, and pain. Mixed-effects regression models were used to analyze concurrent and lagged associations among social activity, mood, fatigue, and pain. RESULTS Participants (mean age 58.8, SD 4.3 years) reported being alone 63% of the time, on average, (SD 31.5%) during waking hours. Being alone was related to lower concurrent happiness (beta=-.300; 95% CI -.525 to -.079; P=.008). In lagged analyses, social activity predicted higher levels of fatigue later in the day (beta=-1.089; 95% CI -1.780 to -0.396; P=.002), and higher pain levels predicted being alone in the morning with a reduced likelihood of being alone as the day progressed (odds ratio 0.945, 95% CI 0.901-0.992; P=.02). CONCLUSIONS The use of EMA elucidated a high rate of time spent alone among older PLWH. Promoting social activity despite the presence of pain or fatigue may improve happiness and psychological well-being in this population.
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Affiliation(s)
- Emily W Paolillo
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States.,The Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Alexandra S Rooney
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Christopher N Kaufmann
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States.,The Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Brent T Mausbach
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
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Verhagen SJW, Hasmi L, Drukker M, van Os J, Delespaul PAEG. Use of the experience sampling method in the context of clinical trials. EVIDENCE-BASED MENTAL HEALTH 2018; 19:86-9. [PMID: 27443678 PMCID: PMC5040762 DOI: 10.1136/ebmental-2016-102418] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022]
Abstract
Objective The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. Methods ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life. It allows the assessment of various constructs (eg, quality of life, psychopathology) and psychological mechanisms (eg, stress-sensitivity, coping). These constructs are difficult to assess using cross-sectional questionnaires. ESM can be applied in treatment monitoring, as an ecological momentary intervention, in clinical trials, or in single case clinical trials. Technological advances (eg, smartphone applications) make its implementation easier. Results Advantages of ESM are highlighted and disadvantages are discussed. Furthermore, the ecological nature of ESM data and its consequences are explored, including the potential pitfalls of ambiguously formulated research questions and the specificities of ESM in statistical analyses. The last section focuses on ESM in relation to clinical trials and discusses its future use in optimising clinical decision-making. Conclusions ESM can be a valuable asset in clinical trial research and should be used more often to study the benefits of treatment in psychiatry and somatic health.
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Affiliation(s)
- Simone J W Verhagen
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - J van Os
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Philippe A E G Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Vachon H, Rintala A, Viechtbauer W, Myin-Germeys I. Data quality and feasibility of the Experience Sampling Method across the spectrum of severe psychiatric disorders: a protocol for a systematic review and meta-analysis. Syst Rev 2018; 7:7. [PMID: 29347967 PMCID: PMC5774093 DOI: 10.1186/s13643-018-0673-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/04/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Due to a number of methodological advantages and theoretical considerations, more and more studies in clinical psychology research employ the Experience Sampling Method (ESM) as a data collection technique. Despite this growing interest, the absence of methodological guidelines related to the use of ESM has resulted in a large heterogeneity of designs while the potential effects of the design itself on the response behavior of the participants remain unknown. The objectives of this systematic review are to investigate the associations between the design characteristics and the data quality and feasibility of studies relying on ESM in severe psychiatric disorders. METHODS We will search for all published studies using ambulatory assessment with patients suffering from major depressive disorder, bipolar disorder, and psychotic disorder or individuals at high risk for these disorders. Electronic database searches will be performed in PubMed and Web of Science with no restriction on the publication date. Two reviewers will independently screen original studies in a title/abstract phase and a full-text phase based on the inclusion criteria. The information related to the design and sample characteristics, data quality, and feasibility will be extracted. We will provide results in terms of a descriptive synthesis, and when applicable, a meta-analysis of the findings will be conducted. DISCUSSION Our results will attempt to highlight how the feasibility and data quality of ambulatory assessment might be related to the methodological characteristics of the study designs in severe psychiatric disorders. We will discuss these associations in different subsamples if sufficient data are available and will examine limitations in the reporting of the methods of ambulatory studies in the current literature. SYSTEMATIC REVIEW REGISTRATION The protocol for this systematic review was registered on PROSPERO (PROSPERO 2017: CRD42017060322 ) and is available in full on the University of York website ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017060322 ).
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Affiliation(s)
- Hugo Vachon
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33 blok I, 3000, Leuven, Belgium.
| | - Aki Rintala
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33 blok I, 3000, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616 (VIJV1), 6200 MD, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33 blok I, 3000, Leuven, Belgium
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Bright CE. Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness. J Am Psychiatr Nurses Assoc 2018; 24:209-222. [PMID: 29457508 DOI: 10.1177/1078390318754986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. OBJECTIVE This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. DESIGN This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. RESULTS Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. CONCLUSION Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.
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Affiliation(s)
- Cordellia E Bright
- 1 Cordellia E. Bright, MHA, BSN, RN, PhD Candidate, Medical University of South Carolina, Charleston, SC, USA
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Depp CA, Moore RC, Perivoliotis D, Granholm E. Technology to assess and support self-management in serious mental illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489457 PMCID: PMC4969704 DOI: 10.31887/dcns.2016.18.2/cdepp] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The functional impairment associated with serious mental illness (SMI) places an immense burden on individuals and society, and disability often persists even after efficacious treatment of psychopathologic symptoms. Traditional methods of measuring functioning have limitations, and numerous obstacles reduce the reach and impact of evidence-based interventions developed to improve functioning in SMI. This review describes the potential of technological innovations for overcoming the challenges involved in both functional assessment and intervention in people with SMI. Ecological momentary assessment (EMA), which involves the repeated sampling of naturalistic behaviors and experiences while individuals carry out their daily lives, has provided a new window through which the determinants of day-to-day function in SMI can be observed. EMA has several advantages over traditional assessment methods and has in recent years evolved to use mobile-based platforms, such as text messaging and smartphone applications, for both assessment and promotion of self-management in people with SMI. We will review promising data regarding the acceptability, adherence, and efficacy of EMA-based mobile technologies; explore ways in which these technologies can extend the reach and impact of evidence-based psychosocial rehabilitative interventions in SMI; and outline future directions for research in this important area.
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Affiliation(s)
- Colin A Depp
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Dimitri Perivoliotis
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Eric Granholm
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
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Husky M, Swendsen J, Ionita A, Jaussent I, Genty C, Courtet P. Predictors of daily life suicidal ideation in adults recently discharged after a serious suicide attempt: A pilot study. Psychiatry Res 2017. [PMID: 28624676 DOI: 10.1016/j.psychres.2017.06.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aims of the study are to examine the predictive role of fluctuations in daily life mood, social contexts, and behavior on subsequent suicidal ideation (SI); and to identify clinical and psychological factors associated with the general frequency of SI in a high-risk sample. The sample comprised 42 adults (73.8% female) hospitalized for a suicide attempt. Immediately following hospital discharge, they used Ecological Momentary Assessment for seven consecutive days, providing repeated measures of SI, environmental, contextual, and behavioral factors. Controlling for prior SI, a number of contextual variables were associated with subsequent SI. Being at home or at work were both associated with an increased probability of SI, while being in the home of close others, or in a festive or leisure environment decreased SI probability. Working, passive leisure and inactivity all increased the likelihood of SI. Being alone increased SI while being with close others significantly reduced this risk. Finally, no overall effect for stressful events was found but negative family events specifically were associated with increased likelihood of SI (γ = 0.448, t = 2.255, df = 29, p < 0.05). The findings provide preliminary results regarding proximal environmental and behavioral factors associated with the occurrence of suicidal ideation in a high-risk sample.
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Affiliation(s)
- Mathilde Husky
- University of Bordeaux, Laboratoire de Psychologie EA4139, Institut Universitaire de France, Bordeaux, France.
| | - Joel Swendsen
- University of Bordeaux, PSL Research University, EPHE, CNRS, UMR 5287 INCIA, F-33076 Bordeaux, France
| | - Adela Ionita
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier F-34093, France; University of Montpellier, Montpellier F-34000, France
| | - Isabelle Jaussent
- University of Montpellier, Montpellier F-34000, France; Inserm, U1061, Montpellier F-34093, France
| | - Catherine Genty
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier F-34093, France; University of Montpellier, Montpellier F-34000, France; Inserm, U1061, Montpellier F-34093, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier F-34093, France; University of Montpellier, Montpellier F-34000, France; Inserm, U1061, Montpellier F-34093, France; Fondamental Foundation, Créteil, France
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Schweitzer P, Husky M, Allard M, Amieva H, Pérès K, Foubert-Samier A, Dartigues JF, Swendsen J. Feasibility and validity of mobile cognitive testing in the investigation of age-related cognitive decline. Int J Methods Psychiatr Res 2017; 26:e1521. [PMID: 27539327 PMCID: PMC6877256 DOI: 10.1002/mpr.1521] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 06/03/2016] [Accepted: 06/20/2016] [Indexed: 11/11/2022] Open
Abstract
Mobile cognitive testing may be used to help characterize subtle deficits at the earliest stages of cognitive decline. Despite growing interest in this approach, comprehensive information concerning its feasibility and validity has been lacking in elderly samples. Over a one-week period, this study applied mobile cognitive tests of semantic memory, episodic memory and executive functioning in a cohort of 114 elderly non-demented community residents. While the study acceptance rate was moderate (66%), the majority of recruited individuals met minimal compliance thresholds and responded to an average of 82% of the repeated daily assessments. Missing data did not increase over the course of the study, but practice effects were observed for several test scores. However, even when controlling for practice effects, traditional neuropsychological tests were significantly associated with mobile cognitive test scores. In particular, the Isaacs Set Test was associated with mobile assessments of semantic memory (γ = 0.084, t = 5.598, p < 0.001), the Grober and Buschke with mobile assessments of episodic memory (γ = 0.069, t = 3.156, p < 0.01, and the Weschler symbol coding with mobile assessments of executive functioning (γ = 0.168, t = 4.562, p < 0.001). Mobile cognitive testing in the elderly may provide complementary and potentially more sensitive data relative to traditional neuropsychological assessment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pierre Schweitzer
- University of Bordeaux, Bordeaux, France.,CNRS, INCIA, UMR 5287, Bordeaux, France
| | - Mathilde Husky
- Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Institut Universitaire de France, Boulogne Billancourt, France
| | - Michèle Allard
- University of Bordeaux, Bordeaux, France.,CNRS, INCIA, UMR 5287, Bordeaux, France.,EPHE, Bordeaux, France.,CHU de Bordeaux, France
| | | | - Karine Pérès
- University of Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France
| | - Alexandra Foubert-Samier
- University of Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France.,University Hospital, Memory Consultation, CMRR, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France.,University Hospital, Memory Consultation, CMRR, Bordeaux, France
| | - Joel Swendsen
- University of Bordeaux, Bordeaux, France.,CNRS, INCIA, UMR 5287, Bordeaux, France.,EPHE, Bordeaux, France
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44
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Gloster AT, Miché M, Wersebe H, Mikoteit T, Hoyer J, Imboden C, Bader K, Meyer AH, Hatzinger M, Lieb R. Daily fluctuation of emotions and memories thereof: Design and methods of an experience sampling study of major depression, social phobia, and controls. Int J Methods Psychiatr Res 2017; 26:e1578. [PMID: 28948700 PMCID: PMC6877193 DOI: 10.1002/mpr.1578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/10/2017] [Accepted: 06/28/2017] [Indexed: 12/28/2022] Open
Abstract
Symptom fluctuations and the dynamic contexts provoking these are poorly understood. This deficit is compounded by people's limited ability to accurately report about such dimensions in retrospect. Utilizing the advantages of experience sampling methodology (ESM), this study rigorously describes and tests proximal environmental, neurobiological and psychological factors associated with symptoms and mood states. Participants were assigned to three diagnostic groups: Major Depressive Disorder (MDD; n = 118), Social Phobia (SP; n = 47), or a Control Group without SP or MDD (CG; n = 119). Laboratory assessments included cognitive abilities, memory, constructs, and brain derived neurotrophic factor (BDNF). ESM lasted seven days, with six assessments per day covering symptoms, affect, daily events, social interactions, post-event processing, well-being, etc. Morning cortisol and actigraphy were also assessed during ESM. Thereafter, participants provided subjective retrospective recall estimates of the emotions they reported during ESM. The multi-level data of >10,000 observations will allow for thorough examination of fluctuations of psychopathology and well-being in two highly prevalent disorders. Using two clinical groups and a non-affected control group, the clinical specificity versus generalizability of processes can be directly tested, thus providing stimulating information about the overlap and differences between anxiety and affective disorders. This research informs about the development, fluctuation, and maintaining factors of emotions and symptoms and examines the accuracy with which participants recall these dimensions.
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Affiliation(s)
- Andrew T Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland.,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Marcel Miché
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Hanna Wersebe
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Hospital, Centre for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christian Imboden
- Psychiatric Services, Solothurn, Switzerland.,Psychiatric Services, University of Basel, Basel, Switzerland
| | - Klaus Bader
- Psychiatric Hospital, Centre for Specialized Psychotherapy, University of Basel, Basel, Switzerland
| | - Andrea H Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services, Solothurn, Switzerland.,Psychiatric Services, University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
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45
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Moore RC, Kaufmann CN, Rooney AS, Moore DJ, Eyler LT, Granholm E, Woods SP, Swendsen J, Heaton RK, Scott JC, Depp CA. Feasibility and Acceptability of Ecological Momentary Assessment of Daily Functioning Among Older Adults with HIV. Am J Geriatr Psychiatry 2017; 25:829-840. [PMID: 28065496 PMCID: PMC5453849 DOI: 10.1016/j.jagp.2016.11.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to examine the feasibility, acceptability, and initial validity of using smartphone-based ecological momentary assessment (EMA) to assess daily functioning and other behavioral factors among older HIV+ adults. METHODS Twenty older HIV+ adults (mean age: 59 years) completed laboratory-based neurobehavioral and functional assessments then completed EMA surveys via smartphones five times per day for one week. RESULTS Excellent EMA adherence (86.4%) was found, and participants rated their experience with EMA methods positively. Time-use data indicated participants were spending 74% of their waking-sampled time at home, 63% of their time alone, and 32% of their time engaged in passive leisure activities (e.g., watching TV). Better neurocognitive and functional capacity abilities were correlated with less time spent in passive leisure activities. Lastly, mood and cognitive symptom data collected via EMA were significantly associated with scores from laboratory-based assessments of these same constructs. CONCLUSIONS EMA via smartphones is a feasible and acceptable data collection method among older HIV+ adults and appears to be a promising mobile tool to assess daily functioning behaviors in HIV. These preliminary findings indicate older HIV+ adults are spending a considerable amount of time at home, alone, and engaged in passive leisure activities, primarily watching TV. EMA may contribute to future research examining functional disability among the growing population of older HIV+ adults.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA; the Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA.
| | - Christopher N Kaufmann
- Department of Psychiatry, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA; the Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Alexandra S Rooney
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA; the Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA
| | - Steven Paul Woods
- Department of Psychiatry, University of California San Diego, La Jolla, CA; Department of Psychology, University of Houston, Houston, TX
| | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux, EPHE, Bordeaux, France
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - J C Scott
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; VISN4 Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA; the Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
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46
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Vansimaeys C, Zuber M, Pitrat B, Join-Lambert C, Tamazyan R, Farhat W, Bungener C. Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol. Front Psychol 2017; 8:1172. [PMID: 28747895 PMCID: PMC5506189 DOI: 10.3389/fpsyg.2017.01172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022] Open
Abstract
Context: Stroke has several consequences on survivors’ daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients. Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants’ self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures. Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge. Trial registration: European Clinical Trials Database Number 2014-A01937-40
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Affiliation(s)
- Camille Vansimaeys
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Mathieu Zuber
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Benjamin Pitrat
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de ParisParis, France
| | - Claire Join-Lambert
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Ruben Tamazyan
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Wassim Farhat
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Catherine Bungener
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
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47
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Cho H, Gonzalez R, Lavaysse LM, Pence S, Fulford D, Gard DE. Do people with schizophrenia experience more negative emotion and less positive emotion in their daily lives? A meta-analysis of experience sampling studies. Schizophr Res 2017; 183:49-55. [PMID: 27881233 DOI: 10.1016/j.schres.2016.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 01/06/2023]
Abstract
Research on emotion experience in response to valenced stimuli has consistently shown that people with schizophrenia have the capacity to experience emotion. Specifically, people with schizophrenia report similar experiences to both positive and negative emotion-eliciting stimuli as individuals without the disorder. However, it is less clear if people with schizophrenia experience similar levels of positive emotion and negative emotion outside of standardized laboratory contexts, as in their daily lives. One reliable method for assessing emotion experience in schizophrenia has been the Experience Sampling Method (ESM), or Ecological Momentary Assessment (EMA). Using the PRISMA guidelines for meta-analysis, we reviewed the literature for all studies that included people with and without schizophrenia, and that included a positive or negative emotion assessment during participants' daily lives. The current study is a meta-analysis of 12 EMA studies of emotion experience, which included a total of 619 people with schizophrenia and 730 healthy controls. Results indicate that people with schizophrenia consistently report more negative and less positive emotion than healthy control participants. These findings differ from laboratory-based studies, which may be due to several factors, including environmental differences, effects of the disorder that appear more clearly in daily life, or additional concerns, such as depression, which has been shown to be related to negative emotion in schizophrenia. Importantly, these findings are in line with questionnaire-based measures of emotion experience, lending some support for their use in research and clinical settings.
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Affiliation(s)
- Hyein Cho
- Department of Psychology, San Francisco State University, San Francisco, CA, USA
| | - Rachel Gonzalez
- Department of Psychology, San Francisco State University, San Francisco, CA, USA
| | - Lindsey M Lavaysse
- Department of Psychology, San Francisco State University, San Francisco, CA, USA
| | - Sunny Pence
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Daniel Fulford
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - David E Gard
- Department of Psychology, San Francisco State University, San Francisco, CA, USA.
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48
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Ruscio AM, Gentes EL, Jones JD, Hallion LS, Coleman ES, Swendsen J. Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 124:17-26. [PMID: 25688429 DOI: 10.1037/abn0000025] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although studies have documented heightened stress sensitivity in major depressive disorder (MDD) and generalized anxiety disorder (GAD), the mechanisms involved are poorly understood. One possible mechanism is the tendency to ruminate in response to stress. We used ecological momentary assessment to study ruminative thoughts after stressful events in 145 adults with MDD, GAD, comorbid MDD-GAD, or no psychopathology. Diagnosed individuals reported more event-related rumination than controls, even after adjusting for event stressfulness. Rumination was equally common in MDD and GAD and was especially severe among comorbid cases. More rumination immediately after the event predicted poorer affect, more maladaptive behavior, and more MDD and GAD symptoms at the next signal, even when pre-event levels of these variables were controlled. Rumination mediated, but did not moderate, the association of stress with affect and with symptoms. Stress-related rumination was more deleterious for diagnosed than healthy individuals, more intense for more severe clinical cases, and more persistent for cases with a greater temperamental vulnerability for emotional disorders. These results implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life.
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Affiliation(s)
| | | | | | | | | | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux
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49
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Eddington KM, Burgin CJ, Silvia PJ, Fallah N, Majestic C, Kwapil TR. The Effects of Psychotherapy for Major Depressive Disorder on Daily Mood and Functioning: A Longitudinal Experience Sampling Study. COGNITIVE THERAPY AND RESEARCH 2016; 41:266-277. [PMID: 28579660 DOI: 10.1007/s10608-016-9816-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Experience sampling methodology (ESM) was used in a randomized controlled trial of short-term therapy to examine changes in daily affect and reactivity to daily event appraisals among depressed patients. Fifty-five depressed adults (mean age 37 years, 80% female) were randomly assigned to one of two therapy conditions. Using an interactive voice response system, participants rated activities and emotional functioning eight times per day for seven days. Thirty-one participants completed treatment and repeated ESM post-treatment. Broad improvements in mood, cognition, and physical functioning were similar across treatment conditions, with the largest improvements for markers of positive affect. Participants demonstrated increased resilience, i.e., diminished reactivity to stressors at post-treatment. Changes in reactivity to positive daily situations were minimal. Findings underscore the utility of ESM in psychotherapy research and the importance of including measures of both positive and negative affect and experiences.
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Affiliation(s)
- Kari M Eddington
- University of North Carolina at Greensboro; Greensboro, North Carolina
| | | | - Paul J Silvia
- University of North Carolina at Greensboro; Greensboro, North Carolina
| | - Niloofar Fallah
- University of North Carolina at Greensboro; Greensboro, North Carolina
| | | | - Thomas R Kwapil
- University of North Carolina at Greensboro; Greensboro, North Carolina
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50
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Bak M, Drukker M, Hasmi L, van Os J. An n=1 Clinical Network Analysis of Symptoms and Treatment in Psychosis. PLoS One 2016; 11:e0162811. [PMID: 27643994 PMCID: PMC5028060 DOI: 10.1371/journal.pone.0162811] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Dynamic relationships between the symptoms of psychosis can be shown in individual networks of psychopathology. In a single patient, data collected with the Experience Sampling Method (ESM-a method to construct intensive time series of experience and context) can be used to study lagged associations between symptoms in relation to illness severity and pharmacological treatment. METHOD The patient completed, over the course of 1 year, for 4 days per week, 10 daily assessments scheduled randomly between 10 minutes and 3 hours apart. Five a priori selected symptoms were analysed: 'hearing voices', 'down', 'relaxed', 'paranoia' and 'loss of control'. Regression analysis was performed including current level of one symptom as the dependent variable and all symptoms at the previous assessment (lag) as the independent variables. Resulting regression coefficients were printed in graphs representing a network of symptoms. Network graphs were generated for different levels of severity: stable, impending relapse and full relapse. RESULTS ESM data showed that symptoms varied intensely from moment to moment. Network representations showed meaningful relations between symptoms, e.g. 'down' and 'paranoia' fuelling each other, and 'paranoia' negatively impacting 'relaxed'. During relapse, symptom levels as well as the level of clustering between symptoms markedly increased, indicating qualitative changes in the network. While 'hearing voices' was the most prominent symptom subjectively, the data suggested that a strategic focus on 'paranoia', as the most central symptom, had the potential to bring about changes affecting the whole network. CONCLUSION Construction of intensive ESM time series in a single patient is feasible and informative, particularly if represented as a network, showing both quantitative and qualitative changes as a function of relapse.
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Affiliation(s)
- Maarten Bak
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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