Pending challenges to e-mental health in the COVID-19 era: Acceptability of a smartphone-based ecological momentary assessment application among patients with schizophrenia spectrum disorders.
Eur Psychiatry 2021. [PMCID:
PMC9470873 DOI:
10.1192/j.eurpsy.2021.920]
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Abstract
Introduction
Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.
Objectives
To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.
Methods
Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.
Results
Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).Multivariable binary logistic regression model on ‘user’ as outcome |
| β | SE | Wald | p | OR | 95% CI |
Age | -0.075 | 0.038 | 3.910 | 0.048 | 0.928 | 0.861-0.999 |
Education level | -0.967 | 1.289 | 0.563 | 0.453 | 0.380 | 0.030-4.755 |
Early adolescence premorbid adjustment | -0.285 | 0.110 | 6.695 | 0.010 | 0.752 | 0.606-0.933 |
Trail Making Test A | -0.030 | 0.025 | 1.488 | 0.222 | 0.970 | 0.924-1.018 |
Trail Making Test B | -0.005 | 0.010 | 0.278 | 0.598 | 0.995 | 0.976-1.014 |
Cognitive Insight | 0.062 | 0.061 | 1.043 | 0.307 | 1.064 | 0.944-1.200 |
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X2=25.296,df=6,p<0.001. Nagelkerke-R2=44.7%. Correctly classified: 76.9%, users:54.5%, non-users:88.4%.
Conclusions
Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.
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