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. 2017 Apr 12;5(4):e44.
doi: 10.2196/mhealth.6544.

Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale

Mor Nahum  1   2 , Thomas M Van Vleet  2 , Vikaas S Sohal  3 , Julie J Mirzabekov  4   5 , Vikram R Rao  6 , Deanna L Wallace  7 , Morgan B Lee  7 , Heather Dawes  7 , Alit Stark-Inbar  2   8 , Joshua Thomas Jordan  9 , Bruno Biagianti  2   3 , Michael Merzenich  2 , Edward F Chang  7
Affiliations

Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale

Mor Nahum et al. JMIR Mhealth Uhealth. .

Abstract

Background: Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options.

Objectives: The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states.

Methods: A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS.

Results: Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS ("IMS-12") with two factors: a "depression" factor and an "anxiety" factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01).

Conclusions: Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans.

Keywords: anxiety; depression; ecological momentary assessment; mobile; mood disorders.

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Conflict of interest statement

Conflicts of Interest: Authors Tom Van Vleet, Bruno Biagianti, and Michael Merzenich are all paid employees of Posit Science, a commercial company which develops the mobile mood tracking app and the IMS in particular. Author Mor Nahum is a paid consultant of Posit Science. None of the other authors have any financial interest in Posit Science.

Figures

Figure 1
Figure 1
Posit Science’s mobile mood tracker app. Left: the app’s intro screen on the iPad. The user clicks on any tile to start the assessment. Right: single example items from PHQ-9, GAD-7, Rumination, and IMS are shown. PHQ-9: patient health questionnaire, 9-item. GAD-7: generalized anxiety disorder, 7-item. IMS: Immediate Mood Scaler.
Figure 2
Figure 2
(A) PHQ-9 (red bars) and GAD-7 (blue bars) score distribution. Since the GAD-7 scale only has 4 categories and PHQ-9 has 5 categories, we have included PHQ-9 scores of moderately severe to severe in the “Mod to Severe” category. (B) PHQ-9 individual score correlation with the GAD-7 scale. (C) Correlation between PHQ-9 (red) and GAD-7 (blue) scales and the rumination scale. (D) Correlation between PHQ-9 (red) and GAD-7 (blue) scores with the full IMS score. PHQ-9: patient health questionnaire, 9-item. GAD-7: generalized anxiety disorder, 7-item. IMS: Immediate Mood Scaler.
Figure 3
Figure 3
Correlations between IMS-12 and standardized scales. Correlations between IMS-12 total (left, gray), IMS-12 depression (middle, red), and IMS-12 anxiety (right, blue) with PHQ-9 (A; top row), GAD-7 (B; middle row), and rumination (C; bottom row) scales. Pearson r values and number of subjects are shown for each graph. PHQ-9: patient health questionnaire, 9-item. GAD-7: generalized anxiety disorder, 7-item. IMS: Immediate Mood Scaler.
Figure 4
Figure 4
Repeated IMS data frequency. IMS data was collected within days and across days for 56 participants. (A) A histogram showing the total number of sessions completed by participants. (B) Number of sessions completed on the same day (multiple sessions for participants). (C) A histogram showing the unique days of IMS assessments completed by participants. (D) Total number of sessions completed as a function of baseline PHQ-9 score (r=.18, P=.18). PHQ-9: patient health questionnaire, 9-item. IMS: Immediate Mood Scaler.
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