Experienced Burden of and Adherence to Smartphone-Based Ecological Momentary Assessment in Persons with Affective Disorders

Abstract

(1) Background: The use of smartphone-based ecological momentary assessment (EMA) questionnaires in affective disorder research has rapidly increased. Though, a thorough understanding of experienced burden of and adherence to EMA is crucial in determining the usefulness of EMA. (2) Methods: Persons with current affective disorders (n = 100), remitted persons (n = 190), and healthy controls (n = 94) participated in a smartphone-based EMA two-week monitoring period. Our primary outcomes were (momentary) perceived burden of and adherence to EMA. (3) Results: In the whole sample, lower positive and higher negative affect were associated with slightly higher levels of perceived momentary burden (B = -0.23 [95%CI = -0.27-0.19], B = 0.30 [95%CI = 0.24-0.37], respectively). The persons with current affective disorders reported slightly higher levels of experienced momentary burden (Mdn = 1.98 [IQR = 1.28-2.57]), than the remitted persons (Mdn = 1.64 [IQR = 1.11-2.24]) and healthy controls (Mdn = 1.28 [IQR = 1.04-1.92]). Nevertheless, the persons with current affective disorders still showed very high adherence rates (Mdn = 94.3% [IQR = 87.9-97.1]), at rates on a par with the remitted persons (Mdn = 94.3% [IQR = 90.0-97.1]) and healthy controls (Mdn = 94.3% [IQR = 90.0-98.6]). (4) Discussion: Frequent momentary questionnaires of mental well-being are slightly more burdensome to the persons with current affective disorders, but this does not seem to have a negative impact on adherence. Their high rate of adherence to EMA-which was similar to that in remitted persons and healthy controls -suggests that it is feasible to apply (short-duration) EMA.

Keywords: adherence; affective disorders; anxiety disorders; burden; depression; ecological momentary assessment.

Figure 1

Flowchart of the Ecological Momentary Assessment (EMA) and Actigraphy sub-study (NESDA-EMAA).

Figure 2

Person-mean momentary burden as reported on the EMA measures. Note: Value labels: 1 = ’No burden’; 4 = ’Moderate burden’; 7 = ’High burden’. Thick black line shows the median, error bars show the interquartile range (IQR), whiskers show +/−1.5 IQR, ● = outlier, deviates by ≥ 1.5× IQR, * = significant at p < 0.017 (Bonferroni-adjustment), and ** = significant at p < 0.0001. 3.3. Adherence to the daily EMA questionnaires.

Figure 3

Mean scores of the retrospective evaluation of experienced burden. Note: Mean scores of the retrospective evaluation; a reflection of experienced burden over the whole EMA monitoring period. Score range between 1 and 7, higher score indicates more burden. Thick black line shows the median, error bars show the interquartile range (IQR), whiskers show +/−1.5 IQR, and ● = outlier, deviates by ≥ 1.5× IQR.

Figure 4

Adherence to the EMA questionnaires. Note: Participants were invited to conduct a total of 70 EMA questionnaires. Thick black line shows the median, error bars show the interquartile range (IQR), whiskers show +/−1.5 IQR, and ● = outlier, deviates by ≥ 1.5× IQR.