Real-time Associations between Functional Behaviors and Depressed Mood in Post-stroke Individuals: Smartphone-based Ecological Momentary Assessment

Abstract

<h3>Research Objectives</h3> To assess real-time associations between daily functional behaviors and depressed mood (DM) in indivdiuals after stroke using smartphone-based ecological momentary assessment (EMA). <h3>Design</h3> EMA involved repeated sampling of real-time daily functional activities and DM in stroke survivors' natural environments. We used multilevel models to examine concurrent and time-lagged associations between daily functional behaviors and DM. <h3>Setting</h3> Home and community. <h3>Participants</h3> Two hundred and two participants with mild-to-moderate chronic stroke participants (90% ischemic stroke; 45% female; 44% black). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Participants completed EMA five times per day for two weeks by reporting their daily functional behaviors regarding where, with whom, and what activity was spent and their DM level. <h3>Results</h3> Participants spent 28% of the wake-up time in passive leisure activities but spent less time in physical and vocational activities (4% and 9%, respectively). Lower DM was concurrently associated with time spent in social activities (β=-0.023 ± 0.011) and instrumental activities of daily living (β=-0.061 ± 0.013); spending time with family members (β=-0.061 ± 0.014), spouses (β=-0.043, ± 0.016), friends (β=-0.094, ± 0.021), and coworkers (β=-0.050 ± 0.021); locating in restaurants (β=-0.068 ± 0.029), and homes of family members (β=-0.039 ± 0.020) or friends (β=-0.069 ± 0.031). DM was reported higher when patients rated lower in perceived satisfaction, performance, and engagement of activities in concurrent (βs=-0.036 ± 0.003, -0.053 ± 0.003, -0.044 ± 0.003) and time-lagged models (βs=-0.011 ± 0.004, -0.012 ± 0.004, -0.013 ± 0.004). <h3>Conclusions</h3> EMA can delineate real-time associations between post-stroke functional behaviors and DM. Findings suggest promoting participation in social activities and instrumental activities of daily living as important intervention targets to reduce DM in stroke survivors. <h3>Author(s) Disclosures</h3> None disclosed.