Ecological Momentary Assessment Research Articles

Design Guidelines for Improving Mobile Sensing Data Collection: Prospective Mixed Methods Study

Background Machine learning models often use passively recorded sensor data streams as inputs to train machine learning models that predict outcomes captured through ecological momentary assessments (EMA). Despite the growth of mobile data collection, challenges in obtaining proper authorization to send notifications, receive background events, and perform background tasks persist. Objective We investigated challenges faced by mobile sensing apps in real-world settings in order to develop design guidelines. For active data, we compared 2 prompting strategies: setup prompting, where the app requests authorization during its initial run, and contextual prompting, where authorization is requested when an event or notification occurs. Additionally, we evaluated 2 passive data collection paradigms: collection during scheduled background tasks and persistent reminders that trigger passive data collection. We investigated the following research questions (RQs): (RQ1) how do setup prompting and contextual prompting affect scheduled notification delivery and the response rate of notification-initiated EMA? (RQ2) Which authorization paradigm, setup or contextual prompting, is more successful in leading users to grant authorization to receive background events? and (RQ3) Which polling-based method, persistent reminders or scheduled background tasks, completes more background sessions? Methods We developed mobile sensing apps for iOS and Android devices and tested them through a 30-day user study asking college students (n=145) about their stress levels. Participants responded to a daily EMA question to test active data collection. The sensing apps collected background location events, polled for passive data with persistent reminders, and scheduled background tasks to test passive data collection. Results For RQ1, setup and contextual prompting yielded no significant difference (ANOVA F1,144=0.0227; P=.88) in EMA compliance, with an average of 23.4 (SD 7.36) out of 30 assessments completed. However, qualitative analysis revealed that contextual prompting on iOS devices resulted in inconsistent notification deliveries. For RQ2, contextual prompting for background events was 55.5% (χ21=4.4; P=.04) more effective in gaining authorization. For RQ3, users demonstrated resistance to installing the persistent reminder, but when installed, the persistent reminder performed 226.5% more background sessions than traditional background tasks. Conclusions We developed design guidelines for improving mobile sensing on consumer mobile devices based on our qualitative and quantitative results. Our qualitative results demonstrated that contextual prompts on iOS devices resulted in inconsistent notification deliveries, unlike setup prompting on Android devices. We therefore recommend using setup prompting for EMA when possible. We found that contextual prompting is more efficient for authorizing background events. We therefore recommend using contextual prompting for passive sensing. Finally, we conclude that developing a persistent reminder and requiring participants to install it provides an additional way to poll for sensor and user data and could improve data collection to support adaptive interventions powered by machine learning.

The Impact of Incentivization on Recruitment, Retention, Data Quality, and Participant Characteristics in Ecological Momentary Assessments

Ecological Momentary Assessment (EMA) study participation is usually incentivized using monetary (e.g., fixed or performance-contingent payment) or non-monetary (e.g., feedback) compensation. This study investigates the impact of this incentivization on recruitment, retention, data quality, and participant characteristics in a sample of 74 students. For this purpose, an EMA study (time-based sampling) was conducted in participants’ daily life using a 2 Payment (fixed/ performance-contingent) x 2 Feedback (yes/ no) experimental between-subjects design. Offering feedback increased the likelihood of participation and reduced the likelihood of participants receiving fixed payment to drop out. Offering feedback additionally improved data quality. Furthermore, offering feedback attracted participants with higher interest in research and the study topic. Offering fixed vs performance-contingent payment had little effect on the outcomes of interest. Offering feedback as compensation in EMA studies may facilitate recruitment and increase data quality; however, it may also risk higher selection bias. Conclusions are drawn from a relatively small student sample; the results thus need to be replicated in larger and more diverse samples.

Comparison Between Ecological Momentary Assessment and Self-Report of Awake Bruxism Behaviours in a Group of Healthy Young Adults.

The aim of this investigation was to compare the self-reported frequency of awake bruxism (AB) behaviours by means of a validated single-observation point questionnaire (i.e., Oral Behaviour Checklist [OBC]) with the frequency reported in real-time with an Ecological Momentary Assessment (EMA) over 1 week. One hundred healthy young adults took part in the study. The frequency of some activities belonging to the spectrum of AB behaviours (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using the EMA approach with smartphone technology support over 1 week. The OBC questionnaire was used to evaluate the self-reported frequency of the same AB behaviours. Spearman's rank correlation coefficient was adopted to test the correlation between the average score of each OBC question considered (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) and the average frequency of the corresponding EMA item. Statistical analysis showed a weak-to-moderate level of correlation between the two different AB assessment methods. Mandible bracing showed the highest level of correlation, while teeth grinding had the lowest one. While the OBC represents a valid and easy-to-administer screening tool for evaluating bruxism behaviours, the EMA approach provides a more detailed real-time report on AB behaviours.

Exploring the Utility of a Real-Time Approach to Characterising Within-Person Fluctuations in Everyday Stress Responses.

Few studies have measured components of stress responses in real time-an essential step in designing just-in-time interventions targeting moments of risk. Using ecological momentary assessment (EMA), we characterised stress response components to everyday stressors, including reactivity (the response following a stressor), recovery (the return towards baseline), and pile-up (the accumulation of stressors) (RRPs) by quantifying the dynamics of response indicators (i.e., subjective stress, negative affect, and perseverative cognition). To determine the utility of these novel measures in capturing and characterising acute moments of the stress response, this study evaluated the proportion of variance in RRPs attributed to (1) between-person, (2) between-days, and (3) within-day (momentary) levels. Healthy adults (n=123; aged 35-65, 79% women, 91% non-Hispanic White) participated in a 14-day study assessing stress response via EMA 6times a day. RRPs were constructed from 10,065 EMA reports. Multilevel models with moments nested within days nested within persons were used to partition variance in the RRPs. Reactivity and recovery indicators captured the most variation within-days (i.e., across moments; range 76%-80% and 87%-89%, respectively), with small amounts of variance between-person. For pile-up, variation was mostly observed between-days (range 60%-63%) and between-persons (range 27%-31%). In contrast, raw measures of stress response reflected substantial between-person (range 32%-54%) and within-day (range 34%-53%) variance. These results demonstrated that a person-specific approach to measuring stress response components (i.e., RRPs) can capture the dynamic within-person variation in stress response, as it occurs in real time, making it well-suited for use in novel just-in-time interventions targeting moments of risk.

A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial.

Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Approval was granted by the university's institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant's progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults' compliance and engagement in intensive longitudinal studies. DERR1-10.2196/57664.

How can digital citizen science approaches improve ethical smartphone use surveillance among youth: Traditional surveys versus ecological momentary assessments.

Ubiquitous use of smartphones among youth poses significant challenges related to non-communicable diseases, including poor mental health. Although traditional survey measures can be used to assess smartphone use among youth, they are subject to recall bias. This study aims to compare self-reported smartphone use via retrospective modified traditional recall survey and prospective Ecological Momentary Assessments (EMAs) among youth. This study uses data from the Smart Platform, which engages with youth as citizen scientists. Youth (N = 77) aged 13-21 years in two urban jurisdictions in Canada (Regina and Saskatoon) engaged with our research team using a custom-built application via their own smartphones to report on a range of behaviours and outcomes on eight consecutive days. Youth reported smartphone use utilizing a traditional validated measure, which was modified to capture retrospective smartphone use on both weekdays and weekend days. In addition, daily EMAs were also time-triggered over a period of eight days to capture prospective smartphone use. Demographic, behavioural, and contextual factors were also collected. Data analyses included t-test and linear regression using Python statistical software. There was a significant difference between weekdays, weekends and overall smartphone use reported retrospectively and prospectively (p-value = <0.001), with youth reporting less smartphone use via EMAs. Overall retrospective smartphone use was significantly associated with not having a part-time job (β = 139.64, 95% confidence interval [CI] = 34.759, 244.519, p-value = 0.010) and having more than two friends who are physically active (β = -114.72, 95%[CI] = -208.872, -20.569, p-value = 0.018). However, prospective smartphone use reported via EMAs was not associated with any behavioural and contextual factors. The findings of this study have implications for appropriately understanding and monitoring smartphone use in the digital age among youth. EMAs can potentially minimize recall bias of smartphone use among youth, and other behaviours such as physical activity. More importantly, digital citizen science approaches that engage large populations of youth using their own smartphones can transform how we ethically monitor and mitigate the impact of excessive smartphone use.

Real-time experiences of racism and stress in association with postpartum weight retention: A longitudinal ecological momentary assessment study.

Racial inequities in postpartum weight have been documented with limited studies on the influences of racism and other forms of discrimination. In a prospective longitudinal study applying ecological momentary assessment (EMA) and ambulatory assessment of weight, we measured the association between discrimination, stress and postpartum weight change. The Postpartum Mothers Mobile Study (PMOMS) is a cohort of 313 pregnant and birthing individuals who were followed during their second and third trimester through 1 year postpartum. They were recruited in clinical settings between 2017-2020 in a major city center in Pennsylvania. Measures of racism and gender-based discrimination were collected via random EMA surveys throughout pregnancy and postpartum; and weight was collected via blue-tooth enabled scales at least weekly. Among Black participants, a 10% increase in the number of days a participant experienced racial discrimination in the past month was associated with retaining 0.3 more pounds; 10% increase in EMA gender discrimination was associated with retaining 0.4 more pounds; and EMA stress reported in the past month was associated with decreased weight retention. Chronic experiences of racial and gender discrimination may contribute to weight retention immediately after pregnancy and beyond.

A bibliometric analysis and visualization of non-suicidal self-injury in adolescents

BackgroundNon-suicidal self-injury(NSSI)is a widespread occurrence among adolescents, and this behavior can bring serious consequences. In recent years, the prevalence of NSSI continues to rise, which has attracted the attention of many researchers. But currently there is no research exploring the overall research distribution of NSSI in adolescents through quantitative analysis. Therefore, it is necessary to understand the status of development and main research hotspots of NSSI in adolescents via bibliometric analysis.MethodsWe searched the relevant studies from the Web of Science Core Collection(WoSCC)from January 1, 2014 to December 31, 2023. Using CiteSpace and VOSviewer visual analysis tools, we analyzed studies from the perspectives of country, region, institution, journal, author, and keywords.ResultA total of 2177 studies related to NSSI in adolescents were included. USA and Harvard University were the leading country and institution in this research field. Penelope Hasking was the most prolific author. Frontiers in Psychiatry and the Journal of Affective Disorders were the most productive journals. The most high-frequency keywords were ‘depression’, ‘mental health’, ‘emotion regulation’ and ‘borderline personality disorder’. ‘mindfully’, ‘intervention’, ‘self-compassion’ and ‘ecological momentary assessment’ were the emerging keywords.ConclusionsExploring the relevant factors and mechanisms of comorbidities, identifying etiology and risk/protective factors, and finding the impact of NSSI on adolescents are the hot topics. Moreover, intervention measures and interdisciplinary collaborative research for NSSI in adolescents will emerge as frontiers in the future.

Factors associated with momentary acts of aggression: An investigation using machine learning approaches in ecological momentary assessment data.

Factors associated with momentary acts of aggression: An investigation using machine learning approaches in ecological momentary assessment data.

Supplemental Material for Factors Associated With Momentary Acts of Aggression: An Investigation Using Machine Learning Approaches in Ecological Momentary Assessment Data

Supplemental Material for Factors Associated With Momentary Acts of Aggression: An Investigation Using Machine Learning Approaches in Ecological Momentary Assessment Data

Out of sight but in mind: Experimentally activating partner representations in daily life buffers against common stressors.

Lab experiments have shown that reminders of romantic partners buffer against stressors. Yet, tightly controlled experiments do not mimic what transpires in people's actual lives. Thus, an important question is as follows: To what extent do reminders of romantic partners confer affective benefits when they occur "in the wild" as people experience their daily activities? To capture people's emotional experience in real time, two studies, each spanning 3 months, used event-contingent ecological momentary assessments with a within-subject experimental manipulation. Prior to encountering a stressful event (taking an exam), participants received either a supportive text message from their partner or no message (Studies 1 and 2), or a supportive text message from the research team (Study 2). Receiving supportive partner messages, compared to no messages or messages from the research team, led to less negative affect and greater positive affect, and to less negative affect and greater positive affect about the exam itself. Receiving supportive partner messages had no statistically significant effects on subjective stress. Interestingly, the quality of the partner messages, as coded by independent raters, did not significantly predict the magnitude of the affective benefits. These findings suggest that receiving any supportive partner message, and not necessarily more subtle differences in the quality of the message, may be the key ingredient for these benefits to occur. The present work advances understanding of how the symbolic presence of partners confers affective regulatory benefits in everyday life. Implications for emotion regulation and the utility of integrating perspectives from adult attachment are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neuroinflammation, Stress-Related Suicidal Ideation, and Negative Mood in Depression

Brain translocator protein 18k Da (TSPO) binding, a putative marker of neuroinflammatory processes (eg, gliosis), is associated with stress and elevated in depressed and suicidal populations. However, it is unclear whether neuroinflammation moderates the impact of daily life stress on suicidal ideation and negative affect, thereby increasing risk for suicidal behavior. To examine the association of TSPO binding in participants with depression with real-world daily experiences of acute stress-related suicidal ideation and negative affect, as well as history of suicidal behavior and clinician-rated suicidal ideation. Data for this cross-sectional study were collected from June 2019 through July 2023. Procedures were conducted at a hospital-based research center in New York, New York. Participants were recruited via clinical referrals, the Columbia University research subject web portal, and from responses to internet advertisements. Of 148 participants who signed informed consent for study protocols, 53 adults aged 18 to 60 years who met DSM-5 diagnostic criteria for current major depressive disorder completed procedures with approved data and were enrolled. Participants were free of schizophrenia spectrum disorders, active physical illness, cognitive impairment, and substance intoxication or withdrawal at the time of scan. All participants underwent positron emission tomography imaging of TSPO binding with 11C-ER176 and concurrent arterial blood sampling. A weighted average of 11C-ER176 total distribution volume (VT) was computed across 11 a priori brain regions and made up the primary outcome measure. Clinician-rated suicidal ideation was measured via the Beck Scale for Suicidal Ideation (BSS). A subset of participants (n = 21) completed 7 days of ecological momentary assessment (EMA), reporting daily on suicidal ideation, negative affect, and stressors. In the overall sample of 53 participants (mean [SD] age, 29.5 [9.8] years; 37 [69.8%] female and 16 [30.2%] male), 11C-ER176 VT was associated at trend levels with clinician-rated suicidal ideation severity (β, 0.19; 95% CI, -0.03 to 0.39; P = .09) and did not differ by suicide attempt history (n = 15; β, 0.18; 95% CI, -0.04 to 0.37; P = .11). Exploratory analyses indicated that presence of suicidal ideation (on BSS or EMA) was associated with higher 11C-ER176 VT (β, 0.21; 95% CI, 0.01 to 0.98; P = .045). In 21 participants who completed EMA, 11C-ER176 VT was associated with greater suicidal ideation and negative affect during EMA periods with stressors compared with nonstress periods (β, 0.12; SE, 0.06; 95% CI, 0.01 to 0.23; P = .03 and β, 0.19; SE, 0.06; 95% CI, 0.08 to 0.30; P < .001, respectively). TSPO binding in individuals with depression may be a marker of vulnerability to acute stress-related increases in suicidal ideation and negative affect. Continued study is needed to determine the causal direction of TSPO binding and stress-related suicidal ideation or negative affect and whether targeting neuroinflammation may improve resilience to life stress in patients with depression.

Firearm Availability Reduces the Stability of Suicidal Ideation: Results from an Ecological Momentary Assessment Study

Firearm availability is correlated with increased risk of suicide but its link with suicidal ideation remains unclear. Previous studies are limited by retrospective reports and prospective designs with lengthy gaps between assessments that are ill-suited for measuring fluctuations in suicidal ideation. This study used ecological momentary assessment (EMA) to repeatedly assess suicidal ideation in a sample of 138 U.S. adults (81 handgun owners, 57 non-owners). Participants received six EMA prompts per day for 28 consecutive days. Results revealed no group differences in the frequency, maximum amplitude, or variability of suicidal ideation across male and female handgun owners and non-owners. Stability of suicidal ideation significantly differed across groups, however (F(1,132) = 4.5, p = 0.036); male handgun owners had the strongest stability and male non-owners had the weakest stability. Stability of suicidal ideation was significantly lower when participants reported a firearm was nearby as compared to when no firearm was nearby (F(4,17732) = 5.6, p < 0.001). Results suggest firearm availability increases reactivity to the environment, slows recovery from acutely elevated risk states, and may increase vulnerability to sudden shifts to higher risk states characterized by increased probability of suicidal behavior. Although these effects were observed in both handgun owners and non-owners, they disproportionately impact handgun owners because they report being near firearms more often.

Kratom (Mitragyna speciosa) use for self-management of pain: Insights from cross-sectional and ecological momentary assessment data

Kratom (Mitragyna speciosa) is increasingly used in the US for self-management of pain, despite limited research on its efficacy and safety. To better understand how and why people use kratom for pain self-management, we analyzed baseline survey data (N = 395) and 15-day ecological momentary assessment (EMA) data (N = 357) from kratom consumers across the US. Although we recruited participants based on their kratom use, not on whether they used it for pain management, nearly half (49.1 %) met criteria for chronic pain, with many reporting substantial pain relief and high effectiveness of kratom in managing pain. A majority (69.2 %) reported difficulties in obtaining adequate pain treatment, and most indicated that these challenges impacted their decision to try kratom. Most participants did not report concerns about overuse or significant side effects. EMA data showed that, regardless of chronic-pain status, pain relief was the most frequently endorsed primary motivation for daily kratom use. There were no significant association between daily pain levels and kratom use frequency, and no difference in the daily kratom use between those with vs. without chronic pain. Recent kratom use was associated with lower current pain levels. Stronger subjective effects of kratom were associated with lower pain levels. This effect was significantly moderated by chronic-pain status: those with chronic pain showed a stronger link between subjective kratom effects and pain reduction. These findings underscore the urgent need for systematic, rigorous research on long-term implications, efficacy, and safety of kratom in pain management to guide informed clinical practices and regulatory policies. PerspectiveThis study reveals that chronic pain is common among kratom consumers, who frequently use it for pain self-management and report significant relief, as shown by ecological momentary assessment. There is an urgent need for research into kratom's safety, efficacy, and mechanisms to guide clinical practice and inform policies.

ASSESSMENT OF ORAL BEHAVIORS AND PSYCHOSOCIAL ASPECTS OF FEDERAL POLICE OFFICERS

Objective: To evaluate the oral behaviors and psychosocial aspects of adults belonging to the Federal Police class. Methods: An observational longitudinal study was conducted with 30 adult individuals from the special group of Federal Police from the city of Curitiba, Paraná. The median age of participants was 39.70 (± 7.35) years. Quality of life, anxiety and perceived stress were assessed using the SF-36, GAD-7 and PSS-14 questionnaires respectively. Awake bruxism was evaluated using the Ecological Momentary Assessment method with the WhatsApp mobile application. Messages were sent 15 times a day, seven days a week, between 9:00 am and 7:00 pm, at random times, to choose one of five oral behaviors: teeth contact, teeth clenching, teeth grinding, mandibular bracing, and relaxed jaw muscles. Cronbach's alpha test, Shapiro-Wilk’s test, Wilcoxon's non-parametric test for paired samples, Friedman's non-parametric test for paired samples, Spearman's non-parametric correlation test, and Kruskal-Wallis non-parametric test, followed by Dunn's 2–2 comparison test were employed. Results: The most frequent oral behaviors during the week were relaxed jaw muscles (49.75 ± 29.28), teeth contact (31.50 ± 24.71), mandibular bracing (10.42± 18.99), teeth clenching (6.82 ± 8.96), and teeth grinding (1.48 ± 3.04). Quality of life was considered excellent, anxiety was low, and there was no stress. There was no correlation between stress, anxiety and quality of life and awake bruxism. Conclusion: The federal police officers evaluated showed a high frequency of awake bruxism, but the psychosocial aspects were considered excellent.

Temporal interaction of suicidal ideations and behaviors with loneliness in persistent depressive disorder - a feasibility study using ecological momentary assessment.

Individuals with persistent depressive disorder (PDD) are at increased risk for suicidality. Suicidality may be precipitated by loneliness. However, their temporal interplay in PDD has not been studied. We conducted a feasibility study using ecological momentary assessment (EMA) to measure short-term courses of suicidality and loneliness in 20 inpatients with PDD and current suicidality. EMA adherence of 13 completers was 81.3%. Suicidal ideations and loneliness varied with one standard deviation over three to six hours. This pilot study confirmed the feasibility of EMA in PDD and provided new insights in dynamics of suicidality and loneliness informing future study designs.

Using Ecological Momentary Analysis to explore stigma experiences in the real world for adults with acquired hearing loss

Objective The aim of this study was to use Ecological Momentary Assessment (EMA) to capture how stigma-induced identity threat is experienced by adults with hearing loss and how they respond to such threats in daily life. Design and study sample Twenty adults with hearing loss from 53 to 88 years (mean age of 69.4 years) completed a range of demographic and stigma questionnaires in the laboratory and, over a two-week period, answered daily EMA surveys. Results A total of 633 EMA surveys were collected. Five participants reported 13 listening events in which they experienced stigma. These events were typically when conversing with family or friends who were aware of the adults’ hearing loss. Conclusions The number of individual stigma experiences captured by EMA were low, when viewed across a large number of social interactions. However, as a group, a quarter of the participants in this study experienced stigma over a two-week period, typically from others close to them. This suggests that stigma experiences may be a regular occurrence for some adults with hearing loss.

If You Give a Therapist a Network: A Qualitative Analysis of Therapists' Reactions to Their Patients' EMA-Based Network Models.

Network models hold much promise for use in the form of personalized feedback, which the TheraNet Project aims to investigate. In the present study, we share therapists' first reactions to patient network models based on ecological momentary assessment (EMA) data. Therapists (N = 24) were taught to interpret the network models based on their patient's data. They were provided with concrete use suggestions at the end of the workshop. The workshops were analysed using descriptive qualitative content analysis. The resulting codes were then grouped thematically. Therapists spoke about using the networks for "case conceptualization", "therapy planning", and "psychoeducation", but also commented on the "study design". Before the concrete suggestions, therapists most frequently voiced thoughts on its uses for "case conceptualization". After the suggestions, "psychoeducation" was mentioned most frequently. Therapists intuitively connected network models to case conceptualizations. Once concrete suggestions were provided, therapists more frequently discussed networks as psychoeducative tools.

Day-to-day variations and effects of urinary and fecal incontinence among adults with spina bifida: an ecological momentary assessment diary pilot study

BackgroundNo studies have evaluated the day-to-day variations in urinary incontinence (UI) and fecal incontinence (FI) among adults with spina bifida (SB). We aimed to 1) describe variations in UI/FI over 30 days, 2) assess factors associated with the negativity effects of incontinence, and 3) correlate anxiety about incontinence and health-related quality of life (HRQOL) among adults with SB (exploratory). MethodsAdults with SB participated in a larger 30-day smartphone-based ecological momentary assessment (EMA) study of well-being and incontinence. We analyzed baseline demographics, temporal variables (baseline UI/FI, incontinence, and negativity on days prior), and incontinence episode-specific variables (number of daily episodes, incontinence interval, quantity). Urinary and fecal incontinence-related anxiety (UIA/FIA) was measured on a 5-point Likert scale (“How anxious were you because of urine/stool leaks today?”), HRQOL with QUALAS-A (scores range 0-100, 0=lowest HRQOL). Mixed-effects, random intercept ordinal and linear regression was used. ResultsEighty-nine adults participated at a median age of 33 years old (71% female, 53% shunted, 49% community ambulators). Participants contributed 2578 total diary days: 61% were associated with any incontinence (41% UI only, 6% FI only, 13% both). Eighty-two (92%) adults reported UI on a median of 16 days, but experiences varied: 6% had a single episode, while 33% had UI on 28-30 days (Summary Figure). Seventy adults (79%) reported FI on a median of 5 days, less frequently than UI (p<0.001), but experiences varied: 11% had a single FI episode, while 31% had FI on 10 or more days. Fewer participants reported any UIA than FIA (50% vs. 72%, respectively, p<0.001). On multivariate regression, (1) higher UIA was reported by individuals with higher baseline UIA, higher UIA on days prior, multiple daily episodes and higher UI quantity (p<=0.02), while (2) higher FIA was reported by those with lower baseline HRQOL, fewer FI episodes on days prior, higher FIA on days prior, and higher UI quantity (p<=0.02). FIA was correlated with lower end-of-study HRQOL (p=0.03). DiscussionInstances of incontinence are not uniform experiences. Their effects vary with factors beyond the actual episode. This suggests novel potential points of intervention to improving long-term HRQOL among people with incontinence. ConclusionDay-to-day experiences of UI and FI vary among adults with SB across multiple dimensions. Anxiety about incontinence when it occurs varies not only based on individual- and episode-specific characteristics, but also on incontinence in the preceding days. Operationalizing these insights into potential clinical interventions warrants further investigation.

Modifiable factors for somatic symptom persistence in patients with somatic symptom disorder: study protocol for a longitudinal cohort with an embedded ecologically momentary assessment (SOMA.SSD)

IntroductionSomatic symptom disorder (SSD) is a distressing mental disorder characterised by the presence of at least one persistent somatic symptom and a significant psychological burden due to the symptom(s), as well as excessive thoughts, feelings or behaviours related to them or associated health concerns. The primary aim of our study is to deepen the understanding of risk factors and mechanisms for somatic symptom persistence. Specifically, we will investigate the role of patients’ expectations and somatic comorbidity regarding symptom persistence.Methods and analysisIn a prospective 12-month cohort study, n=240 patients with SSD will be recruited from the outpatient clinics of the Department of Psychosomatic Medicine and Psychotherapy at the University Medical Center Hamburg-Eppendorf. The roles of two hypothesised predictors (ie, expectations and comorbidity) will be analysed together with known predisposing and maintaining factors of persistent somatic symptoms. The study entails macrolevel and microlevel assessments to investigate symptom severity over different timespans. Assessments at the macrolevel take place at baseline, 6 and 12 months. At the microlevel, a 10-day ecological momentary assessment study will be implemented to elucidate patients’ dynamic experience with somatic symptoms in their natural environments. In order to elicit possible framing effects on the 10-day course of symptom severity, participants are randomised to either a positive or a negative expectation framing group. Cross-lagged panel models will be used to analyse data at the macrolevel. At the microlevel, multivariate latent growth curve models will be conducted to relate temporal changes in predictor and outcome variables to one another.Ethics and disseminationThe study was approved by the Ethics Committee of the Medical Associations Hamburg, Germany (2020-10197-BO-ff). The results will enable us to draw conclusions regarding the role of expectations for future targeted treatment options and regarding the utility of somatic comorbidity as a potential diagnostic specifier of SSD. Dissemination of our results will be achieved through scientific publications, and lay summaries for study participants, patient advocacy groups and the general public.Trial registration numberISRCTN36251388.