Ecological Momentary Assessment Data Research Articles

Ecological momentary assessment in eating disorders research: recent findings and promising new directions.

Ecological momentary assessment (EMA) is an important tool for clarifying common precipitants and consequences of eating disorder symptoms that might be meaningfully targeted in treatments for these pernicious disorders. This article reviews recent advances in EMA work conducted within clinical eating disorder samples. Published studies from the past 2.5 years can broadly be categorized as involving functional analysis of eating disorder behaviors, examining hypothesized predictors of eating disorder symptoms, or applying novel approaches to EMA data. Examples of the latter category include the use of latent profile analysis with EMA data, integration of neurocognitive (e.g., ambulatory inhibitory control task) or biological indicators (e.g., fMRI, plasma leptin), and examining changes in associations between momentary variables over time through multiwave EMA data collection. EMA studies in eating disorders have advanced significantly in recent years, with findings demonstrating strong support for the emotion regulation function of eating disorder behaviors and momentary predictors of distinct eating disorder symptoms. The use of novel statistical and data collection approaches represent exciting areas of growth, with likely implications for intervention approaches, including those that utilize ambulatory technology to deliver treatment.

Dynamic fluctuations of emotional states in adolescents with delayed sleep phase—A longitudinal network modeling approach

Background: Very late sleep rhythms are risks for social adjustment problems in adolescence. Using ecological momentary assessment data, we quantified and visualized temporal and contemporaneous within-persons dynamical relations of sleepiness and emotions in adolescents with and without late sleep rhythms.Methods: We analyzed a temporal network via multilevel vector autoregression (mlVAR) modeling and a contemporaneous network through the partial associations between the residuals of temporal and the between-subject multilevel models. We tested whether these networks were different between those with a late circadian rhythm [concurrent delayed sleep phase (DSP) N = 172, 37% boys, 63% girls] and those without (N = 143, 22% boys, 78% girls).Results: In adolescents without DSP, the temporal networks showed continuity only for low mood from the previous to the following time point. In adolescents with DSP, there were more predictable patterns of emotions. Feelings of depression led to a decrease of positive emotions and increase of irritation and anxiety. The contemporaneous networks showed clusters of positive and negative emotions in both groups and sleepiness decreased the experience of positive emotions concurrently.Limitations: DSP in our current study was based only on one out of three diagnostic criteria of the full disorder (DSM-5) and it was assessed only once.Conclusions: These findings indicate that the dynamic organization of emotions and sleepiness is different in adolescents with and without DSP. DSP adolescents have more predictable and maladaptive emotional patterns during the day. Results provide new insight about why individuals with DSP are at a heightened risk for decreased emotional adjustment.

Does laughing have a stress-buffering effect in daily life? An intensive longitudinal study.

Positive affect is associated with alleviating mental and physiological stress responses. As laughter is a common physiological operationalization of positive affect, we investigated whether the effects of experiencing a stressful event on stress symptoms is lessened by frequency and intensity of daily laughter. Using an intensive longitudinal design, we ambulatory assessed the self-reported experience of stressful events, stress symptoms and the frequency as well as the intensity of laughter in university students’ daily lives. Our hierarchical ecological momentary assessment data were analyzed with multilevel models. The results support the stress-buffering model of positive affect: We found that the frequency of laughter attenuated the association between stressful events and subsequent stress symptoms. The level of intensity of laughter, however, was found to have no significant effect. Future studies should use additional psychophysiological indicators of stress and straighten out the differential contributions of frequency and intensity of daily laughter.

Leveraging Mobile Sensing to Understand and Develop Intervention Strategies to Improve Medication Adherence.

Interventions to improve medication adherence have had limited success and can require significant human resources to implement. Research focused on improving medication adherence has undergone a paradigm shift, of late, with a shift towards developing personalized, theory-driven interventions. The current research integrates foundational and translational science to implement a mechanisms-focused, context-aware approach. Increasing adoption of mobile and wearable sensing systems presents new opportunities for understanding how medication-taking behaviors unfold in natural settings, especially in populations who have difficulty adhering to medications. When combined with survey and ecological momentary assessment data, these mobile and wearable sensing systems can directly capture the context of medication adherence in situ, including personal, behavioral, and environmental factors. The purpose of this paper is to present a new transdisciplinary research framework in medication adherence, highlight critical advances in this rapidly-evolving research field, and outline potential future directions for both research and clinical applications.

Differences in Affective Dynamics Among Eating Disorder Diagnostic Groups.

Emotion regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Using EMA data from three large studies, a series of linear mixed models showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating disorders diagnostic groups and have implications towards distinct conceptualizations and treatments.

Mind-Wandering in Adolescents Predicts Worse Affect and Is Linked to Aberrant Default Mode Network–Salience Network Connectivity

Understanding the fluctuating emotional and cognitive states of adolescents with depressive symptoms requires fine-grained and naturalistic measurements. This study used ecological momentary assessment (EMA) to investigate the affective correlates and consequences of mind-wandering in adolescents with anhedonia (AH) and typically developing (TD) controls. In addition, we examined the association between mind-wandering and resting state functional connectivity between the medial prefrontal cortex (mPFC), a core hub of the default mode network (DMN) linked to internally oriented mentation, and networks linked to attentional control (dorsal attention network [DAN]) and affect/salience detection (salience network [SN]). A total of 65 adolescents, aged 12 to 18 years (TD= 36; AH= 29), completed a resting state functional magnetic resonance imaging scan and subsequently used a smartphone application for ecological momentary assessment (EMA) data collection (2-3 times/d for 5 days). Each survey (N= 678) prompted adolescents to report on their current positive and negative affect (PA and NA), cognition, and activity. The frequency of mind-wandering was higher for AH (70.0% of EMA samples) relative to TD (59.2%) participants, and the participants with AH were more likely to mind-wander to unpleasant content. Mind-wandering was associated with higher concurrent NA, even when controlling for plausible confounds (eg, current activity, social companion, rumination). Time-lagged analyses revealed a bidirectional association between mind-wandering and PA. Greater levels of mind-wandering within the AH group were associated with stronger mPFC-SN/DAN connectivity. Rates of mind-wandering were high, especially among adolescents with anhedonia, and predicted worse affect. The relation between mind-wandering and enhanced mPFC-SN coupling may reflect heightened bottom-up influence of affective and sensory salience on DMN-mediated internally oriented thought.

A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study.

BackgroundCoronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care.ObjectiveThe ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants.MethodsUsing a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment.ResultsAll 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04).ConclusionsThe mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings.

Possible Application of Ecological Momentary Assessment to Older Adults' Daily Depressive Mood: Integrative Literature Review.

BackgroundEcological momentary assessment is a method of investigating individuals’ real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults.ObjectiveThe aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice.MethodsWe searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles’ references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were “ecological momentary assessment,” “smartphone assessment,” “real time assessment,” “electronic daily diary,” “mHealth momentary assessment,” “mobile-based app,” and “experience sampling method,” combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days.ResultsOf the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants’ depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device.ConclusionsEcological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users’ experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting.

Evaluation of Self-Reported Stress Reduction from Ashwagandha and B Vitamin Supplementation Using Ecological Momentary Assessment (EMA)

Abstract Objectives Chronic stress and anxiety are linked to poor health outcomes that include depression, weight gain, hypertension, and even cardiovascular disease. Stress and anxiety continue to cause physical symptoms in 77% of individuals in America. Remedies to help alleviate stress and anxiety are needed. This study evaluated the benefits of ashwagandha and B vitamin supplementation on stress and anxiety reduction. Methods In this study, 40 women between the ages of 30 and 50 were recruited to evaluate the synergistic effects of ashwagandha and B vitamin supplementation, for four weeks, on stress and anxiety. Ecological Momentary Assessment (EMA) is a method that allows for stress to be recorded in real time, allowing for individual changes to be monitored. The 60-item daily stress inventory was used to measure stress throughout the day via EMA. EMAs were randomly sent 5 times per day for 7 consecutive days at 3 different time points: before the start of the intervention, ten days after starting the intervention, and then the last 7 days of the intervention. Results Overall, in a pairwise comparisons analysis, the average perceived stress from reported stressors was statistically significantly decreased post-intervention (P = 0.044) when compared to pre-intervention EMA data. Additionally, in a mixed model analysis, 4-week supplementation statistically significantly reduced perceived feelings of reported “stress” (mean difference of −4.892; 95% CI: −10.00 to 0.217; P = 0.018), and increased sense of feeling “concentrated” (mean difference of 8.136; 95% CI: 0.650 to 15.623; P = 0.026) and “revitalized” (mean difference of 8.373; 95% CI: 1.868 to 14.878; P = 0.003) after 4 weeks. Conclusions This study provides evidence of stress reduction from ashwagandha and B vitamin supplementation. Future research should conduct a double-blind placebo-controlled trial of this supplement's effect on stress. Funding Sources This research was funded by the Food Sciences Corporation. Funder had no role in data collection, data analysis or interpretation, or writing of the abstract.

T38. POSTER PRESENTATION: HAMLETT: HANDLING ANTIPSYCHOTIC MEDICATION, A LONGTERM EVALUATION OF TARGETED TREATMENT A PRAGMATIC SINGLE-BLIND RANDOMISED CONTROLLED TRIAL OF CONTINUATION VERSUS DISCONTINUATION OF PSYCHOTIC MEDICATION

BackgroundWhen achieving remission after a first psychotic episode using antipsychotic medication, international guidelines generally recommend continuation of use for >1 year. However, patients often have a strong wish to stop earlier due to side-effects, affecting everyday functioning. Recently, guidelines have been questioned as one Dutch study found that more patients achieved long-term functional remission after early discontinuation. Yet, this finding has not yet been replicated. Psychiatrists, patients and family are unsure which regime to follow: to continue or not to continue?MethodsIn total 512 participants will be included who achieved remission after first-episode psychosis and use antipsychotic medication. Recruitment takes place at 24 Dutch sites. HAMLETT is a multicenter pragmatic single-blind randomized controlled trial with two conditions (1:1): maintenance treatment versus discontinuation/dose reduction of antipsychotic medication.Main research question: Is long-term general functioning better if patients reduce/discontinue antipsychotic medication at an early stage (3–6 months after remission of their first psychotic episode), than when they continue medication >1 year? General functioning is measured in two ways: with the WHO-DAS interview and with Ecological Momentary Assessments (EMA).EMA is a structured diary method in which individuals are asked in daily life to report on their current thoughts, feelings and symptoms, as well as the context (e.g. location, company, activity) and the appraisal of the context (e.g. stress). Diaries are completed via a smartphone diary app maximally 10 times daily at semi-random moments, over eight consecutive days. Momentary positive/negative affect, self-esteem, subjective well-being, paranoia, hallucinations, sleep, and frequency, type and appraisal of social company and activities are assessed on a 1–7 scale. At baseline and after 6 months, 1, 2, 3 and 4 years follow-up, patients of both arms will perform EMA. This results in an intensive time series of psychopathology, subjective well-being and social functioning in relation to antipsychotic medication and a range of contextual influences.ResultsThe study is active and currently recruiting patients (since September 2017), At present 194 patients have been included, 20% participated in EMA measurements. Results of the interim analysis and preliminary of EMA data will be presented.DiscussionThe HAMLETT study investigates the effects of maintenance treatment versus discontinuation/dose reduction of antipsychotic medication after remission of first episode psychosis on personal and social functioning, psychotic symptom severity, health-related quality of life and cognitive functioning. The HAMLETT study will offer evidence to guide patients and clinicians when evaluating optimal treatment duration for psychotic disorders. Using different types of outcome measures will provide a more in-depth analysis of effects of continuation/ discontinuation on functioning.

The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study.

Affect regulation models of eating disorder behavior, which predict worsening of affect prior to binge-eating episodes and improvement in affect following such episodes, have received support in anorexia nervosa and bulimia nervosa. However, limited work has examined the trajectories of affect surrounding binge eating in binge-eating disorder (BED). In the current study, ecological momentary assessment data from 112 men and women with BED were used to examine the trajectories of positive affect (PA), negative affect (NA), guilt, fear, hostility, and sadness relative to binge-eating episodes. Prior to binge episodes, PA significantly decreased, whereas NA and guilt significantly increased. Following binge episodes, levels of NA and guilt significantly decreased and PA stabilized. Overall, results indicate improvements in affect following binge-eating episodes, suggesting that binge eating may function to alleviate unpleasant emotional experiences among individuals with BED, which is consistent with affect regulation models of eating pathology. Because improvements in negative affect were primarily driven by change in guilt, findings also highlight the relative importance of understanding the relationship between guilt and binge-eating behavior within this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Affect relative to day-level drinking initiation: Analyzing ecological momentary assessment data with multilevel spline modeling.

Affect regulation models state that affect both motivates and reinforces alcohol use. We aimed to examine whether affect levels and rates of change differed across drinking versus nondrinking days in a manner consistent with affect regulation models. Four hundred four regularly drinking adults, aged 18-70 years, completed ecological momentary assessments over 3 weeks. Participants provided positive affect (PA; enthusiastic, excited, happy) and negative affect (NA; distressed, sad) reports during all prompts; alcohol consumption reports were also provided. Multilevel spline models revealed that on drinking days, PA was higher and NA was lower both before and after drinking compared to matched times on nondrinking days. PA and NA were also higher and lower, respectively, both before and after drinking, when heavy drinking days were compared to moderate drinking days. Examination of affect rates of change revealed that (a) accelerating increases in PA and accelerating decreases in NA preceded drinking initiation, (b) PA increases and NA decreases were seen up to 2 hr after drinking initiation, and (c) pre- and postdrinking PA increases were larger on heavy versus moderate drinking days, whereas only postdrinking NA decreases were larger on heavy drinking days. Results supported affect regulation models while adding nuance, showing accelerating changes in predrinking affect on drinking days and pre- and postdrinking differences in affect levels and rates of change across days of varying drinking intensity. Beyond theory, our results suggest that accelerating changes in affect may provide a clue to future commencement of heavy drinking, which may aid momentary intervention development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Studying Complex Adaptive Systems With Internal States: A Recurrence Network Approach to the Analysis of Multivariate Time-Series Data Representing Self-Reports of Human Experience

We discuss formal, theoretical and practical issues with the statistical analysis of multivariate time series data that represent self-reports of human experience, often referred to as Ecological Momentary Assessment (EMA) data, or, Experience Sampling Method (ESM) data. We argue such time series likely violate the assumptions required for valid statistical inference, such as the memoryless-ness property (due to the presence of long-range temporal correlations) and ergodicity (due to non-stationarity and non-homogeneity of central moments). Moreover, we consider the common practice of interpreting outcomes of self-reports as if they were outcomes of classical physical measurements as extremely problematic and suggest to consider them as records of the temporal evolution of observables of a complex adaptive system with internal state dynamics. We propose to address some of these issues by analyzing the Change Profile instead of the observed time series, using recurrence-bases analyses, specifically, (multiplex) recurrence networks. We analyze a publicly available data set in which 4 participants rated 6 questions about their self-esteem and physical self, twice a day over a period of 512 days and introduce the concept of recurrence networks weighted by recurrence time. The edge weights represent either recurrence times or recurrence time frequencies and results show the scaling relation between vertex degree and vertex strength (the weighted variant of vertex degree), is associated to the scaling relation between frequency and spectral power based on the ‘raw’ time series. In addition, we present a new spiral layout for recurrence networks that might be more appropriate when the detection of critical periods, regime shifts and tipping points requires insight in the temporal order in which those events occur. We conclude a complex systems approach to analyzing multivariate time series of self-reports of human experience is preferred over and above fitting statistical models like the Gaussian Graphical Model, or its derivatives.

MHealth technology for ecological momentary assessment in physical activity research: a systematic review.

ObjectiveTo systematically review the publications on ecological momentary assessment (EMA) relating to physical activity (PA) behavior in order to classify the methodologies, and to identify the main mHealth technology-based tools and procedures that have been applied during the first 10 years since the emergence of smartphones. As a result of this review, we want to ask if there is enough evidence to propose the use of the term “mEMA” (mobile-based EMA).DesignA systematic review according to PRISMA Statement (PROSPERO registration: CRD42018088136).MethodFour databases (PsycINFO, CINALH, Medline and Web of Science Core Collection) were searched electronically from 2008 to February 2018.ResultsA total of 76 studies from 297 potential articles on the use of EMA and PA were included in this review. It was found that 71% of studies specifically used “EMA” for assessing PA behaviors but the rest used other terminology that also adjusted to the inclusion criteria. Just over half (51.3%) of studies (39) used mHealth technology, mainly smartphones, for collecting EMA data. The majority (79.5%) of these studies (31 out of 39) were published during the last 4 years. On the other hand, 58.8% of studies that only used paper-and-pencil were published during the first 3 years of the 10-year period analyzed. An accelerometer was the main built-in sensor used for collecting PA behavior by means of mHealth (69%). Most of the studies were carried out on young-adult samples, with only three studies in older adults. Women were included in 60% of studies, and healthy people in 82%. The studies lasted between 1 and 7 days in 57.9%, and between three and seven assessments per day were carried out in 37%. The most popular topics evaluated together with PA were psychological state and social and environmental context.ConclusionsWe have classified the EMA methodologies used for assessing PA behaviors. A total of 71% of studies used the term “EMA” and 51.3% used mHealth technology. Accelerometers have been the main built-in sensor used for collecting PA. The change of trend in the use of tools for EMA in PA coincides with the technological advances of the last decade due to the emergence of smartphones and mHealth technology. There is enough evidence to use the term mEMA when mHealth technology is being used for monitoring real-time lifestyle behaviors in natural situations. We define mEMA as the use of mobile computing and communication technologies for the EMA of health and lifestyle behaviors. It is clear that the use of mHealth is increasing, but there is still a lot to be gained from taking advantage of all the capabilities of this technology in order to apply EMA to PA behavior. Thus, mEMA methodology can help in the monitoring of healthy lifestyles under both subjective and objective perspectives. The tendency for future research should be the automatic recognition of the PA of the user without interrupting their behavior. The ecological information could be completed with voice messages, image captures or brief text selections on the touch screen made in real time, all managed through smartphone apps. This methodology could be extended when EMA combined with mHealth are used to evaluate other lifestyle behaviors.

Bridging the gap between performance-based assessment and self-reported everyday functioning: An ecological momentary assessment approach

Objective: In the real-world environment, multiple and interacting state-dependent factors (e.g., fatigue, distractions) can cause cognitive failures and negatively impact everyday activities. This study used ecological momentary assessment (EMA) and a n-back task to examine the relationship between fluctuating levels of cognition measured in the real-world environment and self-report and performance-based measures of functional status.Method: Thirty-five community-dwelling older adults (M age = 71.80) completed a brief battery of objective and self-report measures of cognitive and functional status. After completing 100, 45-second trials to reach stable performance on a n-back task, EMA data collection began. Four times daily for one week, participants received prompts on a tablet to complete a n-back task and a brief survey. From the EMA n-back trials, measures of EMA average performance and intra-individual variability (IIV) across performances were created.Results: For the EMA n-back, the correlation between IIV and EMA average was weak and non-significant. IIV associated with self-report measures, and EMA average with the objective, performance-based functional status composite. Hierarchical regressions further revealed that IIV was a significant predictor of self-reported functional status and cognitive failures over and above EMA average performance and global cognitive status. In contrast, for the objective, functional status composite, IIV did not explain additional variance.Conclusions: The findings suggest that IIV and self-report measures of functional status and cognitive failures may capture a real-world cognitive capacity that fluctuates over time and with context; one that may not easily be captured by objective, performance-based measures designed to assess optimal function.

ECOLOGICAL MOMENTARY ASSESSMENT FOR ASSESSING DEPRESSION IN ADVANCED DEMENTIA: A PILOT STUDY

Introduction Up to 38% of individuals with moderate to severe dementia experience clinical depression. Although most studies demonstrate lower rates of clinical depression as dementia advances, this may be attributed to the difficulty of assessment at this stage. Though clinical interviews are thorough in assessing depression, they are often time- and resource-contingent. Instead, healthcare providers often turn to screening tools or scales. However, conventional tools for assessing depression have problems with validity in this population. Individuals with dementia who self-report may lack insight and have memory impairments. Retrospective recall bias may also impact proxy reports from caregivers, particularly in institutional settings. A comprehensive approach that incorporates both self and proxy inputs, is sensitive to changes over time and with lower risk of recall bias is crucial in improving performance of depression assessments for people with dementia. In this study, we propose sampling mood data several times daily and in real-time, in order to shorten the period of recall and to maximize representativeness. This approach, known as Ecological Momentary Assessment (EMA), provides data used to measure target symptoms with greater sensitivity than retrospective methods in a variety of populations. EMA is delivered using mobile technology and has shown to be a feasible and acceptable method of assessment. However, the use of a proxy mobile EMA for depression in dementia has yet to be developed or evaluated. The objective of this study was to design and pilot a mobile EMA tool for assessing depression in individuals with dementia. Specific aims sought to evaluate the tool's feasibility and reliability in assessing depressive symptoms. Methods A literature review was conducted to determine commonly used and validated assessments for depression in dementia. These assessments were analyzed for common items, where items less commonly used or not relevant to be collected using EMA were excluded. Wording of items were also analyzed to develop the specific structure of questions for the EMA tool. The tool was piloted in a study on the Specialized Dementia Unit (SDU) at the Toronto Rehabilitation Institute (TRI). Nine participants (22% female, mean age = 77±10.2?years, mean Mini Mental State Examination score = 5) with moderate to severe dementia were enrolled in the study. Participants were assessed for clinical outcomes of depression using the Provisional Diagnostic Criteria for Depression in Dementia (PDC-dAD), the Neuropsychiatric Inventory (NPI) Dysphoria subscale and the improved Clinical Global Impressions Scale (iCGI) at admission and discharge. Observations were completed on phones that had access to the EMA tool via RedCap survey software by research and nursing staff. Across six weeks, five researchers were involved in observing participants at different time points and in different combinations. Separately, five nurses completed observations twice per shift for every shift during their work week. Brief follow-up interviews were conducted to ascertain the nurse experience of using the tool and the Systems Usability Scale (SUS) was completed. Total SUS scores and nurse completion rates using the EMA tool were generated to demonstrate feasibility. Results Six depression assessments validated in dementia were found and demonstrated adequate performance outcomes. Items fell into either mood-related, dementia-related, vegetative, psychotic or positive mood symptom groups. The mood-related group was analyzed separately for prominent items, which included sadness, anxiety, pessimism, loss of interest and irritability. Wording of items were modified to be consistent with being collected in real-time, rather than retrospectively. These items were incorporated as core observational domains in the application to be tested. Sadness and anxiety were additionally included as self-report items as studies have shown these to be most discordant between individuals with dementia and informants. The tool was piloted on the SDU at TRI with research and nursing staff. Preliminary data analyses demonstrated that when admitted to the unit, 22% of participants met criteria for major depression as demonstrated by the PDC-dAD and 44% were experiencing at least some degree of depressive symptoms as demonstrated by the NPI Dysphoria subscale. Three nurses were recruited to observe patients. The average SUS score was 80% and average completion rate was 82% across nurses. Preliminary analyses of the EMA data demonstrated a total of 1,557 observations across five raters and three nurses, where no participants had less than 75% of their data collected. Conclusions This research provides an innovative approach in assessing depression in dementia. Future steps involve evaluation of the tool's inter-rater reliability and exploring outcomes related to validity and responsiveness to change of the EMA tool. This research was funded by: This research has been generously funded by the Walter & Maria Schroeder Institute for Brain Innovation and Recovery.

Youth daily exposure to tobacco outlets and cigarette smoking behaviors: does exposure within activity space matter?

To examine whether daily exposure to tobacco outlets within activity spaces is associated with cigarette smoking and with the number of cigarettes smoked by youth that day. The study used geographic ecological momentary assessment (GEMA) data that combined daily surveys with ecological momentary assessment of global positioning systems (GPS) using geographic information systems (GIS) to allow for real-time data collection of participants' environments and behaviors. Eight mid-sized California (USA) city areas. The analytical sample included 1065days, which were clustered within 100 smoker and non-smoker participants (aged 16-20years, 60% female). Any cigarette smoking and number of cigarettes smoked on a given day, the number of tobacco outlets within 100m of activity space polylines each day, the number of minutes participants spent within 100m of tobacco outlets each day and demographic characteristics (age, sex, race/ethnicity and perceived socio-economic status). Controlling for demographic characteristics, the findings of multi-level mixed effects logistic models were inconclusive, whether or not the number of tobacco outlets within 100m of youths' activity space polylines or the number of minutes spent within 100m of tobacco outlets were associated with whether the participant smoked cigarettes on a given day [odds ratio (OR)=1.05, P=0.24; OR=0.99, P=0.81, respectively]. However, in multi-level zero-inflated negative binomial models, the risk of smoking an additional cigarette on a given day increased with each additional tobacco outlet [incidence rate ratio (IRR)=1.04, P<0.05] and each additional minute spent within 100m of tobacco outlets (IRR=1.01, P<0.001) each day. Among young people in urban California, differences in day-to-day exposure to tobacco outlets within activity spaces does not seem to be significantly associated with whether a person smokes a cigarette on a given day, but higher exposure to tobacco outlets appears to be positively associated with the number of cigarettes smoked on that day.

Negative Affect and Loss of Control Eating Among Bariatric Surgery Patients: an Ecological Momentary Assessment Pilot Investigation.

Research shows that loss of control (LOC) eating impacts weight outcomes following bariatric surgery, but mechanisms explaining the development and/or maintenance of post-surgical LOC eating remain unclear. Ecological momentary assessment (EMA) research among eating disorder populations has demonstrated prospective relationships between negative affect (NA) and LOC eating; however, this momentary effect has not been examined among bariatric surgery patients. Thus, this study used EMA data to examine momentary relationships between NA and LOC eating among pre- and post-bariatric surgery patients. Fourteen pre- and 17 post-RYGB patients completed 2weeks of EMA data collection. Participants responded to seven signals daily wherein they rated their mood and severity of LOC eating. Higher momentary NA predicted more severe LOC eating for all participants. Group had a moderating effect, demonstrating that the association between NA and LOC eating was stronger among the post-surgery group. Percent total body weight loss (%TBWL) had a moderating effect within the post-surgery group, demonstrating that the relationship between NA and LOC eating was stronger for those who experienced less weight loss. Finally, between-subjects analyses revealed that, for individuals with lower %TBWL, lower overall NA and higher overall positive affect (PA) were related to greater LOC eating. This research demonstrates that affect influences the effect of LOC eating on weight loss following bariatric surgery. While further work is needed to extend these preliminary findings, this research suggests that affective experience might become an important target in the assessment and treatment of LOC eating among bariatric patients.

Mathematically Modeling Anhedonia in Schizophrenia: A Stochastic Dynamical Systems Approach.

Anhedonia, traditionally defined as a diminished capacity for pleasure, is a core symptom of schizophrenia (SZ). However, modern empirical evidence indicates that hedonic capacity may be intact in SZ and anhedonia may be better conceptualized as an abnormality in the temporal dynamics of emotion. To test this theory, the current study used ecological momentary assessment (EMA) to examine whether abnormalities in one aspect of the temporal dynamics of emotion, sustained reward responsiveness, were associated with anhedonia. Two experiments were conducted in outpatients diagnosed with SZ (n = 28; n = 102) and healthy controls (n = 28; n = 71) who completed EMA reports of emotional experience at multiple time points in the day over the course of several days. Markov chain analyses were applied to the EMA data to evaluate stochastic dynamic changes in emotional states to determine processes underlying failures in sustained reward responsiveness. In both studies, Markov models indicated that SZ had deficits in the ability to sustain positive emotion over time, which resulted from failures in augmentation (ie, the ability to maintain or increase the intensity of positive emotion from time t to t+1) and diminution (ie, when emotions at time t+1 are opposite in valence from emotions at time t, resulting in a decrease in the intensity of positive emotion over time). Furthermore, in both studies, augmentation deficits were associated with anhedonia. These computational findings clarify how abnormalities in the temporal dynamics of emotion contribute to anhedonia.

Assessment of Microstressors in Adults: Questionnaire Development and Ecological Validation of the Mainz Inventory of Microstressors.

BackgroundMany existing scales for microstressor assessment do not differentiate between objective (ie, observable) stressor events and stressful cognitions or concerns. They often mix items assessing objective stressor events with items measuring other aspects of stress, such as perceived stressor severity, the evoked stress reaction, or further consequences on health, which may result in spurious associations in studies that include other questionnaires that measure such constructs. Most scales were developed several decades ago; therefore, modern life stressors may not be represented. Ecological momentary assessment (EMA) allows for sampling of current behaviors and experiences in real time and in the natural habitat, thereby maximizing the generalization of the findings to real-life situations (ie, ecological validity) and minimizing recall bias. However, it has not been used for the validation of microstressor questionnaires so far.ObjectiveThe aim is to develop a questionnaire that (1) allows for retrospective assessment of microstressors over one week, (2) focuses on objective (ie, observable) microstressors, (3) includes stressors of modern life, and (4) separates stressor occurrence from perceived stressor severity.MethodsCross-sectional (N=108) and longitudinal studies (N=10 and N=70) were conducted to evaluate the Mainz Inventory of Microstressors (MIMIS). In the longitudinal studies, EMA was used to compare stressor data, which was collected five times per day for 7 or 30 days with retrospective reports (end-of-day, end-of-week). Pearson correlations and multilevel modeling were used in the analyses.ResultsHigh correlations were found between end-of-week, end-of-day, and EMA data for microstressor occurrence (counts) (r≥.69 for comparisons per week, r≥.83 for cumulated data) and for mean perceived microstressor severity (r≥.74 for comparisons per week, r≥.85 for cumulated data). The end-of-week questionnaire predicted the EMA assessments sufficiently (counts: beta=.03, 95% CI .02-.03, P<.001; severity: beta=.73, 95% CI .59-.88, P<.001) and the association did not change significantly over four subsequent weeks.ConclusionsOur results provide evidence for the ecological validity of the MIMIS questionnaire.