EMA Study Research Articles

Temporal prediction of suicidal ideation in an ecological momentary assessment study with recurrent neural networks

IntroductionEcological Momentary Assessment (EMA) holds promise for providing insights into daily life experiences when studying mental health phenomena. However, commonly used mixed-effects linear statistical models do not fully utilize the richness of the ultidimensional time-varying data that EMA yields. Recurrent Neural Networks (RNNs) provide an alternative data analytic method to leverage more information and potentially improve prediction, particularly for non-normally distributed outcomes. MethodsAs part of a broader research study of suicidal thoughts and behavior in people with borderline personality disorder (BPD), eighty-four participants engaged in EMA data collection over one week, answering questions multiple times each day about suicidal ideation (SI), stressful events, coping strategy use, and affect. RNNs and mixed-effects linear regression models (MEMs) were trained and used to predict SI. Root mean squared error (RMSE), mean absolute percent error (MAPE), and a pseudo-R2 accuracy metric were used to compare SI prediction accuracy between the two modeling methods. ResultsRNNs had superior accuracy metrics (full model: RMSE = 3.41, MAPE = 42 %, pseudo-R2 = 26 %) compared with MEMs (full model: RMSE = 3.84, MAPE = 56 %, pseudo-R2 = 16 %). Importantly, RNNs showed significantly more accurate prediction at higher values of SI. Additionally, RNNs predicted, with significantly higher accuracy, the SI scores of participants with depression diagnoses and of participants with higher depression scores at baseline. ConclusionIn this EMA study with a moderately sized sample, RNNs were better able to learn and predict daily SI compared with mixed-effects models. RNNs should be considered as an option for EMA analysis.

Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study.

Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants' PA. Multilevel regression analyses in R were performed to examine these within-person associations. Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive.

Auditory reality and evaluation of hearing-aid function

Knowledge about people’s auditory reality (AR), i.e., the variety of listening demands and environments experienced in everyday life, is crucial when developing and evaluating hearing-aid function. We have previously investigated AR of older people with impaired hearing and generally seen an “easy” AR (many reports of passive listening and focused listening to TV, mainly in quiet). In the current study, we included participants with both normal and impaired hearing to investigate if participants with impaired hearing are avoiding difficult situations. The EMA study ran for a week with six daily prompts. In addition to the EMA survey items from our previous study, sound levels were recorded, and avoidance was investigated in an exit interview and by analyzing differences in AR between the groups. Preliminary analyses show that there were differences between the two groups in terms of where they were when they responded. The differences in listening task were small, but the participants with impaired hearing rated the reported situations to be more difficult than the normal-hearing participants. Our new results will be presented together with a discussion about the consequences of our auditory reality data on the way we evaluate hearing-aid function.

156. Daily Association of Drug Use Cravings and Physical and Emotional Well-Being among Students Attending a Recovery High School during COVID-19: Results from an EMA Study

156. Daily Association of Drug Use Cravings and Physical and Emotional Well-Being among Students Attending a Recovery High School during COVID-19: Results from an EMA Study

An examination of bidirectional associations between physical activity and mood symptoms among individuals diagnosed and at risk for bipolar spectrum disorders

ObjectivesActivation, a construct including energy and activity, is a central feature of Bipolar Spectrum Disorders (BSDs). Prior research found motor activity is associated with affect, and this relationship may be stronger for individuals with BSDs. The aims of this study were to investigate bidirectional relationships between physical activity and mood and evaluate whether bipolar risk status moderated potential associations. MethodsYoung adults at low-risk, high-risk, and diagnosed with BSD participated in a 20-day EMA study in which they wore an actiwatch to measure physical activity and sleep/wake cycles. They also reported depressive and hypo/manic symptoms three times daily. Multilevel linear models were estimated to examine how bipolar risk group moderated bidirectional relationships between physical activity and mood symptoms at within-day and between-day timescales. ResultsPhysical activity was significantly associated with subsequent mood symptoms at the within-day level. The relationship between physical activity and depressive symptoms was moderated by BSD risk group. An increase in physical activity resulted in a greater reduction of depressive symptoms for the BSD group compared to the low-risk and high-risk groups. ConclusionsInterventions targeting activity like behavioral activation may improve residual inter-episode mood symptoms.

Prompt-level predictors of compliance in an ecological momentary assessment study of young adults' mental health

BackgroundEcological momentary assessment (EMA) has become a popular method of gathering information about participants as they go about their daily lives. However, participant non-compliance, especially non-random compliance, in EMA is a concern. Better knowledge of the moment-to-moment factors that predict prompt non-response can inform the design of strategies to mitigate it. MethodWe used data from a general population young adult (n = 260) EMA study, ‘decades-to-minutes’ (D2M) and fitted dynamic structural equation models (DSEMs) to explore a range of candidate momentary predictors of missing the next prompt. ResultsWe found that higher levels of stress, overall negative affect, and the specific negative affective state of ‘upset’ at a given prompt predicted a greater likelihood of missing the next prompt. However, no other specific affective states, alcohol use, experiencing social provocations nor aggressive behaviour predicted missing the next prompt. LimitationsThe primary limitation of the present study was a lack of information on predictors concurrent with missed prompts. ConclusionsFindings point to the potential value of gathering information on momentary negative affect (especially feeling upset) and stress to help inform strategies that intervene to prevent application disengagement at optimal moments and to feed into strategies to mitigate bias due to non-random non-response in EMA studies.

Supplemental Material for Who Disengages From Emotion and When? An EMA Study of How Urgency and Distress Intolerance Relate to Daily Emotion Regulation

Supplemental Material for Who Disengages From Emotion and When? An EMA Study of How Urgency and Distress Intolerance Relate to Daily Emotion Regulation

Coping with the ‘new (ab)normal’ in school: an EMA study of youth coping with the return to in-person education during the COVID-19 pandemic

Many concerns exist about potential long-term psychosocial impacts of the COVID-19 pandemic on young people. While the school has been identified as having a vital role in psychological recovery post-disaster more generally, it is unclear as yet how young people have adapted to the return to in-person education. This paper reports on the preliminary findings from an intensive Ecological Momentary Analysis exploration of the affective wellbeing, experiences and coping of 82 Irish second-level students. The participants were found to experience more positive than negative events, and to have moderate-high levels of positive affect and perceived coping during the 7-day period of monitoring. However, the findings also suggest that some students, particularly those with pre-existing psychological difficulties, may be in need of additional targeted support. Accordingly, it is recommended that in the short to medium-term, second-level schools should strive to prioritise the psychological recovery and resilience of students such as through an emphasis on re-establishing and consolidating a sense of student connectedness.

Intensive Longitudinal Data Collection Using Microinteraction Ecological Momentary Assessment: Pilot and Preliminary Results.

BackgroundEcological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual’s behaviors and states. A new approach, microinteraction EMA (μEMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using μEMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated.ObjectiveThis paper describes the μEMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the μEMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the μEMA app, changes made to the main TIME Study μEMA protocol and app based on the pilot feedback, and preliminary μEMA results from a subset of active participants in the TIME Study.MethodsThe TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non–EMA burst days, participants answer μEMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and μEMA in a semistructured interview. A pilot study was used to test and refine the μEMA protocol before the main study.ResultsChanges made to the μEMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 μEMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%).ConclusionsThe TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that μEMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives.

Intact neural and behavioral correlates of emotion processing and regulation in weight-recovered anorexia nervosa: a combined fMRI and EMA study

Altered emotion processing and regulation mechanisms play a key role in eating disorders. We recently reported increased fMRI responses in brain regions involved in emotion processing (amygdala, dorsolateral prefrontal cortex) in acutely underweight anorexia nervosa (AN) patients while passively viewing negatively valenced images. We also showed that patients’ ability to downregulate activity elicited by positively valenced pictures in a brain region involved in reward processing (ventral striatum) was predictive of worse outcomes (increased rumination and negative affect). The current study tries to answer the question of whether these alterations are only state effects associated with undernutrition or whether they constitute a trait characteristic of the disorder that persists after recovery. Forty-one individuals that were weight-recovered from AN (recAN) and 41 age-matched healthy controls (HC) completed an established emotion regulation paradigm using negatively and positively valenced visual stimuli. We assessed behavioral (arousal) and fMRI measures (activity in the amygdala, ventral striatum, and dorsolateral prefrontal cortex) during emotion processing and regulation. Additionally, measures of disorder-relevant rumination and affect were collected several times daily for 2 weeks after scanning via ecological momentary assessment. In contrast to our previous findings in acute AN patients, recAN showed no significant alterations either on a behavioral or neural level. Further, there were no associations between fMRI responses and post-scan momentary measures of rumination and affect. Together, these results suggest that neural responses to emotionally valenced stimuli as well as relationships with everyday rumination and affect likely reflect state-related alterations in AN that improve following successful weight-recovery.

The Role of Affective Instability in Loss of Control Eating in Youth with Overweight/Obesity Across Development: Findings from Two EMA Studies.

Affective instability is common during adolescence, but at high levels it is associated with a variety of internalizing and externalizing disorders, including eating disorders. Although most models focus on affective intensity as a mechanism for explaining eating disorders in adults, affective instability may be more developmentally relevant at predicting eating behaviors in youth. Using ecological momentary assessment, this manuscript explored the association between loss of control over eating (LOC), a key component of dysregulated eating in youth, and affective instability in youth with overweight/obesity in two separate studies, one with youth in middle childhood and early adolescence (Study 1: ages eight to 13) and one in youth in early through middle adolescence (Study 2: ages 12-17). Overall, there was no association between affective instability and LOC in Study 1, but in Study 2, age moderated the association between positive affective instability and LOC, such that greater between-person positive affective instability (i.e., relative to peers) was associated with lower average LOC for youth earlier in adolescence and higher average LOC for those later in adolescence. Negative affective instability was also associated with LOC in Study 2, such that on days when youth reported less within-person negative affective instability (i.e., relative to their own average), they also reported greater average LOC. Findings across the two studies indicate that the association between affective instability and LOC may not emerge until adolescence, and when it does, both positive and negative affective instability may be important to consider.

Ecological Momentary Assessment: A Meta-Analysis on Designs, Samples, and Compliance Across Research Fields.

Ecological Momentary Assessments (i.e., EMA, repeated assessments in daily life) are widespread in many fields of psychology and related disciplines. Yet, little knowledge exists on how differences in study designs and samples predict study compliance and dropout-two central parameters of data quality in (micro-)longitudinal research. The current meta-analysis included k = 477 articles (496 samples, total N = 677,536). For each article, we coded the design, sample characteristics, compliance, and dropout rate. The results showed that on average EMA studies scheduled six assessments per day, lasted for 7 days, and obtained a compliance of 79%. Studies with more assessments per day scheduled fewer assessment days, yet, the number of assessments did not predict compliance or dropout rates. Compliance was significantly higher in studies providing financial incentives. Otherwise, design or sample characteristics had little effects. We discuss the implications of the findings for planning, reporting, and reviewing EMA studies.

Salivary oxytocin and touch in everyday life: Results from an EMA study during Covid-19 lockdown

BackgroundAffectionate touch is important in human social life. Previous research demonstrated that touch is associated with release of endogenous oxytocin and has calming and stress reducing effects. Less is known about the impact of Covid-19-related lockdown on psychobiological outcomes in everyday life. We, thus, focused on the relationship between daily social touch and oxytocin levels during Covid-19 lockdown.Methods173 women and 74 men (age: M=32.6, SD=13.1) participated in ecological momentary assessment on two consecutive days during Covid-19 pandemic in Spring 2020. At 6 timepoints per day participants collected saliva samples and simultaneously reported subjective momentary burden, mood and social interactions, including social touch. Concentrations of salivary oxytocin, cortisol, and alpha amylase were analyzed using enzyme linked immunoassay.ResultsHierarchical linear model (HLM) analyzes showed a significantly negative association between social touch intensity and self-reported burden levels (t=-2.683; p=.007) as well as positive association with oxytocin concentrations (t=2.476; p=.013).ConclusionsThese preliminary finding show that individuals experiencing intense social touch have higher salivary oxytocin concentrations and report less burden in their everyday life. While further analyses within this study are being conducted, these results suggest that oxytocin might play a mediating role between social touch and the individual's well-being.

Describing Ecological Momentary Assessment Methods for Collecting Dietary Intake in a Racially/Ethnically Diverse Sample

ObjectivesEcological momentary assessment (EMA) is an innovative tool being used in the obesity field to capture real-time information about people’s health. A recent systematic review regarding the use of EMA to assess dietary intake and physical activity in youth found the need for standardized reporting of EMA measures and methods. This presentation will discuss EMA methods used in the NIH-funded Family Matters study, including survey design, registration/technology, EMA protocols, implementation, and lessons learned for future EMA studies. MethodsFamily Matters is an incremental, two-phased (Phase I = 150 participants; Phase II = 627 participants), mixed-methods study conducted with a racially/ethnically diverse and immigrant/refugee sample from largely low-income households. Across two phases, the Family Matters research team designed and administered EMA surveys to parents of 5–9 year olds to measure momentary factors of importance to child weight and weight-related behaviors including parent feeding practices, child eating behaviors, meal preparation, and foods served at family meals. ResultsEMA data allowed for many cutting-edge research questions to be addressed, innovative analyses to be run, and methodological approaches to be advanced. Many diet-related topics were investigated, including 1) the investigation of both within-and across-day relationships between transient and chronic stress and parent feeding practices; 2) parental stress and mood earlier in the day and its association with parent feeding practices later in the day; and 3) family meal characteristics by meal type and day of the week. Additionally, concordance between diet-related EMA measures and objectively collected 24-hour dietary recalls was examined. Family Matters EMA diet-related measures will be presented and related results discussed. ConclusionsThis presentation will be valuable for researchers interested in using EMA for collecting obesity-related measures, such as dietary intake, physical activity, parent feeding practices, and stress/mood. Funding SourcesResearch is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge).

The Effect of Training on Participant Adherence With a Reporting Time Frame for Momentary Subjective Experiences in Ecological Momentary Assessment: Cognitive Interview Study.

BackgroundEcological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants’ adherence to the reporting instructions.ObjectiveThis study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants’ adherence to the EMA reporting timeframe instructions.MethodsTelephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen κ=0.64, 95% CI 0.55-0.73).ResultsThe results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (χ21=16.6; P<.001) in which the enhanced training condition yielded more reports within the intended reporting time frames for momentary EMA reports. Cognitive interview data from the coverage model did not lend themselves to reliable coding and were not analyzed.ConclusionsThe results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies.

Impulsivity and Sleep Disturbance Predict Next-Day Mood Symptoms in a Sample at High Risk for Bipolar Disorder: An EMA Study

Impulsivity and Sleep Disturbance Predict Next-Day Mood Symptoms in a Sample at High Risk for Bipolar Disorder: An EMA Study

Motives for Substance Use in Daily Life: A Systematic Review of Studies Using Ecological Momentary Assessment.

The motivational model of substance use posits four motive subtypes (coping, enhancement, social, conformity) dynamically interact with contextual factors to impact decisions about substance use. Yet, prior studies assessing the motivational model have relied on between-person, cross-sectional evaluations of trait motives. We systematically reviewed ecological momentary assessments (EMA) studies (N=64) on motives for substance use to examine: methodological features of EMA studies examining the motivational model, support for the motivational model between and within individuals, and associations between trait motives and daily processes. Results of the reviewed studies provide equivocal support for the motivational model, and suggest that EMA measures and trait measures of motives might not reflect the same construct. The reviewed body of research indicates most studies have not examined the momentary and dynamic nature of the motivational model and more research is needed to inform interventions that address heterogeneous reasons for substance use in daily life.

Evaluation of Hearing Aids in Everyday Life Using Ecological Momentary Assessment: What Situations Are We Missing?

Background Ecological momentary assessment (EMA) is a method to evaluate hearing aids in everyday life that uses repeated smartphone-based questionnaires to assess a situation as it happens. Although being ecologically valid and avoiding memory bias, this method may be prone to selection biases due to questionnaires being skipped or the phone not being carried along in certain situations. Purpose This investigation analyzed which situations are underrepresented in questionnaire responses and physically measured objective EMA data (e.g., sound level), and how such underrepresentation may depend on different triggers. Method In an EMA study, 20 subjects with hearing impairment provided daily information on reasons for missed data, that is, skipped questionnaires or missing connections between their phone and hearing aids. Results Participants often deliberately did not bring the study phone to social situations or skipped questionnaires because they considered it inappropriate, for example, during church service or when engaging in conversation. They answered fewer questions in conversations with multiple partners and were more likely to postpone questionnaires when not in quiet environments. Conclusion Data for social situations will likely be underrepresented in EMA. However, these situations are particularly important for the evaluation of hearing aids, as individuals with hearing impairment often have difficulties communicating in noisy situations. Thus, it is vital to optimize the design of the study to find a balance between avoiding memory bias and enabling subjects to report retrospectively on situations where phone usage may be difficult. The implications for several applications of EMA are discussed. Supplemental Material https://doi.org/10.23641/asha.12746849.

Ecological momentary assessment of daily drug use and harm reduction service utilization among people who inject drugs in non-urban areas: A concurrent mixed-method feasibility study

BackgroundEcological momentary assessments (EMA) can improve data accuracy and be useful for understanding the real-time co-occurrence of drug use and harm reduction service utilization among people who inject drugs (PWID); however, feasibility and acceptability of EMA in this population is unknown. MethodsWe conducted qualitative interviews (n = 45) and EMA surveys (n = 38) with PWID in cities and towns outside of Massachusetts' and Rhode Island's capital cities to 1) assess EMA feasibility and acceptability and 2) examine day-level correlations between drug use and harm reduction service utilization. ResultsQualitative and quantitative data demonstrated that a 14-day EMA study was both feasible and acceptable. Interviews identified housing instability and related disruptions in cellphone access as challenges to consistent EMA participation. In the 14-day EMA study, EMA completion was high (mean = 10.1 days,SD = 5.3). High completion was associated with higher education (p = 0.005), receiving EMA via SMS text (vs. email, p = 0.017), and not having injected crack in the past month (p = 0.026). Of those who responded (n = 29), 100 % reported willingness to participate in a similar future study. Past 24 -h use of harm reduction services was positively associated with past 24 -h injection drug use (p = 0.013), but not past 24 -h syringe sharing (p = 0.197). ConclusionFindings support the acceptability, feasibility, and potential utility of EMA for understanding daily experiences of PWID. Future studies should explore strategies to overcome structural barriers to maximize EMA participation, and assess how injection practices, syringe sharing, and use of harm reduction services interact to impact health risks in larger and diverse samples of PWID.

4178 The feasibility/acceptability of using smartphone technology to assess mental health symptoms among Spanish-speaking outpatients

OBJECTIVES/GOALS: Geographic and linguistic isolation is associated with negative mental health outcomes, including increased risk for suicide, among ethnic/racial minorities. This study explores the feasibility of using smartphone technology with active and passive sensing to assess mental health symptoms and social behavior among at risk Spanish-speakers. METHODS/STUDY POPULATION: Participants were 13 Spanish-speaking adult outpatients who reported hopelessness/suicide ideation in the last month. Participants completed a baseline interview, 2-weeks of remote ecological momentary assessments (EMA; 4xday) using a smartphone with optional passive sensing (GPS, ambient sound recording), and a final interview. All participants identified as Hispanic (84.6% female, M age = 42.24 years). 53.8% identified as White, with 46.2% reporting race as Other (e.g., Indio, Trigueña). On average, participants had lived in the USA for 6.56 years (SD = 12.63 years). A majority (69.2%) met for Major Depressive Episode Current. At baseline, 53.8% reported passive and 23.1% reported active suicide ideation in the last month. 46.2% of participants reported a previous suicide attempt. RESULTS/ANTICIPATED RESULTS: A majority (84.6%) of participants consented to all passive data collection (GPS tracking and ambient sound recording). One participant dropped out after baseline and did not complete the EMA study portion. Participants completed on average 76.93% EMA survey instances (SD = 18.01%). Baseline depression/anxiety severity were significantly positively associated with symptom severity at 2-week follow-up (p &lt; .01); however, baseline suicide ideation was not associated with ideation at follow-up. Participants did not report significant changes in mood or ideation from baseline to 2-week follow-up. Symptom severity at baseline was not associated with EMA instances completed. Percent of EMA instances completed were also not associated with symptom severity at follow-up, controlling for baseline severity. DISCUSSION/SIGNIFICANCE OF IMPACT: Results support the feasibility of smartphones to assess mental health symptoms and behaviors in real time, real world settings with Spanish-speakers. A majority of patients consented to active and passive remote assessments. Adherence to remote EMA was good and study attrition was minimal. Implications and future directions will be discussed.