A pilot study on ecological momentary assessment in asylum-seeking children and adolescents resettled to Germany: Investigating compliance, post-migration factors, and the relation between daily mood, sleep patterns, and mental health

Abstract

Background Asylum-seeking children and adolescents (ASCs) resettled to western countries show elevated levels of psychological distress. While research on the mental health of ASCs is increasing, less is known about their day-to-day living experiences such as their daily mood, sleep patterns, and post-migration factors. Moreover, no examination in situ, using smartphone-assisted ecological momentary assessment (EMA), has been conducted up to now among ASCs. Furthermore, we do not know if screening measures succeed in reflecting the daily mood of ASCs experienced in everyday life. Methods We undertook a smartphone-assisted EMA study over a two-week period with 3 measurements a day. Participants were N = 40 ASCs from 10 different countries who had resettled to Germany. They completed standardized questionnaires screening for history of trauma and clinical symptoms (post-traumatic stress symptoms, depression, and anxiety) that were carried out in interview-like settings, and they participated in the subsequent EMA where they rated mood, sleep parameters, and post-migration factors on a daily basis. Multilevel models of clinical symptoms, daily mood, and sleep parameters were computed based on a total of 680 measurements. Results The multiply traumatized and highly distressed participants reported different levels of discrimination, and various social activities and contacts in the EMA. The overall compliance rate was shown to be 40.5%. Higher PTSS and anxiety scores were associated with lower levels of daily mood and poorer outcomes of some sleep parameters. Depression scores were not associated with any of the variables assessed in the EMA. Conclusions Smartphone-assisted EMA among ASCs resettled to Germany proved to be implementable despite a rather low compliance rate. Not only do ASCs show high symptom levels, they are also affected by these symptoms in their daily lives. The results emphasize the need for concise screenings and psychological treatment for this high-risk population. Limitations include the convenient nature of the sample and the lack of a comparison group.

Remote measurement technologies for depression in young people: A realist review with meaningful lived experience involvement and recommendations for future research and practice

“…Whilst a meta-analysis found an association between more prompts per day and higher adherence in clinical samples 44 , prompt fatigue at the daily level was common across studies, with more robust engagement obtained in studies employing weekly or biweekly EMA protocols 45,46 . It may be that the timing and content of prompts is more important than frequency, with the suggestion of smart prompts triggered when an individual is more likely to be receptive and able to respond 47 , allowing convergence of prompt, motivation, and ability as the three elements required for a behaviour to occur 48,49 . Provision of incentives, personalised feedback and gamification were also mentioned as ways to encourage continued engagement 50 .…”

“…Five studies reported no significant effect of depression symptom severity on drop out [95,101], EMA prompt response rates 44 , amount of entries / missing data 67 or exclusion due to missing data 76 . Two studies suggested that those with greater depression symptom severity may be less likely to drop out 47 , with continued engagement beyond the minimum time required by the study 115 . Only 1 study found greater depression symptom severity, as well as treatment intensity, to be related to lower use of their smartphone app 101 .…”

“…RMT data features have been considered in isolation so far; however, their combination in linear regression and machine learning models increased predictive performance, with classification accuracy for standardised measures of depression ranging from 77 -86% 42,58,[73][74][75] . Further improvements were obtained through contextual filtering of RMT data features (e.g., weekday / weekend sleep, daytime / evening conversation frequency) 76 , normalisation relative to an individual's own data 77 , and inclusion of parent-report EMA responses 47,73 .…”

State‐level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study

“…A sample of 50 participants was estimated to provide statistical power of >.80. were mostly female (n = 28; 57.1%) and self-identified as White (n = 32; 65.3%), multi-racial (n = 7; 14.3%), Hispanic or Latino (n = 3; 6.1%), Native Hawaiian or Pacific Islander (n = 2; 4.1%), Black or African American (n = 1; 2.0%), Asian (n = 1; 2.0%) or other (n = 3; 6.1%). Participants were included in analyses if they responded to at least 35% of EMA signals during the 14-day protocol (based on average compliance rates required for inclusion in prior EMA studies of children and adolescents; Hiekkaranta et al, 2021;Michel et al, 2022;Müller et al, 2021;Parker et al, 2022;van Roekel et al, 2019;Woods et al, 2020), and had accuracy above 0% on at least 50% of completed WM tasks, indicating that responses reflected at least some level of effort. A total of 17 participants were removed from analyses due to low compliance (n = 14) or attrition (n = 3).…”

Zooming in on everyday ethnic-racial discrimination: A review of experiencing sampling methodology studies in adolescence

“…Most studies (85%) consisted either exclusively or partially of African American or Black participants. One study (Müller et al, 2021) used a signal-contingent design, where participants were prompted to fill out daily diaries at random intervals by the researchers, while all others ESM studies adopted an intervalcontingent design, in which participants filled out daily diaries in the evening. Number of days sampled ranged from 9 to 58 while the most common sampling period was 14 days (68%, 13 studies).…”