Feasibility and acceptability of post-hospitalization ecological momentary assessment in patients with psychotic-spectrum disorders

Abstract

Background Up to 50% of patients with psychotic-spectrum disorders are medication nonadherent. The use of real-time assessment via ecological momentary assessment (EMA) on mobile devices might offer important insights into adherence behaviors that cannot be measured in the clinic. However, existing EMA studies have only studied acutely ill patients during hospitalization or more stable patients in the community. Methods Feasibility and acceptability of EMA in 65 patients with psychotic-spectrum disorders who were recently discharged from the hospital were assessed. EMA was administered for four weeks via study-provided mobile devices. Feasibility was measured by study recruitment/retention rates, patients' connectivity, and completion rates. Quantitative and qualitative acceptability data were collected. Results Participants completed 28-31% of offered EMA assessments. The only significant predictor of reduced EMA completion was recent cannabis use. EMA completion was maintained from weeks 1-3 but significantly dropped at the fourth week. Patient acceptability feedback was generally positive; negative comments related primarily to technological problems. Conclusions This was the first study to use EMA in recently discharged patients with psychotic-spectrum disorders. EMA is feasible and acceptable in this population, but completion rates were lower than in more stable samples. Future research should consider limiting the assessment period, screening for substance use, and integrating assessment with intervention elements to increase EMA engagement.

Time-lagged predictors of daily medication nonadherence beliefs during the month post-hospital discharge in patients with psychotic–spectrum disorders

“…In the “parent study” (Moitra et al, 2017), 49 patients returned the device at 1 month follow-up and 37 completed EMA surveys. In the current analysis, of the 37 who completed surveys, 12 participants were excluded due to completing too few surveys for use in time-lagged analysis (≤ 10 surveys).…”

“…Details of study methods have been previously reported (Moitra et al, 2017). Eligibility criteria were: (a) currently hospitalized (inpatient/partial psychiatric hospital); (b) DSM-5 criteria for a schizophrenia-spectrum disorder or a mood disorder with psychotic features based on Structured Clinical Interview for DSM-IV (SCID); (c) 18 years or older; (d) prescribed oral antipsychotic medication; and (e) ability to speak/read English sufficiently to complete the assessments.…”

“…The current investigation is an analysis of data from a larger study testing the feasibility and acceptability of EMA in patients with psychosis leaving the hospital (Moitra et al, 2017). In this previous study, we found EMA completion rates similar to those reported in other studies using acutely ill samples.…”

Identifying psychosis spectrum disorder from experience sampling data using machine learning approaches

“…Several feasibility studies showed that mobile device delivered ESM assessments are well accepted even among patients with serious mental illness, with similar completion rates to those in other diseases (Edwards et al, 2016;Kimhy et al, 2006;Moitra et al, 2017).…”

Ecological Momentary Assessment

“…Misstrauen, paranoide Ideen, oder desorganisiertes Verhalten, sind häufige Symptome einer Psychose und stellen augenscheinlich zunächst ein Hindernis für eine EMA-Studie oder Intervention dar. Die aktuelle Studienlage zeigt jedoch, dass Personen mit Erkrankungen aus dem Psychosespektrum mit unterschiedlichen Symptomausprägungen erfolgreich eingeschlossen werden konnten, einschließlich Patienten mit akuten Halluzinationen, paranoiden oder anderen Wahnideen und formalen Denkstörungen (21,(24)(25)(26)(27)(28). Außerdem wurde EMA erfolg-reich in Studien durchgeführt, in denen Patienten mit simultanem Alkoholmissbrauch oder dem Konsum anderer Drogen eingeschlossen wurden (29)(30)(31)(32).…”