# Daily mood monitoring of symptoms using smartphones in bipolar disorder A pilot study assessing the feasibility of ecological momentary assessment [[HOPE-S Project Index]] #EMI #EMA By Stefani Schwart, Summer Schultz ... et all --- [[List of EMA EMI SYSTEMS]] [[Designing EMI and EMA]] ==Takeaway for me is borrowing the idea of having 4 scaling questions. Maybe also can simplify the mood flow chart that we have currently. Is Social Stress important?== --- They uses EMA to explore if they can monitor patients with Bipolar Disorder [[Bipolar Disorder]] # How do they do it? - EMA surveys generated twice a day at random time interval - Once prompted, 30mins to complete, can snooze for 20 mins later. They also can refuse to answer. They also can submit survey any time of the day of they missed the prompt. - However potential bias "*Although allowing subjects to complete ratings through self-generated surveys when auto-generated surveys are missed improves convenience and may have improved compliance, this protocol may introduce bias. Subjects may not be able or may choose not to answer surveys for a particular symptom-related reason, or may choose to generate surveys at a particular time with regard to how they are feeling.*" # What do they want to measure? - ==Mood, Energy, Speed of Thoughts and Impulsivity == - Hypothesis: BD group would demonstrate lower mood and energy, and higher speed of thoughts, impulsivity and social stress. - *"We hypothesized that using smartphones to capture EMA ratings of mood symptoms would be feasible in those with BD, as measured by completion rates. To measure symptomology of BD, we selected a visual analog scale for mood, energy, speed of thoughts and impulsivity. These four areas correspond to independent factors of mania shown through factor analysis: dysphoric mood (mood), psychomotor pressure (energy), psychosis (not conducive to self-report measure), increased hedonic function (impulsivity) and irritable aggression (Cassidy et al., 1998a; 1998b). Additionally, mood, energy and intellect (thoughts) are the three areas noted through careful, longitudinal study of phenomenology by Emil Kraepelin to cycle out of sync, producing mixed states (Kraepelin, 1921; Mackinnon and Pies, 2006). It was hypothesized that the BD group would demonstrate lower mood and energy; and higher speed of thoughts, impulsivity and social stress. We hypothesized that greater variability in all symptoms would be present in the BD group."* - Asked the user the following questions ^88108f - For Mood, Energy, Speed of thoughts and impulsivity - On a scale 0 to 100 (50 is default) - Asked the user to mark how they are feeling in term of mood, energy, speed of thoughts and impulsivity. - 0 is low/depressed. 100 is up and elated. - ==For Social Stress== - "I am with others" - YES or NO - NO - - "I would rather be alone" - (1 = strong agree, 7 = strongly disagree) - if YES - Then reversed coded "I would rather be alone"(1 = strongly disagree, 7 = strongly agree) ==Because patient may be alone and OK being alone. Or with others but rather be alone== "*Participants were responsible for completing surveys twice a day at random, requesting information regarding mood state, energy and stress levels, and other symptoms. Once signaled to respond, participants had 30 min to complete the survey, with the option to delay survey completion for up to 20 min via a snooze feature. Each auto- generated survey timed out after 30 min if the participant did not complete and submit the survey. In order to best implement the EMA model, participants were instructed to complete the surveys at the time that they were generated by the device. However, participants could manually enter a survey any time that day if they missed an automated prompt. Participants could refuse to answer questions at any time. The surveys were active for fourteen days. Please see Fig 1 for screen shots of the survey.*" --- Pilot study.