Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults

Moore, Raeanne C.; Depp, Colin A.; Wetherell, Julie Loebach; Lenze, Eric J.

doi:10.1016/j.jpsychires.2016.01.011

Cited by 275Mental Health Research TopicsMindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults

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Moore, Raeanne C., Depp, Colin A., Wetherell, Julie Loebach, Lenze, Eric J.·2016·Journal of Psychiatric Research

DOI 10.1016/j.jpsychires.2016.01.011PMC PMC4769895

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Abstract

As mobile data capture tools for patient-reported outcomes proliferate in clinical research, a key dimension of measure performance is sensitivity to change. This study compared performance of patient-reported measures of mindfulness, depression, and anxiety symptoms using traditional paper-and-pencil forms versus real-time, ambulatory measurement of symptoms via ecological momentary assessment (EMA). Sixty-seven emotionally distressed older adults completed paper-and-pencil measures of mindfulness, depression, and anxiety along with two weeks of identical items reported during ambulatory monitoring via EMA before and after participation in a randomized trial of Mindfulness-Based Stress Reduction (MBSR) or a health education intervention. We calculated effect sizes for these measures across both measurement approaches and estimated the Number-Needed-to-Treat (NNT) in both measurement conditions. Study outcomes greatly differed depending on which measurement method was used. When EMA was used to measure clinical symptoms, older adults who participated in the MBSR intervention had significantly higher mindfulness and significantly lower depression and anxiety than participants in the health education intervention at post-treatment. However, these significant changes in symptoms were not found when outcomes were measured with paper-and-pencil measures. The NNT for mindfulness and depression measures administered through EMA were approximately 25-50% lower than NNTs derived from paper-and-pencil administration. Sensitivity to change in anxiety was similar across administration modes. In conclusion, EMA measures of depression and mindfulness substantially outperformed paper-and-pencil measures with the same items. The additional resources associated with EMA in clinical trials would seem to be offset by its greater sensitivity to detect change in key outcome variables.

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Experiential sampling has greater sensitivity to clinical changes than standardized questionnaires.
“(a) greater sensitivity to clinical changes (Moore et al., 2016)”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Moore et al., 2016
The Discussion reports that ecological momentary assessment may be more sensitive than paper-and-pencil measures to changes in depression and mindfulness after a mindfulness intervention in distressed older adults. It also says sensitivity to change in anxiety was comparable across methods, so the unqualified claim of greater sensitivity to clinical changes overstates the finding. The supplied passages do not provide page numbers. (LLM, conf=0.86)
Experimental — accuracy not yet measured
EMA has advantages over one-time in-clinic measures, including generating more stable estimates of neurobehavioural symptoms for outcomes research, assessing dynamic changes among theoretically linked constructs, reducing recall bias for patients with neurobehavioural disorders, and enabling modeling of causal intra-individual relationships.
“This approach has many advantages87 over “one-time, in-clinic” measures, including the generation of more stable estimates of neurobehavioural symptoms for outcomes research;88 the assessment of dynamic changes among theoretically linked constructs;89 the reduction of recall bias for patients with neurobehavioural disorders;90,91 and the ability to model causal intra-individual relationships.92”
From Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders (2021) · cites this paper as [88]

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Self-citation

Authors: Moore, R. C., Depp, C. A., Wetherell, J. L., & Lenze, E. J.
Affiliations: University of California San Diego (US)
Washington University in St. Louis (US)
Corresponding author: Moore, Raeanne C.
ORCID: Moore, Raeanne C.
Depp, Colin A.
Wetherell, Julie Loebach
Lenze, Eric J.
Venue: Journal of Psychiatric Research
Publisher: Elsevier BV
Published: 2016-04
Volume: 75
Pages: 116-123
ISSN: 0022-3956 (ISSN-L)
DOI: 10.1016/j.jpsychires.2016.01.011
PMC: PMC4769895
OpenAlex: W2263248765
Cited by: 274
References: 34
Citations by year: 2026: 29 · 2025: 26 · 2024: 38 · 2023: 26 · 2022: 31 · 2021: 30 · 2020: 31 · 2019: 20 · 2018: 18 · 2017: 17 · 2016: 7
FWCI: 29.34
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychiatric Research (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institute on Aging (AG049369, R01AG049369)
National Institute of Mental Health (K23MH107260, L30 MH104725, R01MH100417, MH100417)
National Center for Complementary and Integrative Health (R34AT007070, R34AT007064)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: ecological momentary assessment, mindfulness, depression, anxiety, older adults, mindfulness-based stress reduction, patient-reported outcomes, ambulatory monitoring, number needed to treat, sensitivity to change, health education intervention, emotional distress
MeSH terms: Ecological Momentary Assessment, Aged, Anxiety Disorders, Depression, Female, Humans, Male, Statistics as Topic, Outcome Assessment, Health Care, Executive Function, Mindfulness

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Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults

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