Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: a systematic review

May combine two claims.

Patient dropout in selected EMA studies was related to diagnosis change, subjective burden, technical problems, incomplete data, retrospective completion of the electronic diary, missed prompts, worsening of symptoms, or non-attendance at follow-up sessions.

“Patient dropout was related to diagnosis change, subjective burden, technical problems, incomplete data, retrospective completion of the electronic diary, missed prompts, worsening of symptoms, or non-attendance at follow-up sessions.”

May combine two claims.

Most selected EMA studies collected data using randomized or semi-randomized schemas, whereas nine studies prompted participants at fixed time points during the day.

“Most of the studies collected data using randomized or semi-randomized schemas, whereas nine studies prompted participants to note information at fixed time points during the day.”

May combine two claims.

Depression was associated with lower perceived sleep quality, which in turn affected negative emotional reactivity to both neutral and unpleasant events during the day.

“Through the daily administration of morning self-reports about sleep patterns, O’Leary et al. found that depression was associated with lower perceived sleep quality, which in turn affected negative emotional reactivity to both neutral and unpleasant events during the day [47].”

• cites [47] Small, 2017, Sleep quality in healthy and mood-disordered persons predicts daily life emotional reactivity, Cogn. Emot. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A reduction in depressive symptoms was already observable one day after beginning pharmacological treatment, and symptoms on day 7 were predictive of treatment outcome.

“According to the results, a reduction in depressive symptoms was already observable one day after beginning the treatment, and symptoms on day 7 were predictive of treatment outcome.”

May combine two claims.

The control group was more likely to exaggerate retrieval of positive affect rather than negative affect, but this trend was not observed in depressed patients.

“Interestingly, the control group was more likely to exaggerate the retrieval of PA rather than NA, but this trend was not observed in depressed patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A few selected EMA studies did not report compliance information.

“A few studies did not report this information [35,40,41,42,51,57,60].”

• cites [35] Ottaviani, C., Shahabi, L., Tarvainen, M., Cook, I., Abrams, M., and Shapiro, D. (2015). Cognitive, behavioral, and autonomic correlates of mind wandering and perseverative cognition in major depression. Front. Neurosci. sourceNot checked yet

  Not checked in the free run.

• cites [40] Schaffer, A., Kreindler, D., Reis, C., and Levitt, A.J. (2013). Use of Mental Health Telemetry to Enhance Identification and Predictive Value of Early Changes During Augmentation Treatment of Major Depression. J. Clin. Psychopharmacol. sourceNot checked yet

  Not checked in the free run.

• cites [41] Hung, 2016, Smartphone-based ecological momentary assessment for Chinese patients with depression: An exploratory study in Taiwan, Asian J. Psychiatr. sourceNot checked yet

  Not checked in the free run.

• cites [42] Stetler, 2004, Uncoupling of social zeitgebers and diurnal cortisol secretion in clinical depression, Psychoneuroendocrinology sourceNot checked yet

  Not checked in the free run.

• cites [51] Putnam, K.M., and McSweeney, L.B. (2008). Depressive symptoms and baseline prefrontal EEG alpha activity: A study utilizing Ecological Momentary Assessment. Biol. Psychol. sourceNot checked yet

  Not checked in the free run.

• cites [57] Slofstra, 2018, Exploring the relation between visual mental imagery and affect in the daily life of previously depressed and never depressed individuals, Cogn. Emot. sourceNot checked yet

  Not checked in the free run.

• cites [60] Fisher, A.J., Reeves, J.W., Lawyer, G., Medaglia, J.D., and Rubel, J.A. (2017). Exploring the idiographic dynamics of mood and anxiety via network analysis. J. Abnorm. Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Booij et al. identified higher cortisol and α-amylase levels among depressed individuals.

“Booij et al. identified higher cortisol and α-amylase levels among depressed individuals [36].”

• cites [36] Booij, S.H., Bos, E.H., Bouwmans, M.E.J., Van Faassen, M., Kema, I.P., Oldehinkel, A.J., and De Jonge, P. (2015). Cortisol and α-amylase secretion patterns between and within depressed and non-depressed individuals. PLoS ONE. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In most selected EMA studies, participants could complete self-reports for a fixed time period after the prompt, ranging from a few minutes to a maximum of one hour.

“In most of the studies, participants could complete self-reports for a fixed time period after the prompt, ranging from a few minutes to a maximum of one hour.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Conrad and colleagues could not find cortisol differences between depressed and non-depressed participants.

“Nevertheless, Conrad and colleagues could not find cortisol differences between depressed and non-depressed participants.”

May combine two claims.

Sixteen selected EMA studies reported compliance rates higher than 85%, five showed rates between 84% and 70%, and four collected 65% of the total possible answers.

“Sixteen studies reported compliance rates higher than 85%, five studies showed rates between 84% and 70%, and four studies collected 65% of the total possible answers.”

May combine two claims.

Negative affect was positively associated with cortisol 50% of the time, while the association between cortisol and positive affect was almost always negative.

“For instance, NA was positively associated with cortisol 50% of the time, while the association between cortisol and PA was almost always negative.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two selected EMA studies gave participants the possibility of postponing prompts to increase compliance.

“To increase compliance, two studies also gave participants the possibility of postponing prompts.”

May combine two claims.

A total of 33 articles were included in the systematic review, comprising 26 EMA studies and 7 EMI studies.

“A total of 33 articles were included (EMA = 26; EMI = 7).”

May combine two claims.

Among remitted MDD patients, reduced cortisol levels throughout the day and a different interaction between affect and cortisol were observed despite remission.

“Finally, interesting outcomes were also observed among remitted MDD patients [44]. Despite remission, patients showed reduced cortisol levels throughout the day and a different interaction between affect and cortisol, thus suggesting a reduction in the HPA axis’ responsiveness as a potential marker of recurrent depression.”

• cites [44] Huffziger, 2013, Effects of mood and rumination on cortisol levels in daily life: An ambulatory assessment study in remitted depressed patients and healthy controls, Psychoneuroendocrinology sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

According to the model, a worsening of depressive mood was associated with increased intermittency of locomotor activity.

“According to their model, a worsening of depressive mood was associated with increased intermittency of locomotor activity.”

May combine two claims.

Both healthy and depressed participants showed higher levels of positive affect following physical activity, but no decrease in negative affect.

“Both healthy and depressed participants showed higher levels of PA following physical activity, but no decrease in NA.”

Probably not a substantial claim: may not pass S3 (load-bearing).

After eliminating duplicates and first selection by titles and abstracts, 401 articles were retrieved.

“After eliminating duplicate papers, we made a first selection by reading titles and abstracts, and 401 articles were retrieved.”

May combine two claims.

Sleep quality affected daily mood, but not vice versa, because higher sleep quality was associated with increased positive affect and decreased negative affect the following day.

“Nevertheless, sleep quality affected daily mood, but not vice versa, because higher sleep quality was associated with increased PA and decreased NA the following day.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The search produced a total of 4993 articles.

“This search produced a total of 4993 articles.”

May combine two claims.

A bidirectional relationship was found between affect and fatigue, and melatonin: melatonin is associated with changes in affect and fatigue, and affect and fatigue are predictors of melatonin levels.

“A bidirectional relationship between affect and fatigue, and melatonin was pointed out: Melatonin is associated with changes in affect and fatigue; however, affect and fatigue are also predictors of melatonin levels.”

May combine two claims.

Sleep duration affected next-day physical activity, but no difference between depressed and non-depressed individuals was observed.

“Similarly, sleep duration was found to affect next-day physical activity, but again, no difference between depressed and non-depressed individuals was observed [38].”

• cites [38] Bouwmans, M.E.J., Oude Oosterik, N.A.M., Bos, E.H., de Groot, I.W., Oldehinkel, A.J., and de Jonge, P. (2018). The Temporal Order of Changes in Physical Activity and Subjective Sleep in Depressed Versus Nondepressed Individuals: Findings From the MOOVD Study. Behav. Sleep Med. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

After applying selection criteria, 40 papers were obtained.

“We finally selected publications by applying the selection criteria described in the following paragraph, obtaining 40 papers.”

May combine two claims.

Participants who did not show the association between affect/fatigue and melatonin were likely to report higher rates of depression, worse sleep quality, and lower energy expenditure.

“Participants that did not show this association were likely to report higher rates of depression, worse sleep quality, and lower energy expenditure.”

May combine two claims.

Medlink usability scores were encouraging for ease of use and learnability but low for perceived usefulness and satisfaction.

“participants reported encouraging scores for ease of use (mean = 5.7 ± 1.1) and learnability (mean = 6.1 ± 1.5), but low scores for perceived usefulness (mean = 4.6 ± 1.0) and satisfaction (mean = 4.8 ± 0.8)”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Help4Mood patients reported sometimes being bored by excessively long sessions and would have appreciated more psychoeducational material and a more tailored experience.

“patients reported sometimes being bored by excessively long sessions. They would have appreciated receiving more psychoeducational material and a more tailored experience”

Probably not a substantial claim: may not pass S3 (load-bearing).

Psymate participants would have appreciated receiving more specific and practical advice related to EMA-based feedback.

“participants would have appreciated receiving more specific and practical advice related to the EMA-based feedback (3.2 ± 2.0)”

May combine two claims.

Psymate EMA-derived feedback was highly appreciated and considered valuable.

“the feedback was highly appreciated (usefulness of feedback = 6.2 ± 0.7) and considered valuable (feedback to improve daily skills = 5.4 ± 1.1)”

May combine two claims.

Medlink weekly psychoeducation lessons had encouraging ratings and were reported as the most interesting and useful parts of the application.

“encouraging ratings were observed for the weekly psychoeducation lessons (liking = 6.0 ± 1.1; ease of use = 6.6 ± 0.5; learnability = 6.6 ± 0.5; and usefulness = 5.8 ± 1.7), which were also reported to be the most interesting and useful parts of the application”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mobylize satisfaction was rated 5.71 on a scale from 1 to 7.

“satisfaction with the application was rated as 5.71 on a scale from 1 to 7”

May combine two claims.

Psymate participants did not find the number of daily prompts and the time needed to complete assessments stressful.

“The number of daily prompts and the time needed to complete assessments was not stressful (number of beeps per day = 3.1 ± 1.6; time to answer = 2.5 ± 1.5).”

May combine two claims.

Compliance and dropout rates showed encouraging results, with most studies reporting more than 70% adherence.

“We also reported compliance and dropout rates, which showed encouraging results, with most of the studies reporting more than 70% adherence.”

May combine two claims.

Help4Mood participants were quite satisfied; most would use it in everyday life and suggest it to other patients.

“Participants involved in the Help4Mood study were quite satisfied with the application. Most of them would use it in everyday life and suggest it to other patients.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Psymate participants found it very simple to use and provided clear instructions.

“participants found that Psymate was very simple to use and provided clear instructions (verbal instructions = 6.6 ± 0.7; written instructions = 6.5 ± 1.0; Psymate answers = 2.6 ± 1.5)”

May combine two claims.

No standard and validated sets of items have been developed for EMA protocols, raising the problem of context validity.

“To date, no standard and validated sets of items have been developed for EMA protocols, raising the problem of context validity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Help4Mood virtual agent was appreciated, but some participants perceived it as too cold, repetitive, and not sufficiently realistic.

“The idea of a virtual agent to guide participants in completing the assessments was appreciated; however, some participants perceived the agent as too cold, repetitive, and not sufficiently realistic.”

May combine two claims.

Medlink feedback interviews showed neutral comments regarding daily self-reports, perceived as not very useful, and contrasting opinions regarding feedback graphs.

“feedback interviews showed neutral comments regarding daily self-reports, that were perceived as not very useful; contrasting opinions were collected regarding feedback graphs”

May combine two claims.

In the current literature, only four ecological interventions have been developed, and only two of them were tested in a randomized-controlled trial.

“In the current literature, only four ecological interventions have been developed, and only two of them were tested in a randomized-controlled trial (RCT).”

May combine two claims.

Our review showed promising results in terms of patient satisfaction and clinical efficacy, further supporting the need for more efforts in this direction.

“Our review showed promising results in terms of patient satisfaction and clinical efficacy, further supporting the need for more efforts in this direction.”

May combine two claims.

Three EMI features were highly appreciated: visual feedback about daily assessments and self-monitoring of daily patterns; psychoeducational material on depression and its mechanisms; and continuous or periodic communication with a trained clinician.

“we were able to identify three EMI features that were highly appreciated: The possibility of receiving visual feedback about daily assessments and, therefore, self-monitoring of daily patterns; the availability of psychoeducational material on depression and its mechanisms; and the opportunity to have continuous or periodic communication with a trained clinician.”

May combine two claims.

Compliance rates were sometimes not encouraging, and a major challenge is to encourage regular use of these technologies throughout the entire treatment process.

“compliance rates were sometimes not encouraging, and a major challenge is to encourage regular use of these technologies throughout the entire treatment process [79]”

• cites [79] Saranummi, 2013, Moving the science of behavioral change into the 21st century: Part 2, IEEE Pulse sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Most EMAs were based only on self-reports, whereas more attempts to integrate information with data from sensors and biosensors were observed for EMIs.

“most of the EMAs were based only on self-reports, whereas more attempts to integrate this information with data gathered from sensors and biosensors were observed for EMIs”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Seventy percent of people suffering from mental disorders do not receive adequate psychological treatment or reach complete clinical remission.

“According to statistics, 70% of people suffering from mental disorders do not receive adequate psychological treatment or reach complete clinical remission [20].”

• cites [20] Henderson, 2013, Mental illness stigma, help seeking, and public health programs, Am. J. Public Health sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Self-reports are affected by recall bias, and depressed patients have been found to alter the content of past experiences when asked to retrieve them retrospectively.

“Likewise, self-reports are affected by recall bias. In other words, depressed patients have been found to alter the content of past experiences when asked to retrieve them retrospectively [8,9], judging symptoms as more severe [10] or increasing the elaboration of negative information [11].”

• cites [8] Ben-Zeev, D., Young, M.A., and Madsen, J.W. (2009). Retrospective recall of affect in clinically depressed individuals and controls. Cogn. Emot. sourceNot checked yet

  Not checked in the free run.

• cites [9] Chamberlain, 2006, The neuropsychology of mood disorders, Curr. Psychiatry Rep. sourceNot checked yet

  Not checked in the free run.

• cites [10] 1995, Self-rating procedures in the evaluation of antidepressants: Review of the literature and results of our studies, Psychopathology sourceNot checked yet

  Not checked in the free run.

• cites [11] Gotlib, 2010, Cognition and Depression: Current Status and Future Directions, Annu. Rev. Clin. Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Risk of bias of EMI studies was assessed by two independent reviewers.

“Differently, risk of bias of EMI studies was assessed by two independent reviewers (D.C and J.F.-Á.).”

May combine two claims.

Two prior reviews focused on EMAs for mood disorders, but most included studies were based on paper-and-pencil daily diaries, and the target population included adults and adolescents with bipolar disorder and borderline personality disorder.

“Although two reviews focused on EMAs for mood disorders [15,16], most of the included studies were based on paper-and-pencil daily diaries, and the target population included adults and adolescents with bipolar disorder (BD) and borderline personality disorder (BPD).”

• cites [15] Hogenelst, 2012, Mood disorders in everyday life: A systematic review of experience sampling and ecological momentary assessment studies, Clin. Psychol. Rev. sourceNot checked yet

  Not checked in the free run.

• cites [16] Trull, 2009, Ecological momentary assessment of mood disorders and mood dysregulation, Psychol. Assess. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Studies were independently selected by three different authors, who first analysed titles and abstracts and subsequently selected full papers meeting inclusion criteria, resolving disagreements through consensus.

“Studies were independently selected by three different authors (D.C., M.S., and J.F.-Á.), who first analysed titles and abstracts and subsequently selected the full papers that met the inclusion criteria, resolving disagreements through consensus.”

May combine two claims.

Mobile technologies allow the shortcomings of traditional diaries to be overcome by eliminating manual data entry and increasing control on backfilling, thus obtaining more accurate data.

“On the one hand, mobile technologies allow the shortcomings of traditional diaries to be overcome by eliminating the need for manual data entry and by increasing control on backfilling, thus obtaining more accurate data.”

May combine two claims.

Higher rumination after a stressful event predicted greater negative affect and more maladaptive behaviours.

“higher rumination after a stressful event predicted greater NA and more maladaptive behaviours”

• cites [52] Ruscio, 2015, Rumination Predicts Heightened Responding to Stressful Life Events in Major Depressive Disorder and Generalized Anxiety Disorder, J. Abnorm. Psychol. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

No risk of bias assessment was performed for the included EMA studies.

“No risk of bias assessment was therefore performed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The hypothesis that mind wandering is not a maladaptive behaviour per se was confirmed.

“Confirming the hypothesis that mind wandering is not a maladaptive behaviour per se”

• cites [35] Ottaviani, C., Shahabi, L., Tarvainen, M., Cook, I., Abrams, M., and Shapiro, D. (2015). Cognitive, behavioral, and autonomic correlates of mind wandering and perseverative cognition in major depression. Front. Neurosci. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In clinically depressed individuals, increased alpha signal in the right prefrontal cortex was positively correlated with higher self-esteem ratings.

“an increased alpha signal in the right prefrontal cortex was positively correlated with higher self-esteem ratings”

• cites [51] Putnam, K.M., and McSweeney, L.B. (2008). Depressive symptoms and baseline prefrontal EEG alpha activity: A study utilizing Ecological Momentary Assessment. Biol. Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

PRISMA criteria were followed for the systematic review.

“Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria [27] were followed.”

• cites [27] Moher, 2009, Preferred reporting items for systematic reviews and meta analyses: The Prisma Statement, PLoS Med. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Quality assessment of EMI studies was assessed with the Downs and Black quality index.

“As both randomized and non-randomized controlled trials were included, quality assessment was assessed with the Downs and Black quality index [30].”

• cites [30] Downs, 1998, The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions, J. Epidemiol. Community Health sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Sadness was only a predictor of social rejection.

“sadness was only a predictor of social rejection”

• cites [58] Hepp, J., Lane, S.P., Carpenter, R.W., Niedtfeld, I., Brown, W.C., and Trull, T.J. (2017). Interpersonal Problems and Negative Affect in Borderline Personality and Depressive Disorders in Daily Life. Clin. Psychol. Sci. sourceNot checked yet

  Not checked in the free run.

The quote only partly states this claim.

Mobylize! was tested in a small pilot study with a sample of 7 MDD patients.

“Mobylize! was tested in a small pilot study with a sample of 7 MMD patients”

• cites [61] Burns, M.N., Begale, M., Duffecy, J., Gergle, D., Karr, C.J., Giangrande, E., and Mohr, D.C. (2011). Harnessing context sensing to develop a mobile intervention for depression. J. Med. Internet Res., 13. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Participants in the pseudo-experimental condition reported decreased depressive symptoms in the first weeks of treatment, but this gain was not maintained across the weeks.

“Participants in the pseudo-experimental condition reported decreased depressive symptoms in the first weeks of the treatment, but this gain was not maintained across the weeks.”

• cites [62] Kramer, 2014, A therapeutic application of the experience sampling method in the treatment of depression: A randomized controlled trial, World Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [63] Simons, C.J.P., Hartmann, J.A., Kramer, I., Menne-Lothmann, C., Höhn, P., van Bemmel, A.L., Myin-Germeys, I., Delespaul, P., van Os, J., and Wichers, M. (2015). Effects of momentary self-monitoring on empowerment in a randomized controlled trial in patients with depression. Eur. Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [64] Hartmann, J.A., Wichers, M., Menne-Lothmann, C., Kramer, I., Viechtbauer, W., Peeters, F., Schruers, K.R.J., Van Bemmel, A.L., Myin-Germeys, I., and Delespaul, P. (2015). Experience sampling-based personalized feedback and Positive affect: A randomized controlled trial in depressed patients. PLoS ONE, 10. sourceNot checked yet

  Not checked in the free run.

• cites [67] Snippe, 2016, Change in daily life behaviors and depression: Within-person and between-person associations, Health Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Women and remitted patients evaluated daily events as more negative than men.

“women and remitted patients evaluated daily events as more negative than men”

• cites [54] Husky, 2009, Past depression and gender interact to influence emotional reactivity to daily life stress, Cognit. Ther. Res. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

With BPD comorbidity, depressed patients were less emotionally influenced by events and perceived themselves as less emotionally reactive.

“depressed patients were found to be less emotionally influenced by events, and to perceive themselves as less emotionally reactive”

• cites [56] Kohling, 2015, Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology, J. Personal. Disord.Not checked yet

  Not checked in the free run.

May combine two claims.

Psymate produced a significant reduction in depressive symptoms in the experimental group that was maintained at follow-up.

“Results showed a significant reduction in depressive symptoms in the experimental group that was maintained in the follow-up assessment.”

• cites [62] Kramer, 2014, A therapeutic application of the experience sampling method in the treatment of depression: A randomized controlled trial, World Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [63] Simons, C.J.P., Hartmann, J.A., Kramer, I., Menne-Lothmann, C., Höhn, P., van Bemmel, A.L., Myin-Germeys, I., Delespaul, P., van Os, J., and Wichers, M. (2015). Effects of momentary self-monitoring on empowerment in a randomized controlled trial in patients with depression. Eur. Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [64] Hartmann, J.A., Wichers, M., Menne-Lothmann, C., Kramer, I., Viechtbauer, W., Peeters, F., Schruers, K.R.J., Van Bemmel, A.L., Myin-Germeys, I., and Delespaul, P. (2015). Experience sampling-based personalized feedback and Positive affect: A randomized controlled trial in depressed patients. PLoS ONE, 10. sourceNot checked yet

  Not checked in the free run.

• cites [67] Snippe, 2016, Change in daily life behaviors and depression: Within-person and between-person associations, Health Psychol. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Depressed patients showed a greater decrease in negative affect and increase in positive affect after a positive event compared to healthy participants.

“depressed patients showed a greater decrease in NA and increase in PA after a positive event”

• cites [50] Thompson, 2012, The everyday emotional experience of adults with major depressive disorder: Examining emotional instability, inertia, and reactivity, J. Abnorm. Psychol. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Women and remitted patients showed worse mood and higher emotional reactivity in response to daily stressors.

“they showed worse mood and higher emotional reactivity in response to daily stressors”

• cites [54] Husky, 2009, Past depression and gender interact to influence emotional reactivity to daily life stress, Cognit. Ther. Res. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

After 6 weeks of self-monitoring, there was a significant improvement in negative emotions' differentiation and a close-to-significance improvement in positive emotions' differentiation, regardless of EMA-derived feedbacks.

“Widdershoven and colleagues observed a significant improvement in negative emotions’ differentiation and a close-to-significance improvement in positive emotions’ differentiation after 6-weeks of self-monitoring, regardless of EMA-derived feedbacks”

• cites [68] Widdershoven, R.L.A., Wichers, M., Kuppens, P., Hartmann, J.A., Menne-Lothmann, C., Simons, C.J.P., and Bastiaansen, J.A. (2019). Effect of self-monitoring through experience sampling on emotion differentiation in depression. J. Affect. Disord. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Use of mobile devices reduces user effort in completing daily assessments and prevents errors by researchers and clinicians due to manual data entry.

“the use of mobile devices reduces the effort required of users in completing daily assessments and prevents errors by researchers and clinicians due to manual data entry”

May combine two claims.

Eleven out of 13 (84.6%) Help4Mood participants completed the protocol and were assessed at follow-up; one withdrew due to worsening mood.

“Eleven out of 13 (84.6%) participants completed the protocol and were assessed for the follow-up. One participant withdrew due to worsening mood.”

May combine two claims.

Medlink patients reported taking 84% of their medication, significantly higher than medication adherence rates reported in the literature.

“Patients reported taking 84% of their medication, which is significantly higher than medication adherence rates reported in the literature.”

• cites [65] Mohr, 2015, MedLink: A Mobile Intervention to Address Failure Points in the Treatment of Depression in General Medicine, Int. Conf. Pervasive Comput. Technol. Healthc.Not checked yet

  Not checked in the free run.

May combine two claims.

Continuous monitoring of patients' symptoms would allow clinicians to monitor treatment efficacy over time, predict short-term mood changes, detect symptom worsening early, and create continuous communication between clinicians and patients.

“the continuous monitoring of patients’ symptoms would allow clinicians to monitor the efficacy of a treatment over time [76], predict short-term mood changes [77], detect symptoms’ worsening in an early stage [78], and create continuous communication between clinicians and patients”

• cites [76] Boswell, J.F., Kraus, D.R., Miller, S.D., and Lambert, M.J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychother. Res. sourceNot checked yet

  Not checked in the free run.

• cites [77] Mikus, 2018, Predicting short term mood developments among depressed patients using adherence and ecological momentary assessment data, Internet Interv. sourceNot checked yet

  Not checked in the free run.

• cites [78] Nuij, C., van Ballegooijen, W., Ruwaard, J., de Beurs, D., Mokkenstorm, J., van Duijn, E., de Winter, R.F.P., O’Connor, R.C., Smit, J.H., and Riper, H. (2018). Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study. Internet Interv. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Smartphones offer the possibility of providing real-time EMA-derived feedback as a therapeutic tool for self-monitoring and sending real-time alerts to clinicians.

“smartphones offer the possibility of providing real-time EMA-derived feedback that can be an important therapeutic tool for patients’ self-monitoring, in addition to the possibility of sending real-time alerts to clinicians in case of need”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Smartphones have the potential of becoming global low-cost tools that can also be adopted in the clinical field.

“smartphones have the potential of becoming global low-cost tools that can also be adopted in the clinical field”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Currently, 2.32 billion people in the world use smartphones, and it has been estimated that by 2020, 70% of the world's population will own one.

“Currently, 2.32 billion people in the world use smartphones, and it has been estimated that, by 2020, 70% of the world’s population will own one [71].”

• cites [71] (2015). Ericsson Consumer Lab Eurupe Ericsson Mobility Report Appendix. Ericsson Mobil. Rep., 1–8.Not checked yet

  Not checked in the free run.

May combine two claims.

In a previous study, compliance was higher in EMA administered through a smartphone and when patients were prompted less than 8 times a day.

“In a previous study, we observed that compliance was higher in EMA administered through a smartphone and when patients were prompted less than 8 times a day [73].”

• cites [73] Colombo, D., Cipresso, P., Fernández Alvarez, J., Garcia Palacios, A., Riva, G., and Botella, C. (2018). An Overview of Factors Associated with Adherence and Dropout to Ecological Momentary Assessments in Depression. Annu. Rev. CyberTherapy Telemed., in press.Not checked yet

  Not checked in the free run.

The quote only partly states this claim.

Use of Mobylize! significantly reduced anxiety symptoms measured with the GAD-7.

“as well as anxiety symptoms, measured with the Generalized Anxiety Disorder Scale (GAD-7)”

• cites [61] Burns, M.N., Begale, M., Duffecy, J., Gergle, D., Karr, C.J., Giangrande, E., and Mohr, D.C. (2011). Harnessing context sensing to develop a mobile intervention for depression. J. Med. Internet Res., 13. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The dynamics of affective states and mood greatly vary from person to person, so ideographic approaches may shed light upon the structure of individual symptom dynamics.

“these dynamics greatly vary from person to person, reasons for which ideographic approaches may shed light upon the structure of individual symptom dynamics [60]”

• cites [60] Fisher, A.J., Reeves, J.W., Lawyer, G., Medaglia, J.D., and Rubel, J.A. (2017). Exploring the idiographic dynamics of mood and anxiety via network analysis. J. Abnorm. Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

No dropouts were reported in Medlink.

“No dropouts were reported.”

May combine two claims.

People with serious mental and physical illnesses own and regularly use smartphones.

“people with serious mental and physical illnesses own and regularly use smartphones [72]”

• cites [72] Davis, 2013, Mobile technologies among people with serious mental illness: Opportunities for future services, Adm. Policy Ment. Health sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Help4Mood use varied: two participants used the application for one or two days, three used it between 3 and 7 days, and the remaining six used it more than 10 times, approximately twice a week.

“Two participants used the application for one or two days, whereas three participants used it between 3 and 7 days. The remaining six participants used it more than 10 times, approximately twice a week.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Throughout 8-week Mobylize treatment, mean log-ins to the mobile application was 7.9, approximately one per week.

“the mean number of log-ins to the mobile application was 7.9 (approximately one per week)”

May combine two claims.

Seven out of eight Mobylize participants (87.5%) completed the intervention; the only dropout was caused by technical problems with the smartphone.

“Seven out of eight participants (87.5%) completed the intervention: The only dropout was caused by technical problems with the smartphone.”

May combine two claims.

Medlink participants entered the application approximately 17.4 times during the 4 weeks of data collection and answered 96% of the prompts.

“participants entered the Medlink application approximately 17.4 times during the 4 weeks of data collection and answered 96% of the prompts”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mobylize completed lessons on the website was 4.8 out of 9 (53.3%).

“the number of completed lessons on the website was 4.8 out of 9 (53.3%)”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mean Help4Mood use was 134 min.

“The mean use was 134 min.”

May combine two claims.

In Psymate, 27 of 33 (81.9%) experimental and 32 of 36 (88.89%) pseudo-experimental participants completed the intervention.

“27 of the 33 participants (81.9%) allocated to the experimental group completed the intervention, whereas 32 out of 36 participants (88.89%) allocated to the pseudo-experimental group completed it.”

May combine two claims.

In Medlink, seven out of nine users read psychoeducation lessons from the first and second week, whereas only half read the third and fourth lessons.

“Seven out of nine users read the psychoeducation lessons from the first and second week, whereas only half of them read the third and fourth lessons.”

May combine two claims.

Psymate participants completed 39.7 out of 50 pre-assessments (79.4%) and 23.7 out of 30 (79%) post-assessment observations.

“participants completed 39.7 out of 50 pre-assessments (79.4%) and 23.7 out of 30 (79%) post-assessment observations”

May combine two claims.

The scientific literature has mostly been based on studies conducted in laboratory settings, thus understudying the daily dynamics of psychopathology.

“the scientific literature has mostly been based on studies conducted in laboratory settings, thus understudying the daily dynamics of psychopathology [70]”

• cites [70] Nilsen, 2013, Moving behavioral theories into the 21st century: Technological advancements for improving quality of life, IEEE Pulse sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Depressed patients could be less likely to consistently complete daily assessments due to the intrinsic nature of the disease.

“Due to the intrinsic nature of the disease, depressed patients could be less likely to consistently complete daily assessments.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The hierarchical sensing model proposed by Mohr highlights the revolution that new sensors and biosensors can bring to mental health, making it possible to collect raw sensor data that can be converted into behavioural markers through machine learning and data mining.

“the hierarchical sensing model proposed by Mohr highlights the great revolution that new sensors and biosensors can bring to the field of mental health [85], making it possible to collect raw sensor data (i.e., the lower level of the hierarchy) that can be converted into “behavioural markers” through machine learning and data mining methods [18]”

• cites [85] Miettunen, 2019, Mobile Phone and Wearable Sensor-Based mHealth Approaches for Psychiatric Disorders and Symptoms: Systematic Review, JMIR Ment. Health sourceNot checked yet

  Not checked in the free run.

• cites [18] Mohr, 2017, Personal Sensing: Understanding Mental Health Using Ubiquitous Sensors and Machine Learning, Annu. Rev. Clin. Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

People might not be willing to share personal information in EMA/EMI.

“Moreover, people might not be willing to share personal information.”

May combine two claims.

In terms of ecological validity, EMAs and EMIs may be advantageous for clinical purposes but disadvantageous for research aims, because they imply less experimental control.

“Finally, in terms of more ecological validity, they may be advantageous for clinical purposes, but disadvantageous for research aims, because they imply less experimental control.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

These physiological signals could provide an EMA and/or EMI platform with additional markers that more closely correlate to a person's affective state and can be used as input to analysis.

“These could provide an EMA and/or EMI platform with additional markers that more closely correlate to a person’s affective state, and that can be used as input to the analysis performed [61].”

• cites [61] Burns, M.N., Begale, M., Duffecy, J., Gergle, D., Karr, C.J., Giangrande, E., and Mohr, D.C. (2011). Harnessing context sensing to develop a mobile intervention for depression. J. Med. Internet Res., 13. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Due to the implementation of novel statistical procedures, a balance between research necessities and clinical utility could be achieved.

“Nevertheless, due to the implementation of novel statistical procedures, a balance between research necessities and clinical utility could be achieved [90].”

• cites [90] Lin, X., Mermelstein, R.J., and Hedeker, D. (2018). A 3-level Bayesian mixed effects location scale model with an application to ecological momentary assessment data. Stat. Med. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Recent advances in sensor technologies have had an impact on applications for remote health, such as postoperative recovery, treatment for chronic patients, and monitoring of elderly individuals.

“Recent advances in sensor technologies have had an impact on applications for remote health [81], such as postoperative recovery [82], treatment for chronic patients [83], and monitoring of elderly individuals [84].”

• cites [81] Majumder, S., Mondal, T., and Deen, M. (2017). Wearable Sensors for Remote Health Monitoring. Sensors, 17. sourceNot checked yet

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• cites [82] Aziz, O., Atallah, L., Lo, B., ElHelw, M., Wang, L., Yang, G.Z., and Darzi, A. (2007). A pervasive body sensor network for measuring postoperative recovery at home. Surg. Innov. sourceNot checked yet

  Not checked in the free run.

• cites [83] Patel, 2012, A review of wearable sensors and systems with application in rehabilitation, J. Neuroeng. Rehabil. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Smartphone sensors increase potentially collectable information, allowing reconstruction of people's habits, sleep patterns, or social life using embedded sensors such as accelerometers, calls, SMS, social network data, or geolocation.

“Smartphone sensors further increase the potentially collectable information, allowing the reconstruction of people’s habits, sleep patterns, or social life by using embedded sensors, such as accelerometers, calls, short message service (SMS), social network data, or geolocation.”

May combine two claims.

The use of EMAs and EMIs is time-consuming and may be perceived as invasive by users.

“These approaches are time-consuming and may be perceived as invasive by users.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Wearable sensors and their associated sensors do not interfere with users' daily routines.

“and acoustic signals), and associated sensors do not interfere with users’ daily routines.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Physiological signals can now be recorded unobtrusively by means of smartwatches and chest bands.

“physiological signals can be nowadays recorded unobtrusively by means of, for example, smartwatches and chest bands”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

EMA protocols require patients to complete multiple assessments throughout a day and often last weeks.

“Patients are required to complete multiple assessments throughout a day, and protocols often last weeks.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

EDA and HRV do not involve recording sensitive information and associated sensors do not interfere with users' daily routines.

“They do not involve recording sensitive information (as opposed to, for example, cameras and acoustic signals), and associated sensors do not interfere with users’ daily routines.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Predictive models that combine information from physiological and behavioural signals can automatically estimate the patient's future mood, stress level, and self-reported health one or a few days in advance.

“Alternatively, predictive models that combine information from physiological and behavioural signals to estimate the patient’s future mood, stress level, and self-reported health (one or a few days in advance) can be automatically inferred [89].”

• cites [89] Shen, 2015, Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace, JMIR Mhealth Uhealth sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Behavioural signals are readily collectable with smartphone sensors, though they may lack the required specificity for mood recognition and prediction, as found by the Mobylize! study.

“several behavioural signals are readily collectable with the use of smartphone sensors, even though they may lack the required specificity for mood recognition and prediction, as found by the Mobylize! study [61]”

• cites [61] Burns, M.N., Begale, M., Duffecy, J., Gergle, D., Karr, C.J., Giangrande, E., and Mohr, D.C. (2011). Harnessing context sensing to develop a mobile intervention for depression. J. Med. Internet Res., 13. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Several opportunities can be found in the integration of EMA and EMI platforms with behavioural and physiological signal processing, further mediated by machine learning algorithms.

“several opportunities can be found in the integration of EMA and EMI platforms with behavioural and physiological signal processing, further mediated by machine learning algorithms”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The relation between physiological signals and affective states is not trivial, and mixed results on it are discussed in the literature.

“Unfortunately, the relation between physiological signals and affective states is not trivial and mixed results are discussed in the literature [87].”

• cites [87] Choi, K.H., Kim, J., Kwon, O.S., Kim, M.J., Ryu, Y.H., and Park, J.E. (2017). Is heart rate variability (HRV) an adequate tool for evaluating human emotions? A focus on the use of the International Affective Picture System (IAPS). Psychiatry Res. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Promising results have already been shown for the application of EMA and EMI to anxiety disorders and stress-related disorders, highlighting the potential of these tools to provide psychological support in daily life and to investigate symptom fluctuations across time.

“Still, promising results have been already shown also regarding the application of EMA and EMI to anxiety disorders [93,94] and stress-related disorders [95,96], highlighting the potential of these tools to provide psychological support in daily life and to investigate symptom fluctuations across time.”

• cites [93] Walz, 2014, Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders: A systematic review, J. Anxiety Disord. sourceNot checked yet

  Not checked in the free run.

• cites [94] Schueller, 2017, Ecological momentary interventions for depression and anxiety, Depress. Anxiety sourceNot checked yet

  Not checked in the free run.

• cites [95] Yoshiuchi, 2008, Application of ecological momentary assessment in stress-related diseases, Biopsychosoc. Med. sourceNot checked yet

  Not checked in the free run.

• cites [96] Gee, B.L., Griffiths, K.M., and Gulliver, A. (2016). Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: A systematic review. J. Am. Med. Inform. Assoc.Not checked yet

  Not checked in the free run.

May combine two claims.

Recent studies obtained promising results for stress recognition via model personalisation and for mood prediction via deep learning, using a combination of behavioural and physiological markers in non-clinical populations.

“Building on recent advances of machine learning, recent studies obtained promising results by means of model personalisation for stress recognition [88] and deep learning for mood prediction [89] using a combination of behavioural and physiological markers in non-clinical populations.”

• cites [88] Kocielnik, R., Sidorova, N., Maggi, F.M., Ouwerkerk, M., and Westerink, J.H.D.M. (2013, January 20–22). Smart technologies for long-term stress monitoring at work. Proceedings of the CBMS 2013—26th IEEE International Symposium on Computer-Based Medical Systems, Porto, Portugal. sourceNot checked yet

  Not checked in the free run.

• cites [89] Shen, 2015, Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace, JMIR Mhealth Uhealth sourceNot checked yet

  Not checked in the free run.

May combine two claims.

There is evidence showing the feasibility and preliminary efficacy of EMA and EMI approaches.

“Altogether, there is evidence showing the feasibility and preliminary efficacy of these approaches, but much more research should be conducted before drawing definite conclusions.”