Burden and Inattentive Responding in a 12-Month Intensive Longitudinal Study: Interview Study Among Young Adults.

IntroductionSmoking cigarettes under the influence of alcohol or cannabis is associated with perceived pleasure. However, it is unclear whether these changes in perceived reward impact the extent of concurrent use of cigarettes with alcohol or cannabis. The current study investigated if self-reported changes in perceived reward from concurrent use of cigarettes with alcohol or cannabis are related to the extent of concurrent use in real-world contexts using a smartphone-based Ecological Momentary Assessment (EMA) study. MethodsThe sample included 126 diverse young adult smokers in the San Francisco Bay Area who reported current alcohol or cannabis use at baseline (M = 22.8 years, 50.8% male, 40.5% sexual minority, 39.7% Non-Hispanic White). Participants completed an online baseline survey and 30 days of smartphone-based daily EMA surveys of cigarette, alcohol, and cannabis use. The baseline assessed self-reported changes in perceived pleasure of smoking cigarettes while using alcohol or cannabis separately. EMA surveys included detailed questions about concurrent use (i.e., the extent of smoking while using another substance) covering the previous day. A total of 2,600 daily assessments were analyzed using mixed models. ResultsHigher perceived pleasure from smoking cigarettes while drinking alcohol or using cannabis at baseline were both associated with a greater extent of concurrent use of cigarettes with alcohol (b = 0.140; SE = 0.066; t = 2.1; p = .035) and cannabis (b = 0.136; SE = 0.058; t = 2.4; p = .019) on a given day. ConclusionsResults suggest that perceived reward from concurrently using cigarettes with alcohol or cannabis is associated with the extent of concurrent use. Findings can inform tailored smoking cessation interventions.

Momentary stress and social context among adolescents at risk for suicide: An experience sampling study.

Perceived social isolation (PSI) significantly affects the emotional well-being of stroke survivors, necessitating effective monitoring and prediction for timely, targeted interventions. While Ecological Momentary Assessment (EMA) has been increasingly used to identify precursor characteristics of PSI, existing prediction methods rely on handcrafted features, which often fail to capture the semantic richness and contextual relationships among survey questions. In this study, we propose a novel approach to predict PSI by processing structured EMA data with language embeddings. A total of 11,802 EMA surveys were collected from 218 stroke survivors, the largest dataset of its kind in social isolation research for this population. Language embeddings were extracted from the structured EMA surveys using a pre-trained language model. These embeddings were then processed by training an autoencoder to generate compact latent representations, which were used for the downstream PSI prediction. Our findings show that the proposed approach achieves accurate PSI prediction, with a weighted $F_{1}$ score of 0.84 and a weighted AUPRC of 0.92, outperforming traditional handcrafted features. Furthermore, by leveraging only three carefully selected questions, our method can optimize a trade-off between validity and usability. This study demonstrates an efficient method for real-time monitoring of psychosocial outcomes in stroke survivors, with potential implications for early intervention and personalized care.

BackgroundRecent research has investigated the utility of mobile phone–delivered interventions for reducing risky single-occasion drinking, also known as binge drinking. In the past five years, focus has been placed on ecological momentary interventions (EMIs), which aim to deliver intervention content in correspondence to real-time assessments of behavior, also known as ecological momentary assessments (EMAs).ObjectiveThis study aims to assess the effect of a fully automated, tailored, mobile phone–delivered EMI termed Mobile Intervention for Drinking in Young people (MIDY) on young people's risky single-occasion drinking behavior.MethodsWe will use a three-armed randomized controlled trial design to determine the impact of MIDY on peak consumption of alcohol among young people. A list of mobile telephone numbers for random digit dialing will be generated, and researchers will telephone potential participants to screen for eligibility. Participants will be randomized into one of three intervention groups. For 6 weeks, EMI, EMA, and attention control groups will complete hourly EMA surveys on their mobile phones on Friday and Saturday nights. EMI participants will receive personalized feedback in the form of text messages corresponding to their EMA survey responses, which focus on alcohol consumption, spending, and mood. EMA participants will not receive feedback. A third group will also complete EMA and receive feedback text messages at the same time intervals, but these will be focused on sedentary behavior and technology use. All groups will also complete a short survey on Saturday and Sunday mornings, with the primary outcome measure taken on Sunday mornings. A more detailed survey will be sent on the final Sunday of the 6-week period, and then again 1 year after recruitment.ResultsThe primary outcome measure will be an observed change (ie, reduction) in the mean peak number of drinks consumed in a single night over the 6-week intervention period between the EMI and attention control groups as measured in the weekly EMA. We expect to see a greater reduction in mean peak drinking in the EMI group compared to that in the attention control group. As a secondary aim, we will assess whether mean peak drinking is reduced in the EMA group compared to the attention control group. We will use a random-effects mixed-modeling approach using maximum-likelihood estimation to provide estimates of differences in peak drinking across time periods between those receiving the intervention (EMI) and attention control participants. An intention-to-treat approach will be taken for the analysis. Individuals and study groups will be modeled as random and fixed factors, respectively.ConclusionsThis study extends our previous work investigating the efficacy of a mobile EMI (MIDY) for reducing risky drinking among young adults in Australia, and will add to the expanding literature on the use of mobile interventions for reducing risky alcohol consumption.Trial RegistrationAustralian New Zealand Clinical Trials Registration (ANZCTR): ACTRN12617001509358p; http://www.anzctr.org.au/ACTRN12617001509358p.aspxInternational Registered Report Identifier (IRRID)DERR1-10.2196/14190

Ecological Momentary Assessment of Social Interactions: Associations With Depression, Anxiety, Pain, and Fatigue in Individuals With Mild Stroke

Acceptability and feasibility of ecological momentary assessment with augmentation of passive sensor data in young adults at high risk for suicide

This study hypothesized that select ecological momentary assessment (EMA) survey items are sensitive to day-to-day fluctuations in personality traits Extraversion (E) and Neuroticism (N). As part of the Einstein Aging Study, 312 older adults (Mage=76.96 years, SD=4.85 years, range=70-90 years) completed up to 5 EMA surveys per day for 16 days and a Big Five trait personality measure. Parallel two-factor multilevel confirmatory factor analyses were conducted for E (Daily-E; Trait-E) and N (Daily-N; Trait-N). The E model showed good fit (CFI=.95; TLI=.94; RMSEA=.02) and a significant correlation of .20 between Daily-E and Trait-E factors. The N model showed poor fit (CFI=.68; TLI=.61; RMSEA=.06). Results suggest EMA items can be used as daily markers of Extraversion, yet results are unclear for Neuroticism due to poor model fit. Daily markers of Extraversion can be used to detect fluctuations in personality traits across days that may predict long-term personality change.

BackgroundNonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment.ObjectiveThis protocol paper presents the DAILY project’s aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life.MethodsThe DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals.ResultsWe will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023.ConclusionsThe findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time.International Registered Report Identifier (IRRID)DERR1-10.2196/46244

Objective The aim of this study was to use Ecological Momentary Assessment (EMA) to capture how stigma-induced identity threat is experienced by adults with hearing loss and how they respond to such threats in daily life. Design and study sample Twenty adults with hearing loss from 53 to 88 years (mean age of 69.4 years) completed a range of demographic and stigma questionnaires in the laboratory and, over a two-week period, answered daily EMA surveys. Results A total of 633 EMA surveys were collected. Five participants reported 13 listening events in which they experienced stigma. These events were typically when conversing with family or friends who were aware of the adults’ hearing loss. Conclusions The number of individual stigma experiences captured by EMA were low, when viewed across a large number of social interactions. However, as a group, a quarter of the participants in this study experienced stigma over a two-week period, typically from others close to them. This suggests that stigma experiences may be a regular occurrence for some adults with hearing loss.

In an observational study, we paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine lagged effects of glycemic regulation on diabetes-related distress (DD), and vice versa, among adults with type 1 diabetes (T1D). Participants (N = 182; median ± SD age 40 ± 14 years; 54% women; 41% Latino; 29% White and 15% Black) wore a blinded CGM device for 14 days and completed five to six EMA surveys per day. We tested expected associations between momentary DD ratings and relevant patient-reported outcomes on validated questionnaires. Using multilevel cross-lagged modeling, we evaluated within-person lagged effects of CGM metrics (mean glucose mean; percentage of time in range [TIR; i.e., 70-180 mg/dL] and percentages of time 181-250, >250, and <70 mg/dL; and coefficient of variation [CV]) over 3-h periods on DD rated 0-100 at the end of that interval and 3 h later. We also examined lagged effects of DD on subsequent CGM metrics. Momentary DD ratings were significantly associated with results of questionnaires for DD, well-being, functional and mental health, and quality of life. Higher mean glucose, less TIR, greater percentage of time 181-250 and >250 mg/dL, and higher CV over 3 h each predicted greater DD at the end of that interval; higher 3-h mean glucose also predicted more DD 3 h later (P < 0.05). Greater DD unexpectedly predicted a lower percentage of time in hypoglycemia over the next 3 h (P < 0.05) but predicted no other CGM metrics. Findings support the validity of EMA of DD in adults with T1D and suggest glucose dysregulation is linked to subsequent increased DD over the short term, not vice versa. These findings have implications for interventions targeting DD.

BackgroundRisky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking.ObjectiveThe objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI.MethodsThis paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described.ResultsRecruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022.ConclusionsThe study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial.International Registered Report Identifier (IRRID)PRR1-10.2196/36849

Schizophrenia is a major cause of disability worldwide. As new treatments for functioning are tested, the need grows to demonstrate real-world functioning gains. Ecological momentary assessment (EMA) may provide a more ecologically valid measure of functioning. In this study, smartphone-based EMA was used to signal participants with schizophrenia (N = 100) and controls (N = 71) 7 times a day for 7 days to respond to brief questionnaires about social interactions and functioning behaviors. Excellent adherence was found, with both groups completing an average of 85% of surveys and only 3% of participants with schizophrenia excluded for poor adherence. Four-week test-retest reliability was high (r = .83 for total productive behaviors). Relative to controls, participants with schizophrenia reported significantly less total productive activity (d = 1.2), fewer social interactions (d = 0.3), more nonproductive behaviors (d = 1.0; watching TV, resting), and more time at home (d = 0.8). Within the schizophrenia group, participants living independently showed better functioning on EMA relative to participants in supported housing (d = 0.8) and participants engaged in vocational activities showed better functioning than individuals not engaged in vocational activities (d = 0.55). Modest correlations were found between EMA and an in-lab self-report measure of functioning activities performed in the community, but not between EMA and measures of functional capacity or potential. This study demonstrated the feasibility, sensitivity reliability, and validity of EMA methods to assess functioning in schizophrenia. EMA provides a much-needed measure of what individuals with schizophrenia are actually doing in real-world contexts. These results also suggest that there may be important disjunctions between indices of abilities and actual real-world functioning.

Ecological momentary assessment of interpersonal theory of suicide constructs in people experiencing psychotic symptoms

BackgroundJust-in-time adaptive interventions (JITAIs) aim to provide psychological support during critical moments in daily life.ObjectiveThis preregistered study aims to evaluate the feasibility of a social support JITAI for individuals with subclinical and clinical levels of depressive symptoms awaiting psychotherapy. Triggered by ecological momentary assessment (EMA) reports, the intervention encouraged participants to activate their (digital) social support networks.MethodsA total of 25 participants completed 2689 EMA surveys and received 377 JITAIs over an 18-day intervention period, including a microrandomized trial, to compare 4 strategies to trigger an intervention: fixed cutoff points of distress variables, personalized thresholds (through Shewhart control charts) of distress variables, momentary support need, and no intervention.ResultsThe results showed high feasibility, with participants completing 85.37% (2689/3150) of the EMA surveys, exhibiting a low study-related attrition rate (7%; total attrition rate was 17%), and reporting minimal technical issues. Engagement and perceived helpfulness were heterogeneous and moderate, with participants seeking support in one-third of the instances after an intervention was triggered instances. JITAIs triggered by self-reported need for support were rated as more appropriately timed, helpful, and effective for promoting support-seeking behavior compared to those based on distress indicators, despite being triggered less frequently. Barriers, such as time constraints and perceived unavailability of support providers, likely affected support-seeking behavior, as indicated by additional qualitative analyses. Exploratory effectiveness analyses indicated Cohen d effect sizes between 0.06 and 0.14 in reducing distress after JITAIs were received.ConclusionsThe findings of this study demonstrate that a social support JITAI is feasible to implement, with high compliance and minimal technical issues. However, further research is needed to evaluate the JITAI’s effectiveness and optimize trigger strategies in addressing individual needs for and barriers to engagement.

Evidence for avolition in bipolar disorder? A 30-day ecological momentary assessment comparison of daily activities in bipolar disorder and schizophrenia