title: Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults.
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.
authors: Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0993, La Jolla, CA 92093-0993, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive 0664, La Jolla, CA 92093-0664, USA; VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161, USA. Electronic address: r6moore@ucsd.edu.
authors: Raeanne C
authors: RC
authors: Moore
authors: Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0993, La Jolla, CA 92093-0993, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive 0664, La Jolla, CA 92093-0664, USA; VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161, USA. Electronic address: cdepp@ucsd.edu.
authors: Colin A
authors: CA
authors: Depp
authors: VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0993, La Jolla, CA 92093-0993, USA. Electronic address: jwetherell@ucsd.edu.
authors: Julie Loebach
authors: JL
authors: Wetherell
authors: Washington University School of Medicine, Department of Psychiatry, 660 So. Euclid Ave, Campus Box 8134, St. Louis, MO 63110, USA. Electronic address: lenzee@psychiatry.wustl.edu.
authors: Eric J
authors: EJ
authors: Lenze
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology / Q000534:rehabilitation*; D003863:Depression / Q000523:psychology / Q000534:rehabilitation*; D000072860:Ecological Momentary Assessment; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D064866:Mindfulness; D017063:Outcome Assessment, Health Care; D013223:Statistics as Topic
keywords: Ecological momentary assessment; Mindfulness-based stress reduction; Mobile assessment; Patient reported outcomes; Psychometrics; Randomized clinical trial