title: Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale.
abstract: BACKGROUND
  Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options.
  
  
  OBJECTIVE
  The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states.
  
  
  METHODS
  A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS.
  
  
  RESULTS
  Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS ("IMS-12") with two factors: a "depression" factor and an "anxiety" factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01).
  
  
  CONCLUSIONS
  Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans.
authors.affiliation: School of OT, Faculty of Medicine, Hebrew University, Jerusalem, Israel.|Posit Science Corporation, San Francisco, CA, United States.
authors.forename: Mor
authors.identifier: http://orcid.org/0000-0002-2861-6486
authors.initials: M
authors.lastname: Nahum
authors.affiliation: Posit Science Corporation, San Francisco, CA, United States.
authors.forename: Thomas M
authors.identifier: http://orcid.org/0000-0003-1639-860X
authors.initials: TM
authors.lastname: Van Vleet
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, United States.
authors.forename: Vikaas S
authors.identifier: http://orcid.org/0000-0002-2238-4186
authors.initials: VS
authors.lastname: Sohal
authors.affiliation: UC Berkeley- UCSF Joint Medical Program, University of California, Berkeley, CA, United States.|School of Medicine, University of California, San Francisco, CA, United States.
authors.forename: Julie J
authors.identifier: http://orcid.org/0000-0001-8684-149X
authors.initials: JJ
authors.lastname: Mirzabekov
authors.affiliation: Department of Neurology, University of California, San Francisco, CA, United States.
authors.forename: Vikram R
authors.identifier: http://orcid.org/0000-0002-6389-2638
authors.initials: VR
authors.lastname: Rao
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, CA, United States.
authors.forename: Deanna L
authors.identifier: http://orcid.org/0000-0003-4309-2737
authors.initials: DL
authors.lastname: Wallace
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, CA, United States.
authors.forename: Morgan B
authors.identifier: http://orcid.org/0000-0001-6936-0109
authors.initials: MB
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, CA, United States.
authors.forename: Heather
authors.identifier: http://orcid.org/0000-0002-8636-1602
authors.initials: H
authors.lastname: Dawes
authors.affiliation: Posit Science Corporation, San Francisco, CA, United States.|Department of Psychology, University of California, Berkeley, CA, United States.
authors.forename: Alit
authors.identifier: http://orcid.org/0000-0001-6434-6447
authors.initials: A
authors.lastname: Stark-Inbar
authors.affiliation: California School of Professional Psychology, Alliant International University, San Francisco, CA, United States.
authors.forename: Joshua Thomas
authors.identifier: http://orcid.org/0000-0002-4714-1893
authors.initials: JT
authors.lastname: Jordan
authors.affiliation: Posit Science Corporation, San Francisco, CA, United States.|Department of Psychiatry, University of California, San Francisco, CA, United States.
authors.forename: Bruno
authors.identifier: http://orcid.org/0000-0002-5955-3019
authors.initials: B
authors.lastname: Biagianti
authors.affiliation: Posit Science Corporation, San Francisco, CA, United States.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-1811-3428
authors.initials: M
authors.lastname: Merzenich
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, CA, United States.
authors.forename: Edward F
authors.identifier: http://orcid.org/0000-0003-2480-4700
authors.initials: EF
authors.lastname: Chang
keywords: anxiety; depression; ecological momentary assessment; mobile; mood disorders