Smartphone-based ecological momentary assessment for Chinese patients with depression: An exploratory study in Taiwan

Mobile mental health has a potential to improve the recognition and management of Chinese patients with depression. Currently, evidence regarding ecological momentary assessment (EMA) for depressive disorder mostly originates from Western studies. Herein, we examined the validity of smartphone-based EMA for depression in Chinese patients and explored the determinants of use. A smartphone application, iHOPE, was used to perform daily EMA of depression, anxiety, sleep and cognitive performance. Outpatients with depressive disorder were recruited to use iHOPE for 8 weeks. Clinical characteristics and smartphone use patterns were assessed at baseline. We enrolled 59 Chinese patients with depression. In 8 weeks, participants interacted with iHOPE for an average of 10.8 (SD=12.3) days; a trend of decreased frequency of use (p=0.03) was observed. Scores of HAM-D at baseline was associated with, of the first 2 weeks, scores of PHQ-9 (p=0.005), EMA of depression (p=0.003) and anxiety (p<0.001), and poorer sleep quality (p=0.023). Among the demographic, clinical and smartphone-use variables examined, only limited internet package for smartphone (<500M per month) predicted higher use of iHOPE (p=0.04). The present study provides initial evidence for the feasibility of smartphone-based EMA in Chinese patients with depression. Level of engagement needs to be improved before determining its clinical usefulness.