Pending challenges to e-mental health in the COVID-19 era: Acceptability of a smartphone-based ecological momentary assessment application among patients with schizophrenia spectrum disorders

Abstract

Introduction

Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.

Objectives

To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.

Methods

Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.

Results

Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).

Multivariable binary logistic regression model on ‘user’ as outcome
	β	SE	Wald	p	OR	95% CI
Age	-0.075	0.038	3.910	0.048	0.928	0.861-0.999
Education level	-0.967	1.289	0.563	0.453	0.380	0.030-4.755
Early adolescence premorbid adjustment	-0.285	0.110	6.695	0.010	0.752	0.606-0.933
Trail Making Test A	-0.030	0.025	1.488	0.222	0.970	0.924-1.018
Trail Making Test B	-0.005	0.010	0.278	0.598	0.995	0.976-1.014
Cognitive Insight	0.062	0.061	1.043	0.307	1.064	0.944-1.200

X²=25.296,df=6,p<0.001. Nagelkerke-R²=44.7%. Correctly classified: 76.9%, users:54.5%, non-users:88.4%.

Conclusions

Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.