JMIR Publications

ABSTRACT

Background:

Borderline Personality Disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity and interpersonal relationships, which typically result in significant and negative deterioration of the person’s overall functioning and wellbeing. Measuring and characterizing rapidly changing patterns of instability in BPD dysfunction as they occur in a person’s daily life can be challenging. Ecological Momentary Assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research, and thus, is well-suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are defined by using frequent repeated assessments that are delivered to participants in real-life, real-time settings, using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant considering all planned prompts sent. Low compliance to prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated and estimated.

Objective:

This meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD.

Methods:

A systematic review was conducted on November 12th 2021, following the PRISMA and MOOSE guidelines to search for articles featuring EMA studies for BPD that reported compliance rates and included sufficient data to extract relevant design features. The PsycInfo, PubMed, Scopus, and Web of Science databases were explored to identify relevant articles. For studies with complete data, random-effect models were conducted to estimate the overall compliance rate and explore its association to study design features.

Results:

28 peer-reviewed EMA studies totaling 2,052 participants were included in the study. Design features including sampling strategy, average prompting frequency, number of items, response window, sampling device utilized, financial incentive, and drop-out rate showed a large variability across studies, and many studies did not report design features. The metanalytic synthesis was, thus, restricted to 18 articles, revealing a pooled compliance rate of 79% across participants. We did not find any a significant relationship between design features and compliance rates.

Conclusions:

Our results show a wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying set-ups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible “nonspecific factors” of the study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can aggregated and interpreted jointly.