JMIR Publications

ABSTRACT

Background:

Ambulatory assessment and mood monitoring are different methods that can use novel technology to deliver a more efficient, flexible and usable method of clinical outcome assessment compared to established measures of behavior and mood. Concerns have been raised around attrition in and adherence to these new protocols, particularly over the medium to long term in people with mood disorders.

Objective:

This systematic review and meta-analysis assessed attrition in and adherence to active and passive ambulatory assessment and mood monitoring protocols in people with bipolar disorder and depression over the medium and long term.

Methods:

Randomised controlled trials and non-randomised studies were identified and rated for risk of bias. Adherence and attrition data were pooled to calculate effect sizes. We analysed specific factors that we hypothesized a priori could affect the prevalence of attrition and adherence by means of subgroup meta-analysis and/or meta-regression modelling.

Results:

77 mood tracking/ambulatory assessment studies including 17,123 participants were evaluated. Pooled adherence was 0.64 ((0.59, 0.70) p-value: <0.001)) and pooled attrition was (0.28 (0.22, 0.34) p value: <0.001). Two factors had a statistically significant sub-group difference for adherence: the presence of financial incentives increased adherence and the presence of mood monitoring reminders decreased it. Three factors had a statistically significant sub-group difference for attrition: digital mood monitoring decreased attrition versus analogue studies but mood monitoring reminders and mood monitoring versus other protocols increased attrition. 17 studies (22%) did not report attrition rates, 20 studies (26%) did not report adherence rates. Most studies had low-moderate risk of bias but heterogeneity was very high. Only 16 studies reported adherence systematically.

Conclusions:

Reporting of attrition and adherence to ambulatory assessment was not systematic or universal and until it is analyses are unlikely to demonstrate clear conclusions. We found very high heterogeneity and evidence of publication bias and this limited the certainty of our conclusions. Financial incentives may increase adherence and attrition may be lower in digital than analogue studies of mood monitoring. There was no statistically significant difference in adherence and attrition between studies of passive and active ambulatory assessment. Reminders of mood monitoring increased attrition and decreased adherence but the results may be confounded by longer length of follow up versus other studies.