A digital companion for ecological momentary assessment and prevention of suicide: A case series on the use of the emma app

Background: Many suicide risk factors have been identified, but traditional clinical methods do not allow the accurate prediction of suicide behaviors. To face this challenge, we developed emma, an app for Ecological Momentary Assessment/Intervention (EMA/EMI) and prediction of suicide risk in high risk patients.Objective: We wanted to test the feasibility of implementing this mHealth-based suicide risk assessment and prevention tool and its impact in subjects at high risk of suicide in real world conditions.Methods: The EMMA Study is an ongoing longitudinal interventional multicenter trial in which patients at high-risk for suicide (n=100) use emma for 6 months. During this period, they complete four EMA types (daily, weekly, monthly, spontaneous) and may use EMI modules. Participants undergo clinical assessment at month 0, 1, 3 and 6 after inclusion.Results: Among the 43 patients already recruited in the EMMA Study, 14 participants had completed the follow-up. Their data were analyzed to evaluate emma implementation and impact on suicide risk management. EMA completion rates were extremely heterogeneous among the 14 participants with a sharp decrease over time. The completion rates of the weekly EMA (25% to 87.5%) were higher than for the daily EMA (0% to 53.3%). Most patients (n=10/14) answered the EMA questionnaires spontaneously. Similarly, the Safety Plan Modules use was very heterogeneous (2 to 75 times). Specifically, 11 patients used the Call Module (1 to 29 times), designed by our team to help them to get in touch with healthcare professionals and/or relatives during a crisis. All patients used the Breathing Space Module and 8 the Emotion Regulation Module (1 to 46 times). The diversity of patient profiles and use of the EMA and EMI modules proposed by emma was highlighted by three case reports.Conclusions: These preliminary results suggest that it is possible and acceptable to collect longitudinal fine-grained contextualized data (EMA) and to offer personalized intervention (EMI) in real time to people at high risk of suicide. Patients have different clinical and digital profiles and needs that require a highly scalable, interactive and customizable app. To become a complementary tool for suicide prevention, emma should be integrated in the existing emergency procedures.

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A Digital Companion, the Emma App, for Ecological Momentary Assessment and Prevention of Suicide: Quantitative Case Series Study (Preprint)

10.2196/preprints.15741 ◽

2019 ◽

Author(s):

Margot Morgiève ◽

Catherine Genty ◽

Jérôme Azé ◽

Jonathan Dubois ◽

Marion Leboyer ◽

...

Keyword(s):

Case Report ◽

High Risk ◽

Ecological Momentary Assessment ◽

Suicide Risk ◽

Completion Rates ◽

Emergency Procedures ◽

Ecological Momentary ◽

Suicidal Thoughts And Behaviors ◽

Suicidal Crisis ◽

Momentary Assessment

BACKGROUND Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed. OBJECTIVE The aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions. METHODS The Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences. RESULTS EMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports. CONCLUSIONS These preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures. CLINICALTRIAL ClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381

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A Digital Companion, the Emma App, for Ecological Momentary Assessment and Prevention of Suicide: Quantitative Case Series Study

JMIR mhealth and uhealth ◽

10.2196/15741 ◽

2020 ◽

Vol 8 (10) ◽

pp. e15741 ◽

Cited By ~ 1

Author(s):

Margot Morgiève ◽

Catherine Genty ◽

Jérôme Azé ◽

Jonathan Dubois ◽

Marion Leboyer ◽

...

Keyword(s):

Case Report ◽

High Risk ◽

Ecological Momentary Assessment ◽

Suicide Risk ◽

Completion Rates ◽

Emergency Procedures ◽

Ecological Momentary ◽

Suicidal Thoughts And Behaviors ◽

Suicidal Crisis ◽

Momentary Assessment

Background Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed. Objective The aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions. Methods The Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences. Results EMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports. Conclusions These preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures. Trial Registration ClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381

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Patients at high risk of suicide before and during a COVID-19 lockdown: ecological momentary assessment study

BJPsych Open ◽

10.1192/bjo.2021.43 ◽

2021 ◽

Vol 7 (3) ◽

Author(s):

Aurora Cobo ◽

Alejandro Porras-Segovia ◽

María Mercedes Pérez-Rodríguez ◽

Antonio Artés-Rodríguez ◽

Maria Luisa Barrigón ◽

...

Keyword(s):

High Risk ◽

Ecological Momentary Assessment ◽

Suicide Risk ◽

Assessment Study ◽

Wish To Die ◽

History Of ◽

Physical Barriers ◽

Suicide Risk Factors ◽

Ecological Momentary ◽

Momentary Assessment

The coronavirus disease 2019 (COVID-19) outbreak may have affected the mental health of patients at high risk of suicide. In this study we explored the wish to die and other suicide risk factors using smartphone-based ecological momentary assessment (EMA) in patients with a history of suicidal thoughts and behaviour. Contrary to our expectations we found a decrease in the wish to die during lockdown. This is consistent with previous studies showing that suicide rates decrease during periods of social emergency. Smartphone-based EMA can allow us to remotely assess patients and overcome the physical barriers imposed by lockdown.

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Assessing Change Over Time in Voice Handicap and Voice-Related Perceived Control Using Ecological Momentary Assessment

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419842267 ◽

2019 ◽

Vol 128 (9) ◽

pp. 829-837 ◽

Cited By ~ 1

Author(s):

Viann N. Nguyen-Feng ◽

Patricia A. Frazier ◽

Ali Stockness ◽

Scott Lunos ◽

Alexis N. Hoedeman ◽

...

Keyword(s):

Ecological Momentary Assessment ◽

Perceived Control ◽

Medical Center ◽

Voice Disorders ◽

Completion Rates ◽

Cross Sectional ◽

Modeling Analysis ◽

Ecological Momentary ◽

Momentary Assessment ◽

Over Time

Objectives: Voice handicap has generally been measured at a single timepoint. Little is known about its variability from hour to hour or day to day. Voice handicap has been shown to be negatively related to voice-related perceived control in cross-sectional studies, but the within-person variability in voice-related perceived control is also unknown. We aimed to use ecological momentary assessment (EMA) to (1) assess the feasibility of EMA to examine daily voice handicap and voice-related perceived control in patients with voice disorders, (2) measure within-person variability in daily voice handicap and perceived control, and (3) characterize temporal associations (eg, correlations over time) between daily voice handicap and perceived control. Methods: Adults with voice problems were recruited from a large public university medical center in the Midwest. They completed baseline measures, followed by twice-daily assessments, including selected items measuring voice handicap and perceived control, and then repeated the baseline measures at the final timepoint. Feasibility was assessed via completion rates. Within-person variability was measured using standard deviations. Temporal associations were characterized using simulation modeling analysis. Results: EMA of voice handicap and perceived control was feasible in this patient population. Momentary voice handicap varied more than perceived control, though both were variable. Multiple patterns of temporal associations between daily voice handicap and perceived control were found. Conclusions: These findings identified important variability in (1) measures of voice handicap and perceived control and (2) their associations over time. Future EMA studies in patients with voice disorders are both feasible and warranted.

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