Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile.
Department of Child and Adolescent Psychiatry Research, University Psychiatric Clinics, University of Basel, Basel, Switzerland.
J Med Internet Res. 2023 Mar 15;25:e44853. doi: 10.2196/44853.
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 well-being. Measuring and characterizing the 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 characterized by 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 with 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 systematic 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 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. RESULTS: In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. CONCLUSIONS: Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of 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 be aggregated and interpreted jointly.
背景:边缘型人格障碍(BPD)的特征是情绪、行为、身份和人际关系频繁且剧烈的瞬间变化,这通常导致人的整体功能和幸福感显著和负面恶化。在一个人的日常生活中测量和描述 BPD 功能障碍中不稳定的快速变化模式可能具有挑战性。生态瞬时评估(EMA)是一种可以在精神病理学研究中捕捉高度动态过程的方法,因此非常适合研究 BPD 中功能障碍领域的强烈可变性模式。EMA 研究的特点是频繁重复评估,使用能够在日常生活中记录对简短自我报告问题的反应的手持设备,以真实生活、实时的方式向参与者提供评估。EMA 研究中的依从性定义为参与者回答提示的比例,考虑发送的所有计划提示。提示时间表的低依从性可能会影响使用这种方法的相对优势。尽管近年来 EMA 在 BPD 方面的文献不断增加,但关于影响 EMA 协议依从性的研究设计特征的发现尚未进行汇编、汇总和估计。 目的:本系统的荟萃分析旨在研究 EMA 研究中 BPD 的研究设计特征与参与者依从性之间的关系。 方法:2021 年 11 月 12 日,根据 PRISMA(系统评价和荟萃分析的首选报告项目)和 MOOSE(观察性研究荟萃分析中的流行病学)指南进行了系统审查,以搜索 EMA 研究 BPD 的文章,这些文章报告了依从率并包含了足够的数据以提取相关设计特征。对于具有完整数据的研究,使用随机效应模型估计总体依从率,并探讨其与设计特征的关系。 结果:共有 28 项同行评审的 EMA 研究,涉及 2052 名参与者,包括在研究中。设计特征(采样策略、平均提示频率、项目数量、响应窗口、采样设备、财务激励和辍学率)在研究之间存在很大差异,许多研究没有报告设计特征。荟萃分析综合仅限于 28 篇文章中的 64%(18/28),显示研究之间的总体依从率为 79%。我们没有发现设计特征与依从率之间存在任何显著关系。 结论:我们的结果表明,评估 BPD 的 EMA 研究在设计和报告方面存在很大差异。在不同的设置下,依从率似乎是稳定的,并且可能标准设计特征并不是直接提高或降低依从性的原因。我们讨论了可能对依从性有影响的研究设计非特异性因素。鉴于 EMA 研究在 BPD 中的前景,我们还讨论了统一 EMA 报告标准的重要性,以便可以联合汇总和解释来自这一丰富文献的数据。
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