Ecological momentary assessment as a clinical tool in psychiatry: promises, pitfalls, and possibilities

In this thesis, the potential of electronic diaries to improve personalized mental health care is explored. Patients can use these diaries to monitor their mood, symptoms, and experiences multiple times per day on their smartphones. The data that they gather can be visualized in diary feedback.

This thesis has investigated the promise, pitfalls, and possibilities of electronic diaries for the treatment of a diverse range of mental disorders, such as depression, bipolar disorder, and psychosis. Diaries seem to offer patients more control over their well-being, improve the personalization of treatments, and benefit the relationship between patient and practitioner. They can be used to monitor the effects of medication or for the timely detection of deterioration of symptoms. At the same time, however, diaries can be burdensome and potentially worsen symptoms by the constant focus on them. As such, diaries should be personalized and made a collaborative effort between patient and practitioner. Finally, we have examined the potential of network analysis, which maps the associations between symptoms, for diary feedback. Unfortunately, network analysis currently is insufficiently evidence-based and overly complex to be suitable for clinical implementation.

This thesis has shown that electronic diaries have the potential to improve mental health care. The research in this thesis has led to the development of PETRA, an online platform that enable patients and clinicians to use personalized diaries in care. In this way, diaries may bring the ideal of personalized mental health care a step closer.