# Demographic and Clinical Characteristics Influencing Ecological Momentary Assessment Compliance in Individuals With Bipolar Disorder: Observational Study

## TL;DR

This study examines how well Chinese individuals with bipolar disorder follow a 14-day mood monitoring program using a WeChat app and identifies factors that influence their compliance.

## Contribution

The study identifies clinical factors influencing EMA compliance in bipolar disorder patients in China, offering insights for improving monitoring protocols.

## Key findings

- The median compliance rate for EMA monitoring was 75% over 14 days.
- Higher mania scores and lower functional impairment were linked to better compliance.
- Compliance did not vary significantly across different mood states.

## Abstract

Bipolar disorder requires immediate and frequent daily symptom monitoring due to its extreme mood fluctuations. Ecological momentary assessment (EMA) technology uses high-frequency data collection to achieve ecologically valid capture of patient symptoms. Investigating EMA compliance among Chinese patients with bipolar disorder and its influencing factors is essential for developing more feasible daily symptom monitoring protocols.

This study aimed to investigate the 14-day compliance rate of EMA among Chinese individuals with bipolar disorder and to examine the demographic and clinical characteristics associated with that compliance.

A total of 100 adults (63 female individuals) with bipolar disorder across mood states (depressive episode, n=29, 29%; hypomanic or manic episode, n=17, 17%; euthymic state, n=54, 54%) completed self-monitoring via the WeChat Mini Program “Xunkang Assessment System” 3 times daily for 14 days. The compliance rate was calculated as the percentage of completed questionnaires out of the total required over 2 weeks. Multivariate ordinal logistic regression was used to explore the factors associated with the compliance rate.

The median compliance rate was 75% (IQR 35.7%-90.4%). Compliance did not differ significantly across mood states (P=.15). In multivariable models, higher Bech-Rafaelsen Mania Scale scores and lower Functioning Assessment Short Test scores were independently associated with better compliance (Bech-Rafaelsen Mania Scale: B=0.11; P=.03 and Functioning Assessment Short Test: B=−0.06; P=.01).

Two-week EMA monitoring via the WeChat Mini Program is feasible among Chinese individuals with bipolar disorder across mood states. Manic symptom severity and functional impairment were associated with EMA adherence and should be considered in study design and interpretation.