Frequent assessment of negative symptoms does not induce depressed mood

Research design/methodology

TYPE: Cohort study with randomized alerts for participants to diary daily pain and fatigue.  

VALIDITY: The cohort of rheumatology patients was selected to introduce a bias regarding predisposition to depression.  This was intended to improve the understanding of results for a sensitive subpopulation.

ENVIRONMENT: Subjects were recruited in a community practice setting and the study was conducted using PDAs among subjects in their homes.

Research question

The primary research question was whether or not momentary assessment of pain and symptoms among a cohort of rheumatology patients would have an iatrogenic effect on depressed mood?

Patient/Problem/Population definition

PATIENT: Rheumatology patients in community practice setting with PDA electronic diary (ED) to measure pain and fatigue in real-time.

PROBLEM: Determine the effects of real-time pain and fatigue assessment on depressed mood among rheumatology patients.
POPULATION: Adult rheumatology patients
TYPE: Therapeutic intervention

Intervention

This study involved a PDA-based therapeutic intervention for momentary pain and fatigue assessment.  It was studied to determine whether it could improve patients' understanding of their pain and fatigue symptoms on a daily basis.

Beck Depression Inventory-II score was measured at baseline and at follow up to determine changes among the subjects.

Outcome

For 20% of subjects, depressed mood improved over the course of the study.  This effect was significant at p<.001. For a small subgroup (10%), depressed mood worsened over the course of the study.

Application of results to patient care

The authors conclude that there is no iatrogenic effect on depressed mood when momentary assessment is introduced for rheumatology patients.  Because this cohort is already predisposed to depressed mood, this finding is important and may suggest that for many patients momentary assessment may be beneficial.  They caution that emotions may play an important role in which direction this effect swings and providers should be mindful of this when planning an intervention for any given cohort.

Further areas for research  

Extended electronic diarying for momentary assessment as well as longitudinal assessment would be beneficial for developing the research in this field. It is expected that other cohorts might produce different effects (e.g. cancer reoccurrence patients) and this should be studied as well.