Ecological Momentary Assessment used as a method to predict functioning in schizophrenia patients

Schizophrenia patients often generate self-reports of their activities and work that diverge from objective information. It is suggested that these participants may not base their reports on their daily experiences. In this study, ecological momentary assessment (EMA) was used to sample daily activities in schizophrenia and determine whether EMA responses were associated with self and observer-reported work skills and everyday activities as measured by Specific Level of Functioning (SLOF) scales. 112 participants were sampled 3 times a day for 30 days. Each survey asked where and with whom they were, what they were doing, and if they were experiencing mood changes or active psychotic symptoms. Participants and observers completed the SLOF scale at study end. Repeated measure statistical modeling was used to determine associations. Being home or alone was associated with self-reports of productive functioning in activities and work skills. Patients with paranoia self-reported their everyday activities as better than those without paranoia even when controlling for other predictors. They also overestimated their functioning when compared to observer reports. Patients who heard voices were more likely to overestimate their work abilities, as did patients who reported delusions. Those with sadness or depression were more likely to underestimate their functioning. Schizophrenia was marked by a disconnect between momentary experiences and self-reports. Positive schizophrenia symptoms are associated with overestimating activities but not work skills. This study showed that schizophrenia patients have high introspective bias, but EMA methods can be used to provide a richer picture of the patient’s daily functioning.