Dropout, Attrition, Adherence, and Compliance in Mood Monitoring and Ambulatory Assessment Studies for Depression and Bipolar Disorder: Systematic Review and Meta-Analysis

Background: Ambulatory assessment and mood monitoring are different methods that can use novel technology to deliver a more efficient, flexible, and usable method of clinical outcome assessment compared with established measures of behavior and mood. Concerns have been raised around attrition in and adherence to these new protocols, particularly over the medium to long term by people with mood disorders. Objective: This systematic review and meta-analysis assessed attrition from and adherence to active and passive ambulatory assessment and mood monitoring protocols by people with bipolar disorder and depression over the medium and long term. Methods: Randomized controlled trials and nonrandomized studies were identified and rated for risk of bias. Adherence and attrition data were pooled to calculate effect sizes. We analyzed specific factors that we hypothesized a priori could affect the prevalences of attrition and adherence by means of subgroup meta-analysis or metaregression modeling. Results: We evaluated 77 mood tracking or ambulatory assessment studies including 17,123 participants. Pooled adherence was 0.64% (95% CI 0.59%-0.70%; P