Employing more frequent assessment intervals than traditional assessment approaches allow, EMA is a strategy used in multiple research settings to capture health and other human behaviors, mood fluctuations, and a host of symptoms as they occur in participants’ natural settings (1). Recent technologic advances, including smartphones and smartwatches, make it possible to more accurately capture in-the-moment experiential data in real-time during participants’ execution of typical daily routines. EMA includes a variety of electronic diary approaches and technologies to “collect data on a schedule (e.g., daily diaries at a particular time, assessments scheduled at random) or in response to clinical events (e.g., symptom episodes, behaviors)” (2).

The EMA approach allows Parazute™ to assess changes in mental status live and calculate if the mental status is trending in a positive or negative direction. If negative, the network of Parazuters will get a notification and can reach out even if it is just a small change. This is to prevent the development of mental micro fluctuations into a major event. The data collection in Parazute™ captures; mood, thinking, feeling, social activity, physical activity, sleep, habits, and suicidal behaviors, and here by addressing the most common aspects of most mental illnesses, including stress, anxiety, depression, bipolar disease, and PTSD. The data collection is both active and passive data collection. Passive data collection happens if the user gives access to health data, like sleep, activity, and phone usage. Active data is collected through a daily short questionnaire (less than 60 sec.) Parazute™ asks the following eight questions daily – based on modification and combination of the Patient Health Questionnaire-4 (PHQ-4) (3) and The Bech–Rafaelsen Mania Scale (MAS) (4). These results have then been applied to the “mental illness continuum” model as developed by the Mental Health Commission of Canada (5,6) – to indicate trends in the mental status of the patient, such as green, yellow, or red.

Since the last time you answered this assessment:
Mood: I have been feeling nervous, anxious or on the edge.
Mood: I have not been able to stop or control worrying.
Mood: I have experienced persistently elevated or irritable mood or/and increased energy levels.
Feeling: I have been feeling down, depressed, or hopeless.
Feeling: I have had little interest or pleasure in doing things.
Thinking: I have not been able to control my thinking.
Habits: I have increased activities like (shopping, gambling, drinking, taking drugs, sex)
Habits: I have been more socially active on social media, texts, phone calls, etc.
The answer possibilities are: Not at all / A little of the time. / A lot of the time. / Nearly all of the time.

A risk assessment for suicidal thinking is also included:
The thought of harming myself has occurred to me: Yes / No

The answers are not used for diagnosis or clinical recommendations – the answers are only used to calculate a difference since the last time the respondent answered the questionnaire – and based on this indicating a negative or positive development in mental status – it is this status that “parazuters” have live access to. If the respondent answers yes to the question about suicidal intent, it automatically overrules all other answers and activates the network of “parazuters”.

References

1. Shiffman S, Stone AA , Hufford MR (2008) Ecological momentary assessment. Annu Rev Clin Psychol 4, 1–32.
2. Stone A, Shiffman S (1994) Ecological momentary assessment (EMA) in behavioral medicine. Ann Behav Med 16, 199–202.
3. Kroenke K , Spitzer RL , Williams JBW , Löwe B (2009) An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics 50, 613–621.
4. Bech, P., Bolwig, T.G., Kramo, P., Rafaelsen, O.J. (1979) The Bech–Rafaelsen Mania Scale and the Hamilton Depression scale. Astra Psychriatrica Scandunavica. Vol 59, issue 4, 420-430.
5. Plouffe RA, Liu A, Richardson JD, Nazarov A. (2022) Validation of the mental health continuum: Short form among Canadian Armed Forces personnel. Health Rep. May 18;33(5):3-12. doi: 10.25318/82-003-x202200500001-eng. PMID: 35587218
6. Chen et al. (2020) Self-reflection and screening mental health on Canadian campuses: validation of the mental health continuum model BMC Psychology 8:76 https://doi.org/10.1186/s40359-020-00446-w