Real-time experience: A systematic review of ecological momentary assessments of everyday functioning in major depressive disorder.

Everyday functioning is defined in many ways, and the seven domains are how these particular studies happened to measure it. They do not map cleanly onto every model, including the ICF, and areas such as work or education and mobility were barely represented. The included studies differed greatly from each other in design, platform, item wording, number of prompts and monitoring length. The authors describe this flexibility as both a strength and the main obstacle to comparing or combining studies. Almost everything the review reports is an association from observational studies rather than an effect of treatment. Only four of the 39 studies were randomised trials. Measurement is not standardized and mostly not validated. Only sleep used a recognised instrument (the sleep diary), and even sleep diaries have no standard format, so most studies wrote their own questions. Grey literature, theses and non-English articles were excluded, which the authors acknowledge may introduce publication bias. The reviewers are occupational therapists with clinical experience in depression, which shaped their focus on functional outcomes; they describe double screening, consensus meetings and a third reviewer to guard against this.

The authors declare no conflicts of interest. Funders named are the Ministry of Health, State of Israel, and the Faculty of Medical & Health Sciences, Tel Aviv University.

Apps that prompt people in daily life are not shown here to treat depression. Two randomised trials of the ZELF-i platform found no significant difference between the groups on symptoms, functioning or affect, and the review pooled no outcomes at all. The findings it does report, such as people feeling worse when alone or sleeping badly alongside more severe depression, are associations from observational studies, not proof that changing these things lifts mood.