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

Introduction: Major depressive disorder (MDD) is a prevalent, episodic and recurrent condition that adversely affects function across everyday life. Recent studies highlight the importance of everyday function in MDD treatment. Given the dynamic nature of everyday functioning, using comprehensive and real-time data collection, such as ecological momentary assessments (EMA), is necessary. Although mood disorder research widely uses EMA, its clinical use to assess everyday function is limited. Therefore, this article aimed to provide an in-depth review of everyday function domains assessed by EMA in MDD. Methods: A systematic review was conducted in accordance with PRISMA guidelines. We searched PubMed, Cochrane, CINAHL, PsycINFO, Social Work Abstracts, Web of Science and Scopus using search terms related to MDD and EMA, from database inception through October 2025. Analysis focused on identifying functional domains, mapping EMA clinical applications, sampling methods and psychometric properties. Consumer and community involvement: No consumer and community involvement was included in this study. Results: Of 46,271 records, 39 met the inclusion criteria. Seven domains were identified: rest and sleep, social participation, daily activities, physical activity, media use, leisure and health management. Beyond monitoring activity patterns, our mapping revealed EMA's unique value in capturing behaviour–emotion interactions and contextual influences. This within-person focus uncovers real-time dynamic mechanisms rather than static deficits. Methods were diverse but demonstrated high compliance, confirming EMA's feasibility. Conclusion: EMA offers a unique pathway to bridge the gap between clinical research and functional recovery. By providing high-resolution data on real-time everyday functioning, EMA enables the design of precision psychiatry interventions tailored to individual occupational patterns. Implementing these ecological assessments can facilitate a transition from generalized care to human-centred, responsive treatments that directly address daily life barriers.