A Pilot Study of Mood Ratings Captured by Mobile Phone Versus Paper-and-Pencil Mood Charts in Bipolar Disorder

Abstract

Objective Patient reported mood charts are frequently used in management of bipolar disorder. Although mood charts have recently been programmed in electronic devices such as mobile phones, little is known about the impact of the method of data capture on the psychometric properties and validity of these data. Methods In an ongoing pilot study, a sample of outpatients with bipolar disorder were randomized to either complete mood charts on a mobile phone or a standard paper-and-pencil mood chart as part of a 12 week-intervention (primary outcomes for the trial await study completion). We compared these conditions across single item rating of mood state, and we hypothesized that mobile phone based data capture would produce greater compliance to mood ratings, variability between and within participants, and concurrent validity with blinded clinician-rated affective symptom severity. Results A total of 56 participants were randomized and 40 participants were included in the analyses. There were no significant differences between conditions on demographic or clinical variables. The rate of compliance was significantly higher in paper-and-pencil versus mobile phone ratings. Ratings demonstrated significantly more variability within individuals in the mobile phone condition. Mobile phone mood ratings were significantly correlated with clinician-rated depressive symptom severity across the study and with manic symptom severity at the Week 6 assessment, whereas paper-and-pencil ratings were not significantly associated with clinician-rated depression or mania. Conclusions Although preliminary, our results suggest a lower rate of compliance with mobile phones compared to paper-and-pencil daily mood rating in bipolar disorder, yet a greater ability to capture variability and concurrent validity in quantifying affective symptoms. This clinical trial is registered at http://www.clinicaltrials.gov as NCT01670123.

A systematic review of the psychometric properties, usability and clinical impacts of mobile mood-monitoring applications in young people

“…Evidence for concurrent validity in adult populations is inconclusive (Depp et al 2012;Palmier-Claus et al 2012;Faurholt-Jepsen et al 2014). Inconsistent methodology across these studies, e.g.…”

“…Inconsistent methodology across these studies, e.g. momentary (Depp et al 2012) v. retrospective assessments (Faurholt-Jepsen et al 2014), varying periods between the event and participants' recollection of the event (Palmier-Claus et al 2012), likely contribute to variable findings. Previous evidence suggests that real-time mood measurement methods (e.g.…”

“…'middle age') may lower likelihood of mood-monitoring app use (Depp et al 2012). Both adult (Palmier-Claus et al 2013) and adolescent (Bradford & Rickwood, 2014) populations expressed some reservations about using apps due to the perceived risk of reduced personal contact .…”

“…There is also evidence for usability (Bardram et al 2013). Participation rates are generally high across studies sampling adults, ranging from 65% (Depp et al 2015) to 88% , though Depp et al (2012) reported much higher completion rates for paper and pencil compared with app measures (82.9% v. 42.1%). Evidence also suggests that apps may help people with mental health problems to monitor triggers (Bardram et al 2013), that the capacity to convey experience can be therapeutic, and that apps could be a useful tool for improving patientclinician communication .…”

Engagement Strategies for Self-Monitoring Symptoms of Bipolar Disorder With Mobile and Wearable Technology: Protocol for a Randomized Controlled Trial (Preprint)

“…Increasingly, BP symptoms are being monitored passively through sensors on smartphones and wearable devices [12][13][14][15][16][17]. Smart-phone platforms MONARCA (MONitoring, treAtment and pRediCtion of bipolAr Disorder Episodes) [18] and PRIORI (Predicting Individual Outcomes for Rapid Intervention) [19] predict mood from patterns of speech and behavior from recorded calls, number of phone calls, and phone call duration.…”