Mood, activity, and sleep measured via daily smartphone-based self-monitoring in young patients with newly diagnosed bipolar disorder, their unaffected relatives and healthy control individuals

Sigurd Arne Melbye, Sharleny Stanislaus, Maj Vinberg, Mads Frost, Jakob Eyvind Bardram, Kimie Sletved, Klara Coello, Hanne Lie Kjærstad, Ellen Margrethe Christensen, Maria Faurholt-Jepsen, Lars Vedel Kessing, Sigurd Arne Melbye, Sharleny Stanislaus, Maj Vinberg, Mads Frost, Jakob Eyvind Bardram, Kimie Sletved, Klara Coello, Hanne Lie Kjærstad, Ellen Margrethe Christensen, Maria Faurholt-Jepsen, Lars Vedel Kessing

Abstract

Diagnostic evaluations and early interventions of patients with bipolar disorder (BD) rely on clinical evaluations. Smartphones have been proposed to facilitate continuous and fine-grained self-monitoring of symptoms. The present study aimed to (1) validate daily smartphone-based self-monitored mood, activity, and sleep, against validated questionnaires and clinical ratings in young patients with newly diagnosed BD, unaffected relatives (UR), and healthy controls persons (HC); (2) investigate differences in daily smartphone-based self-monitored mood, activity, and sleep in young patients with newly diagnosed BD, UR, and HC; (3) investigate associations between self-monitored mood and self-monitored activity and sleep, respectively, in young patients with newly diagnosed BD. 105 young patients with newly diagnosed BD, 24 UR and 77 HC self-monitored 2 to 1077 days (median [IQR] = 65 [17.5-112.5]). There was a statistically significantly negative association between the mood item on Hamilton Depression Rating Scale (HAMD) and smartphone-based self-monitored mood (B = - 0.76, 95% CI - 0.91; - 0.63, p < 0.001) and between psychomotor item on HAMD and self-monitored activity (B = - 0.44, 95% CI - 0.63; - 0.25, p < 0.001). Smartphone-based self-monitored mood differed between young patients with newly diagnosed BD and HC (p < 0.001), and between UR and HC (p = 0.008) and was positively associated with smartphone-based self-reported activity (p < 0.001) and sleep duration (p < 0.001). The findings support the potential of smartphone-based self-monitoring of mood and activity as part of a biomarker for young patients with BD and UR. Smartphone-based self-monitored mood is better to discriminate between young patients with newly diagnosed BD and HC, and between UR and HC, compared with smartphone-based activity and sleep.Trial registration clinicaltrials.gov NCT0288826.

Trial registration: ClinicalTrials.gov NCT02888262.

Keywords: Activity; Bipolar disorder; Mood; Sleep; Smartphones.

Conflict of interest statement

SM, SS, KC, HLK, KS, and MFJ have no conflicts to declare. LVK has, within the preceding 3 years, been a consultant for Lundbeck. MV has the last 3 years been a consultant for Sunovion, Janssen, and Lundbeck. EMC has been a consultant for Eli Lilly, Astra Zeneca, Servier, Bristol-Myers Squibb, Lundbeck, and Medilink within the last 3 years. JEB and MF are co-founders and shareholders of Monsenso ApS.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Screenshots from the Monsenso interface
Fig. 2
Fig. 2
The number of days with smartphone-based self-monitoring in young patients with newly diagnosed bipolar disorder (BD), unaffected relatives (UR), and healthy control individuals (HC). Each circle represents a participant

References

    1. Yatham LN, Berettini WH. Genetics of bipolar disorder: clinical and neurobiological foundations. In: Yatham LN, Maj M, editors. Bipolar disorder: clinical and neurobiological foundations. Singapore: Wiley-Blackwell; 2010.
    1. Frederick KG, Kay Redfield J. Manic-depressive illness. New York: Oxford University Press; 2007.
    1. Kessing LV, Hansen HV, Christensen EM, Dam H, Gluud C, Wetterslev J. Do young adults with bipolar disorder benefit from early intervention? J Affect Disord. 2014;152–154:403–408. doi: 10.1016/j.jad.2013.10.001.
    1. Baldessarini RJ, Tondo L, Baethge CJ, Lepri B, Bratti IM. Effects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disord. 2007;9(4):386–393. doi: 10.1111/j.1399-5618.2007.00385.x.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Hacimusalar Y, Dogan ES. Assessment of the functioning levels and related factors in patients with bipolar disorder during remission. Noro psikiyatri arsivi. 2019;56(3):213–218. doi: 10.29399/npa.23539.
    1. St-Amand J, Provencher MD, Belanger L, Morin CM. Sleep disturbances in bipolar disorder during remission. J Affect Disord. 2013;146(1):112–119. doi: 10.1016/j.jad.2012.05.057.
    1. MacQueen GM, Marriott M, Begin H, Robb J, Joffe RT, Young LT. Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Bipolar Disord. 2003;5(5):349–355. doi: 10.1034/j.1399-5618.2003.00048.x.
    1. Wareham NJ, Jakes RW, Rennie KL, Mitchell J, Hennings S, Day NE. Validity and repeatability of the EPIC-norfolk physical activity questionnaire. Int J Epidemiol. 2002;31(1):168–174. doi: 10.1093/ije/31.1.168.
    1. Pew Research Center (2018) Teens, Social Media & Technology 2018
    1. Rideout V. Measuring time spent with media: the common sense census of media use by US 8- to 18-year-olds. J Child Media JOCAM NEXT. 2016;10(1):138–144. doi: 10.1080/17482798.2016.1129808.
    1. Strejilevich SA, Martino DJ, Murru A, Teitelbaum J, Fassi G, Marengo E, Igoa A, Colom F. Mood instability and functional recovery in bipolar disorders. Acta Psychiatr Scand. 2013;128(3):194–202. doi: 10.1111/acps.12065.
    1. Patel R, Lloyd T, Jackson R, Ball M, Shetty H, Broadbent M, Geddes JR, Stewart R, McGuire P, Taylor M. Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ Open. 2015;5(5):e007504. doi: 10.1136/bmjopen-2014-007504.
    1. O’Donnell LA, Ellis AJ, Van de Loo MM, Stange JP, Axelson DA, Kowatch RA, Schneck CD, Miklowitz DJ. Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder. J Affect Disord. 2018;236:199–206. doi: 10.1016/j.jad.2018.04.021.
    1. Faurholt-Jepsen M, Frost M, Busk J, Christensen EM, Bardram JE, Vinberg M, Kessing LV. Is smartphone-based mood instability associated with stress, quality of life, and functioning in bipolar disorder? Bipolar Disord. 2019;21(7):611–620. doi: 10.1111/bdi.12796.
    1. Stanislaus S, Faurholt-Jepsen M, Vinberg M, Coello K, Kjærstad HL, Melbye S, Sletved KSO, Christensen EM, Frost M, Bardram JE, Kessing LV. Mood instability in patients with newly diagnosed bipolar disorder, unaffected relatives, and healthy control individuals measured daily using smartphones. J Affect Disord. 2020;271:336–344. doi: 10.1016/j.jad.2020.03.049.
    1. Golding J, Northstone K, Miller LL, Davey Smith G, Pembrey M. Differences between blood donors and a population sample: implications for case–control studies. Int J Epidemiol. 2013;42(4):1145–1156. doi: 10.1093/ije/dyt095.
    1. Kupfer DJ, Weiss BL, Foster G, Detre TP, McPartland R. Psychomotor activity in affective states. Arch Gen Psychiatry. 1974;30(6):765–768. doi: 10.1001/archpsyc.1974.01760120029005.
    1. Faurholt-Jepsen M, Brage S, Vinberg M, Christensen EM, Knorr U, Jensen HM, Kessing LV. Differences in psychomotor activity in patients suffering from unipolar and bipolar affective disorder in the remitted or mild/moderate depressive state. J Affect Disord. 2012;141(2–3):457–463. doi: 10.1016/j.jad.2012.02.020.
    1. Scott J, Murray G, Henry C, Morken G, Scott E, Angst J, Merikangas KR, Hickie IB. Activation in bipolar disorders: a systematic review. JAMA Psychiatry. 2017;74(2):189–196. doi: 10.1001/jamapsychiatry.2016.3459.
    1. Faurholt-Jepsen M, Vinberg M, Frost M, Christensen EM, Bardram JE, Kessing LV. Smartphone data as an electronic biomarker of illness activity in bipolar disorder. Bipolar Disord. 2015;17(7):715–728. doi: 10.1111/bdi.12332.
    1. Bauer MS, Crits-Christoph P, Ball WA, Dewees E, McAllister T, Alahi P, Cacciola J, Whybrow PC. Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania. Arch Gen Psychiatry. 1991;48(9):807–812. doi: 10.1001/archpsyc.1991.01810330031005.
    1. Tsanas A, Saunders K, Bilderbeck A, Palmius N, Goodwin G, De Vos M. Clinical insight into latent variables of psychiatric questionnaires for mood symptom self-assessment. JMIR Ment Health. 2017;4(2):e15. doi: 10.2196/mental.6917.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Stanislaus S, et al (2020) Daily self-reported and smartphone-generated activity in patients with bipolar disorder, unaffected relatives and healthy control individuals (In review)
    1. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry J Ment Sci. 1978;133:429–435. doi: 10.1192/bjp.133.5.429.
    1. Harvey AG. Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. Am J Psychiatry. 2008;165(7):820–829. doi: 10.1176/appi.ajp.2008.08010098.
    1. Stone AA, Shiffman S, Schwartz JE, Broderick JE, Hufford MR. Patient compliance with paper and electronic diaries. Control Clin Trials. 2003;24(2):182–199. doi: 10.1016/s0197-2456(02)00320-3.
    1. la Cour Karottki NF, Coello K, Stanislaus S, Melbye S, Kjærstad HL, Sletved KS, Kessing LV, Vinberg M. Sleep and physical activity in patients with newly diagnosed bipolar disorder in remission, their first-degree unaffected relatives and healthy controls. Int J Bipolar Disord. 2020;8:1–16. doi: 10.1186/s40345-020-00181-6.
    1. Jackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. Amsterdam: Elsevier; 2003.
    1. Barnett JH, Smoller JW. The genetics of bipolar disorder. Neuroscience. 2009;164(1):331–343. doi: 10.1016/j.neuroscience.2009.03.080.
    1. Vinberg M, Miskowiak K, Kessing LV. Risk markers for affective disorder, a seven-years follow up study of a twin cohort at low and high risk for affective disorder. J Psychiatr Res. 2013;47(5):565–571. doi: 10.1016/j.jpsychires.2013.01.013.
    1. Sahoo MK, Chakrabarti S, Kulhara P. Detection of prodromal symptoms of relapse in mania and unipolar depression by relatives and patients. Indian J Med Res. 2012;135(2):177–183.
    1. Woo YS, Bahk W-M, Hong J, Yoon B-H, Hwang T-Y, Kim M-D, Jon D-I. Use of a smartphone application to screen for bipolar spectrum disorder in a community sample. Health Inform J. 2016;22(3):779–788. doi: 10.1177/1460458215589601.
    1. BinDhim NF, Shaman AM, Trevena L, Basyouni MH, Pont LG, Alhawassi TM. Depression screening via a smartphone app: cross-country user characteristics and feasibility. J Am Med Inform Assoc JAMIA. 2015;22(1):29–34. doi: 10.1136/amiajnl-2014-002840.
    1. Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder. Acta Psychiatr Scand. 2019;139(5):443–453. doi: 10.1111/acps.13021.
    1. Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. The validity of daily patient-reported anxiety measured using smartphones and the association with stress, quality of life and functioning in patients with bipolar disorder. J Affect Disord. 2019;257:100–107. doi: 10.1016/j.jad.2019.07.029.
    1. Stanislaus S, et al (2020) Daily self-reported and automatically generated smartphone-based sleep measurements in patients with newly diagnosed bipolar disorder, unaffected first-degree relatives, and healthy control individuals. Accepted for publishing in Evid Based Ment Health
    1. Melbye S, et al (2020) Smartphone-based self-monitoring, treatment, and automatically generated data in children, adolescents, and young adults with psychiatric disorders: a systematic review. Resubmitted after review
    1. Gershon A, Kaufmann CN, Torous J, Depp C, Ketter TA. Electronic Ecological Momentary Assessment (EMA) in youth with bipolar disorder: demographic and clinical predictors of electronic EMA adherence. J Psychiatr Res. 2019;116:14–18. doi: 10.1016/j.jpsychires.2019.05.026.
    1. Tsanas A, Saunders KEA, Bilderbeck AC, Palmius N, Osipov M, Clifford GD, Goodwin GΜ, De Vos M. Daily longitudinal self-monitoring of mood variability in bipolar disorder and borderline personality disorder. J Affect Disord. 2016;205:225–233. doi: 10.1016/j.jad.2016.06.065.
    1. Matthews M, Abdullah S, Murnane E, Voida S, Choudhury T, Gay G, Frank E. Development and evaluation of a smartphone-based measure of social rhythms for bipolar disorder. Assessment. 2016;23(4):472–483. doi: 10.1177/1073191116656794.
    1. Kessing LV, Munkholm K, Faurholt-Jepsen M, Miskowiak KW, Nielsen LB, Frikke-Schmidt R, Ekstrom C, Winther O, Pedersen BK, Poulsen HE, McIntyre RS, Kapczinski F, Gattaz WF, Bardram J, Frost M, Mayora O, Knudsen GM, Phillips M, Vinberg M. The Bipolar Illness Onset study: research protocol for the BIO cohort study. BMJ Open. 2017;7(6):e015462. doi: 10.1136/bmjopen-2016-015462.
    1. Coello K, Kjaerstad HL, Stanislaus S, Melbye S, Faurholt-Jepsen M, Miskowiak KW, McIntyre RS, Vinberg M, Kessing LV, Munkholm K. Thirty-year cardiovascular risk score in patients with newly diagnosed bipolar disorder and their unaffected first-degree relatives. Aust N Z J Psychiatry. 2019;53(7):651–662. doi: 10.1177/0004867418815987.
    1. Kjaerstad HL, Mistarz N, Coello K, Stanislaus S, Melbye SA, Harmer CJ, Vinberg M, Miskowiak K, Kessing LV. Aberrant cognition in newly diagnosed patients with bipolar disorder and their unaffected relatives. Psychol Med. 2019 doi: 10.1017/s0033291719001867.
    1. Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N. SCAN. Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry. 1990;47(6):589–593. doi: 10.1001/archpsyc.1990.01810180089012.
    1. Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG. Quantitative rating of depressive states. Acta Psychiatr Scand. 1975;51(3):161–170. doi: 10.1111/j.1600-0447.1975.tb00002.x.
    1. Rosa AR, Sanchez-Moreno J, Martinez-Aran A, Salamero M, Torrent C, Reinares M, Comes M, Colom F, Van Riel W, Ayuso-Mateos JL, Kapczinski F, Vieta E. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007;3:5. doi: 10.1186/1745-0179-3-5.
    1. Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the major depression inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord. 2001;66(2–3):159–164. doi: 10.1016/s0165-0327(00)00309-8.
    1. Altman EG, Hedeker D, Peterson JL, Davis JM. The altman self-rating mania scale. Biol Psychiat. 1997;42(10):948–955. doi: 10.1016/s0006-3223(96)00548-3.
    1. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi: 10.1249/01.mss.0000078924.61453.fb.
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Bardram J, Frost M, Szántó K, Faurholt-Jepsen M, Vinberg M, Kessing LV. Designing mobile health technology for bipolar disorder: a field trial of the monarca system. ACM. 2013 doi: 10.1145/2470654.2481364.
    1. Frost M, Marcu G, Hansen R, Szaántó K, Bardram JE (2011) The MONARCA self-assessment system: persuasive personal monitoring for bipolar patients. In: 2011 5th international conference on pervasive computing technologies for healthcare (PervasiveHealth) and workshops, 23–26 May 2011, pp 204–205. 10.4108/icst.pervasivehealth.2011.246050
    1. Merikangas KR, Swendsen J, Hickie IB, Cui L, Shou H, Merikangas AK, Zhang J, Lamers F, Crainiceanu C, Volkow ND, Zipunnikov V. Real-time mobile monitoring of the dynamic associations among motor activity, energy, mood, and sleep in adults with bipolar disorder. JAMA Psychiatry. 2019;76(2):190–198. doi: 10.1001/jamapsychiatry.2018.3546.

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