Smartphone-based activity measurements in patients with newly diagnosed bipolar disorder, unaffected relatives and control individuals

Sharleny Stanislaus, Maj Vinberg, Sigurd Melbye, Mads Frost, Jonas Busk, Jakob E Bardram, Lars Vedel Kessing, Maria Faurholt-Jepsen, Sharleny Stanislaus, Maj Vinberg, Sigurd Melbye, Mads Frost, Jonas Busk, Jakob E Bardram, Lars Vedel Kessing, Maria Faurholt-Jepsen

Abstract

Background: In DSM-5 activity is a core criterion for diagnosing hypomania and mania. However, there are no guidelines for quantifying changes in activity. The objectives of the study were (1) to investigate daily smartphone-based self-reported and automatically-generated activity, respectively, against validated measurements of activity; (2) to validate daily smartphone-based self-reported activity and automatically-generated activity against each other; (3) to investigate differences in daily self-reported and automatically-generated smartphone-based activity between patients with bipolar disorder (BD), unaffected relatives (UR) and healthy control individuals (HC).

Methods: A total of 203 patients with BD, 54 UR, and 109 HC were included. On a smartphone-based app, the participants daily reported their activity level on a scale from -3 to + 3. Additionally, participants owning an android smartphone provided automatically-generated data, including step counts, screen on/off logs, and call- and text-logs. Smartphone-based activity was validated against an activity questionnaire the International Physical Activity Questionnaire (IPAQ) and activity items on observer-based rating scales of depression using the Hamilton Depression Rating scale (HAMD), mania using Young Mania Rating scale (YMRS) and functioning using the Functional Assessment Short Test (FAST). In these analyses, we calculated averages of smartphone-based activity measurements reported in the period corresponding to the days assessed by the questionnaires and rating scales.

Results: (1) Smartphone-based self-reported activity was a valid measure according to scores on the IPAQ and activity items on the HAMD and YMRS, and was associated with FAST scores, whereas the majority of automatically-generated smartphone-based activity measurements were not. (2) Daily smartphone-based self-reported and automatically-generated activity correlated with each other with nearly all measurements. (3) Patients with BD had decreased daily self-reported activity compared with HC. Patients with BD had decreased physical (number of steps) and social activity (more missed calls) but a longer call duration compared with HC. UR also had decreased physical activity compared with HC but did not differ on daily self-reported activity or social activity.

Conclusion: Daily self-reported activity measured via smartphone represents overall activity and correlates with measurements of automatically generated smartphone-based activity. Detecting activity levels using smartphones may be clinically helpful in diagnosis and illness monitoring in patients with bipolar disorder. Trial registration clinicaltrials.gov NCT02888262.

Keywords: Activity; Bipolar disorder; Electronic monitoring; Remote monitoring; Smartphone.

Conflict of interest statement

SS, SM, JB, and MFJ declare no competing interests. LVK and MV have within recent three years been a consultant for Lundbeck. JEB, MF are co-founders and shareholders of Monsenso ApS.

Figures

Fig. 1
Fig. 1
Boxplots of smartphone-based self-reported activity in patients with newly diagnosed bipolar disorder, unaffected first-degree relatives and healthy control individuals. The bottom and top of the box represent the first and third quartiles and the upper and lower whiskers extend from the box to the largest and lower value, respectively. No further than 1.5 times the interquartile range from the box. Data beyond the whiskers are plotted individually. **p < 0.001

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