mHealth Assessment of Recurrent Clinical States in Bipolar Disorders (MARCS-BD)

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Despite the existence of effective drug treatments and emergent psychotherapies for bipolar disorders (BD), Veterans with BD often drop out of treatment during acute manic or depressive episodes. Clinical experience also suggests that onset of acute mania or depression can lead individuals with BD to disengage from treatment when they most need it. Re-engaging Veterans with BD in treatment is especially important given an established link between BD and poor psychosocial functioning and high rates of suicide among Veterans with BD. A clinical tool that identifies early signs of acute bipolar states could thus improve functional outcomes by enabling well- timed interventions to reduce mood episodes’ severity and their deleterious psychosocial impact. mHealth refers to the use of mobile and wireless devices as part of patient care and offers many potential opportunities for early detection and intervention with acute mood states in this population, but these mHealth approaches have not been investigated in Veterans with BD. The overall purpose of our research program is to develop, validate, and disseminate mHealth tools that can promote social and community functioning and prevent suicide among Veterans with BD by promoting more timely and effective delivery of evidence-based treatments. The goal of this Small Projects in Rehabilitation Research (SPiRE) proposal is to obtain feasibility and acceptability data on a set of smartphone programs (“apps”) as possible means of detecting the onset of acute depression or mania and indicators of increased suicidality and changes in social functioning/participation in Veterans with BD. The project has three aims: (1) to assess the feasibility of enrolling and retaining a sample of 30 Veterans with BD for a three-month trial with passive and active smartphone monitoring, (2) to assess the acceptability of daily symptom ratings and ongoing smartphone monitoring through voice recordings and location services in this population, and (3) to explore the potential utility of voice and continuously collected location data in detecting acute bipolar states and predicting suicidality and changes in social participation in Veterans with BD. The above stated aims will be accomplished through daily self-report assessments, voice sample recordings, and continuously and passively monitored location data using three smartphone apps, in addition to biweekly phone assessments of bipolar symptoms, suicidality, and social participation in a sample of 30 Veterans with BD receiving care at the Minneapolis VA Health Care System. Apps will allow the analysis of daily self-ratings, vocal patterns (especially speech rate), and movement (i.e., increases or decreases in routine and non-routine movement in the community) as potential markers for bipolar episodes, suicidality, and social participation, which will be evaluated in the biweekly phone assessments. Study feasibility will be based on the project’s successful recruitment and retention of the proposed sample, while the acceptability will be in part determined based on the exit interviews at the end of each participant’s study participation (i.e., after the three-month follow-up or earlier in the case of study withdrawal). These exit interviews will provide valuable information regarding acceptability of use of these smartphone apps in Veterans with BD, such as participants’ perceptions about study procedures/apps and potential clinical uses of this type of data, and, if withdrawing from the study early, perceived barriers to study completion. Finally, the study will allow a preliminary exploration of the ability of voice samples and location data to predict changes in bipolar symptoms, suicidality, and social participation as pilot data for future larger studies.