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

尽管存在针对双相情感障碍(BD)的有效药物治疗和紧急心理治疗， 患有BD的退伍军人经常在急性躁狂或抑郁发作时退出治疗。临床经验 也表明急性躁狂症或抑郁症的出现会导致BD患者脱离治疗。 在他们最需要的时候。让患有BD的退伍军人重新参与治疗尤其重要，因为 BD与退伍军人BD心理社会功能差和高自杀率之间的联系。一家诊所 因此，识别急性双相状态早期迹象的工具可以通过使良好的 适时干预，以减少情绪发作的严重性及其有害的心理社会影响。MHealth参考 将移动和无线设备作为患者护理的一部分，并提供了许多潜在的机会 在这一人群中检测和干预急性情绪状态，但这些mHealth方法没有 曾在患有BD的退伍军人中进行过调查。我们研究计划的总体目的是开发、验证和 传播可促进社会和社区运作并防止自杀的移动健康工具 通过促进更及时和更有效地提供循证治疗，为患有BD的退伍军人提供帮助。的目标是 这项康复研究小项目(SPIRE)的提案是为了获得可行性和可接受性数据 一套智能手机程序(“app”)，作为检测急性抑郁症或躁狂发作的可能手段 以及患有BD的退伍军人的自杀增加和社会功能/参与变化的指标。 该项目有三个目标：(1)评估招募和保留30名退伍军人样本的可行性 BD使用被动和主动智能手机监控进行为期三个月的试用，(2)评估每日 通过语音录音和定位服务进行症状评级和持续的智能手机监控 以及(3)探索语音和连续收集的位置数据在检测中的潜在效用 患有BD的退伍军人的急性双相状态和自杀和社会参与变化的预测。 上述目标将通过日常自我报告评估、语音样本录音、 除了每两周一次，还使用三款智能手机应用程序持续和被动地监控位置数据 对30例患有BD的退伍军人进行双相情感症状、自杀和社会参与的电话评估 在明尼阿波利斯退伍军人医疗保健系统接受治疗。应用程序将允许分析日常自我评级，发声 模式(特别是语速)和运动(即，在常规和非常规中增加或减少 社区中的流动)作为双相发作、自杀和社会参与的潜在标记， 将在每两周一次的电话评估中进行评估。可行性研究将以项目的成功为基础 招募和保留拟议样本，而可接受性将部分根据 在每个参与者的研究参与结束时(即，在三个月或更早的跟踪之后)退出访谈 在退学的情况下)。这些离职面谈将提供有关可接受性的有价值的信息 这些智能手机应用在患有BD的退伍军人中的使用情况，例如参与者对学习的看法 这类数据的程序/应用程序和潜在的临床用途，如果及早退出研究， 完成学业的障碍。最后，这项研究将对发声能力进行初步探索 样本和地点数据，以预测双相情感障碍症状、自杀倾向和社会参与的变化 为未来更大规模的研究提供数据。

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.