Smartphone Intervention Did Not Lower Relapse Risk for Bipolar Disorder

Published in JAMA Psychiatry, a recent study found that a smartphone-based self-management intervention for bipolar disorder patients did not significantly improve the time to relapse but did decrease depressive symptoms and improve relational quality of life.

Data from the Centers for Disease Control and Prevention (CDC) shows that about one in 25 Americans battle serious mental illnesses such as schizophrenia, bipolar disorder, or major depression.

In this study, researchers aimed to determine whether a smartphone-based self-management intervention could improve relapse risk, change symptom burden, and improve the quality of life for bipolar disorder patients. The intervention involved the use of an app, a coach, and a website.

The researchers conducted a randomized clinical trial that enrolled patients between March 20, 2017, and April 25, 2019. A total of 205 randomized participants were included in the study.

The study population was diverse. The mean age of participants was 42 years; 61 percent were female, 2 percent were Asian, 10 percent were Black, 6 percent were Hispanic or Latino, 3 percent were multiracial, 83 percent were White, and 1 percent were an unknown race.

Researchers assigned all patients to a group receiving usual care (40 percent) or a group receiving usual care along with the smartphone intervention (60 percent).

Throughout a 16-week period, study participants had a coach visit followed by six phone calls, and they also engaged in a daily and weekly app check-in. The tool provided feedback relating to the development of a personalized wellness plan, while the coach provided support, and data from the website provided summary data and alerts.

Researchers used the time to relapse as the main unit of measurement. Time to relapse was measured as weeks to new mood episodes of depression, mania, hypomania, or mixed conditions. Other measurements were percentage-time symptomatic, calculated as the number of days a participant was symptomatic divided by the number of days in the study, symptom severity, and quality of life.

Researchers found that the use of the smartphone intervention did not reduce relapse risk. However, there was a decrease in the time to relapse for low-risk individuals compared with high-risk individuals.

Regarding secondary measures, researchers noted that low-risk individuals experienced a reduction in manic symptom severity.

Also, the smartphone intervention led to decreased depressive symptom severity and improved relational quality of life overall. However, the intervention did not noticeably reduce the percentage-time symptomatic.

Based on these results, researchers concluded that the smartphone-based self-management intervention did not reach its primary goals despite some benefits.

"These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery," they stated. 

As the digitization of healthcare continues, mHealth strategies and tools are increasingly being developed for patient care.

Another smartphone intervention involved using an app to detect skin cancer among older patients. Known as SkinIO, the app delivered photos of potentially cancerous lesions to dermatologists. Stanford Medicine researchers conducted a trial between November 2020 and July 2021 to assess the app-based intervention.

After reviewing the lesions the app marked as potentially dangerous, researchers found a large portion harmless. They concluded that the app was helpful; however, only partially reliable.

Another group of researchers from the University of Washington and Seattle Children’s developed a smartphone-based tympanometry system that evaluated middle ear function.

The system leverages a rubber-tipped and compact probe inserted into the ear to evaluate air pressure, tympanic membrane, and ossicular chain. The recorded acoustic reflections and pressure data are then transmitted to the smartphone via a headphone jerk and built-in wireless Bluetooth radio to develop a tympanogram.