A smartphone-based tool that includes coaching and an application resulted in some decreases in symptom severity in patients with bipolar disorder.

A team, led by Evan H. Goulding, MD, PhD, Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, tested a smartphone-based self-management intervention tool as a way to improve accessibility and assist individuals with bipolar disorder to maintain wellness.

A Lack of Access

Psychotherapy is not readily accessible for patients with bipolar disorder, despite research showing it can improve relapse risk, symptom burden, and quality of life when combined with pharmacotherapy.

In the assessor-blind randomized clinical trial, the investigators examined 329 patients between March 20, 2017 and April 25, 2019, with 48-week follow-up at clinics in the Chicago and Minneapolis-Saint Paul areas.

The mean age of the patient population was 42 years.

Each participant was randomly assigned to either usual care (n = 205) or usual care combined with the smartphone intervention (n = 124).

The participants were stratified by relapse risk based on the initial clinical status. Low risk was defined as symptomatic recovery and high risk was defined as continued symptomatic, prodromal, recovering, and symptomatic recovery.

The Intervention

The smartphone-based self-management intervention included an application, coach, and website.

Over the 16 week course, coaches visited participants followed by 6 phone calls.

The participants completed daily and weekly app check-ins, while the app provided adaptive feedback and information for developing a personalized wellness plan. The coach also provided support and the website provided summary data and alerts.

The investigators sought primary outcomes of time to relapse, as well as secondary outcomes including percentage-time symptomatic, symptom severity, and quality of life.

Risk Reduction

The results did not show a reduction in relapse risk for the smartphone intervention group (HR, 0.65; 95% CI, 0.39-1.09; log rank P = .08).

On the other hand, there was a decrease in relapse observed for low-risk participants (HR, 0.32; 95% CI, 0.12-0.88; log-rank P = .02). The same was not found for high-risk individuals (HR, 0.86; 95% CI, 0.47-1.57; log-rank P = .62).

There was also reduced manic symptom severity found in low-risk participants (mean difference, −1.4; P = .001).

Once again, this was not true for high-risk individuals mean difference, 0; P = .95).

The smartphone program also resulted in a decrease in depressive symptom severity (mean difference, −0.80]; P = .02) and improved relational quality of life (mean difference, 1.03; P = .02). The new regimen did not decrease the percentage-time symptomatic (mean difference, -5.6; P = .20).

“This randomized clinical trial of a smartphone-based self-management intervention did not detect a significant improvement in the primary outcome of time to relapse,” the authors wrote. “However, a significant decrease in relapse risk was observed for individuals in asymptomatic recovery.

“In addition, the intervention decreased depressive symptom severity and improved relational quality of life,” the team added. “These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery.”

The study, “Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life,” was published online in JAMA Psychiatry.