Interest in self-management app for bipolar disorder plummets among users

The SIMPLe app, an internet-delivered self-management mobile intervention for bipolar disorder (BD), sees high rates of attrition, particularly among young users and patients who had only recently been diagnosed, according to a recent study.

“Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem to play a relevant role as well,” the researchers said. “We believe that an understanding of these associations will help clinicians in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management.”

The current observational ecological study included 390 participants (mean age 34.74 years, 67.7 percent women) who participated in a real-world implementation run of the SIMPLe app. Data collected included app use patterns, clinical information, and treatment history.  

At baseline, participants had had BD for an average of 13.23 years. Nearly half (49.7 percent) reported experiencing at least 10 depressive episodes, while 33.3 percent had at least 10 manic or hypomanic episodes. Most participants were receiving at least one medication such as mood stabilizers (90.5 percent), antipsychotics (64.6 percent), and antidepressants (49.5 percent). More than 70 percent were undergoing psychological treatment. [J Med Internet Res 2022;24:e31565]

In terms of app use, most participants were regular users (n=357), who accessed SIMPLe a mean of 19.42 days per month. The remaining 33 individuals were deemed occasional users, engaging with the app an average of 2.05 days per month.

Notably, user engagement declined consistently, such that by the 6-month follow-up, only around a third of the participants were still using SIMPLe. Fifty-four participants (13.8 percent) used the app for >100 days. On average, regular users had a mean app use survival time of 87.95 days.

In the 357 regular users, the probability of app use survival after 1 month was only 67.4 percent. This further worsened after 3 and 6 months, with corresponding probabilities of 43 percent and 28 percent. Conversely, the cumulative probability of discontinuing app use increased, reaching 83.7 percent and 126.3 percent at 3 and 6 months, respectively.

Log-rank test analysis showed that years since BD onset (p=0.003) and since receiving a formal diagnosis (p=0.003) were significant factors contributing to app discontinuation. The same was true for younger age (p=0.006), housing status (p=0.006), employment status (p=0.02), and the use of opiates (p=0.005) and antipsychotics (p=0.03).

“The outcomes of this real-world study represent the first attempt to evaluate, by means of survival analysis, use, retention patterns, and engagement of a large-scale wide-reaching app-based intervention providing psychoeducational content to patients with BD,” the researchers said.

Designed to help users self-manage BD, the SIMPLe app consists of a graphic 5-item screening test for daily assessment of mood, energy, sleep time, medication adherence, and irritability. On a weekly basis, the app administers a comprehensive yes-or-no test to screen for manic or depressive episodes. Depending on the status of the user, the app can also provide short psychoeducational messages, providing advice or guidance about how to deal with specific episodes.