Smartphone app supports self-management strategies for bipolar disorder

A smartphone-based self-management intervention may reduce relapse risk and manic symptom severity for patients with bipolar disorder in asymptomatic recovery, a randomized clinical trial has shown.

“Bipolar disorder–specific psychotherapy combined with pharmacotherapy improves relapse risk, symptom burden, and quality of life [QoL], but psychotherapy is not easily accessible,” wrote the researchers. “The smartphone-based self-management intervention consisted of an application [app], a coach, and a website developed to increase access to empirically supported self-management strategies for individuals with bipolar disorder.” [JAMA Psychiatry 2022; doi:10.1001/jamapsychiatry.2022.4304]

The core feature of the intervention was to monitor the users’ medication adherence, sleep duration, routine, and wellness levels with a daily check-in. “The app provided adaptive feedback and information for developing a personalized wellness plan, the coach provided support, and the website provided summary data and alerts,” explained the researchers.

To determine if the smartphone intervention can assist individuals with bipolar disorder to maintain wellness, 205 participants (mean age, 42 years; female, 61 percent) were randomized 2:3 to receive usual care or smartphone intervention plus usual care.

Results of the study did not show a significant decrease in the primary outcome of time to relapse for the smartphone intervention (hazard ratio [HR], 0.65; 95 percent confidence interval [CI], 0.39–1.09; log-rank p=0.08). In terms of secondary outcomes, the smartphone intervention decreased depressive symptom severity (mean difference, -0.80; p= 0.02) and improved relational QoL (mean difference, 1.03; p=0.02).

“Interestingly, marked heterogeneity of treatment effect was observed based on the pre-planned relapse risk stratification by initial clinical status [low risk: asymptomatic recovery; high risk: remained symptomatic, prodromal, recovering, and symptomatic recovery],” noted the researchers. Decreases in relapse (HR, 0.32; 95 percent CI, 0.12–0.88; log-rank p=0.02) and manic symptoms were observed for low-risk individuals (mean difference in Young Mania Rating Scale, -1.4; p=0.001), but not for high-risk participants (both p>0.05).

The heterogeneity of treatment effect is consistent with staging models of bipolar disorder, which proposes that individuals in the early stages of the disorder exhibit improvement with adjunctive psychotherapy, whereas those in later stages do not. “[Importantly], this potential heterogeneity of treatment effect supports the recognition that personalized treatment is likely essential to address the diverse needs of individuals with bipolar disorder and improve clinical and recovery outcomes,” highlighted the researchers.

In summary, the study’s results show that the smartphone-based self-management intervention decreases relapse risk and manic symptom severity for patients with bipolar in asymptomatic recovery. However, further work is warranted to confirm the benefits and optimize the smartphone intervention.