Smartphone interventions in bipolar disorder: a position paper

Smartphone-based interventions may be effective in detecting mood swings in between episodes of bipolar disorder and stimulating early intervention. These were the findings of a systematic review and meta-analysis, which were at the basis of a position paper from the International Society for Bipolar Disorders (ISBD) Big Data Task Force [1].

Smartphones offer unique opportunities for real-time monitoring of depressive and manic symptoms in bipolar disorder, detecting prodromal symptoms and immediately acting upon them. Few of the numerous smartphone interventions for bipolar disorder meet quality standards for evidence-based medicine. Dr Gerard Anmella (University of Barcelona, Spain) presented the results of a comprehensive literature search on smartphone-based interventions in bipolar disorder conducted in early 2021. The primary aim was to examine their ability to prevent mood episodes, reduce psychiatric admissions, reduce manic/depressive symptoms, reduce perceived stress, and/or increase functioning and quality of life. The secondary aim was to explore which aspects of smartphone interventions were associated with efficacy in which bipolar disorder subpopulations, and how user-engagement indicators (UEIs) were included and measured.

The researchers identified 4,943 studies, 6 of which were randomised controlled trials (RCTs) that fulfilled selection criteria and were included in the quantitative synthesis. A preliminary meta-analysis showed a non-significant trend of smartphone interventions to reduce manic/depressive symptoms and perceived stress, and to increase functioning and quality of life. All 6 studies reported positive outcomes for UEIs. Dr Anmella noted that most terms were conflated and heterogeneous in meaning.

The authors signaled an urgent need for an expert consensus to establish valid measures (with solid thresholds) for efficacy in smartphone interventions for bipolar disorder and consistent and replicable standard definitions for reporting UEIs, as well as valid objective measures. An expert consensus on smartphone-based interventions in bipolar disorder will allow clinicians to:

• design, compare, and replicate studies and reach higher scientific rigour;
• qualitatively and quantitatively classify and rank smartphone interventions; and
• have accurate and reliable UEIs to evaluate smartphone interventions in bipolar disorder.

1. Anmella G, et al. The efficacy of smartphone-based interventions in bipolar disorder: systematic-review and meta-analyses. A position paper from the ISBD Big Data Task-Force. P.0092, ECNP 2021 Congress, 2–5 October.

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Posted on 26 November, 2021