title: Daily mood monitoring of symptoms using smartphones in bipolar disorder: A pilot study assessing the feasibility of ecological momentary assessment.
abstract: BACKGROUND
  Personal device technology has facilitated gathering data in real-time using Ecological momentary assessment (EMA). We hypothesized that using smartphones to measure symptoms in auto-generated surveys twice a day would be feasible in a group with bipolar disorder (BD). A second exploratory objective of this study was to compare potential differences in core symptoms between BD and healthy control (HC) groups.
  
  
  METHODS
  A two-arm, parallel group, observational study was designed to measure completion rates of surveys of symptoms of mood, energy, speed of thought, impulsivity, and social stress in BD (N=10) and HC (N=10) participants. The surveys were auto-generated twice a day for fourteen days, and subjects could also perform self-generated surveys. Completion rates were compared between BD and HC groups. Scores were averaged for each participant over the 14 day period, and group medians were compared.
  
  
  RESULTS
  Median completion rates did not differ between groups: 95% in BD, 88% in HC (p=0.68); the median completion rate of auto-generated surveys in the BD group was 79% and in the HC group was 71% (p=0.22). The BD group had significantly lower median mood score (p=0.043) and energy score (p=0.007) than the HC group. Median scores of speed of thoughts (p=0.739), impulsivity (p=0.123) and social stress (p=0.056) did not significantly differ between BD and HC. The BD group had significantly higher range of variability of group median mood (p=0.043), speed of thoughts (p=0.002) and impulsivity (p=0.005) scores over the course of 14 days than HC, while range of variability of energy (p=0.218) and social stress (p=0.123) scores did not differ. Results were not significantly different between auto-generated and self-generated surveys for BD or HC.
  
  
  CONCLUSIONS
  This pilot study was conducted for a short time and with a small sample.
  
  
  CONCLUSIONS
  This study demonstrates feasibility of using EMA with a smartphone to gather data on BD symptoms.
authors.affiliation: Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States. Electronic address: sschwartz1@hmc.psu.edu.
authors.forename: Stefani
authors.initials: S
authors.lastname: Schwartz
authors.affiliation: Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States. Electronic address: sschultz1@hmc.psu.edu.
authors.forename: Summer
authors.initials: S
authors.lastname: Schultz
authors.affiliation: Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States. Electronic address: areider@hmc.psu.edu.
authors.forename: Aubrey
authors.initials: A
authors.lastname: Reider
authors.affiliation: Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States; University of Michigan Department of Psychiatry, Ann Arbor, MI, United States; University of Michigan Depression Center, Ann Arbor, MI, United States. Electronic address: esaunders@hmc.psu.edu.
authors.forename: Erika F H
authors.initials: EF
authors.lastname: Saunders
mesh_terms: D000328:Adult; D000339:Affect; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D010865:Pilot Projects; D000068997:Smartphone / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000523:psychology*
keywords: Bipolar disorder; Depression; Ecological momentary assessment; Mania; Mood