Self-assessment and rest-activity rhythm monitoring for effective bipolar disorder management: a longitudinal actigraphy study

Background Recurrent course and disruption of circadian rhythms are among the core features of bipolar disorder (BD). Thus, ongoing symptom monitoring is an essential part of good clinical management.

We conducted a study to validate the English version of the ASERT (Aktibipo questionnaire), a tool for self-assessment of mood symptoms. We also analyzed the relationship of self-assessed symptoms with clinician ratings and actigraphy measures, and investigated the possibility of predicting depressive episodes using subjective and digital measures.

This was a longitudinal study of individuals with BD, followed for up to 11 months. The participants completed weekly mood self-assessments (ASERT) using a smartphone app and wore wrist actigraphs. During monthly appointments, the severity of their mood symptoms was rated by clinicians, and the participants completed questionnaires addressing overall functioning (FAST), and biological rhythms (BRIAN).

The study confirmed the validity and reliability of the ASERT as a measure of subjective mood. Additionally, we found significant associations between ASERT responses, clinical scales, and actigraphy data. In our analysis, a combination of self-assessment and actigraphy data detected depression relapse with 67% sensitivity, 90% specificity, and 81% balanced accuracy. Furthermore, we observed a strong correlation between the stability of daily routine and overall functioning, emphasizing the significance of circadian rhythm disruptions in BD.

This study highlights the potential of digital tools, such as digitally administered self-assessments and actigraphy, to enhance the management of BD by providing valuable insights into mood states and detecting relapse. Further research is needed to refine and optimize these tools for widespread clinical application, such as informing personalized treatment plans. Competing Interest Statement The study was co-funded by Mindpax.me. JS and EB had paid positions at Mindpax.me during the study and preparation of the manuscript. No other authors declare conflict of interest. Funding Statement Work on this study was partially supported by the Mitacs Accelerate International Award (#IT23407), by the Ministry of Health of the Czech Republic, grant nr. NU23-04-00534 and the ERDF-Project Brain dynamics, No. CZ.02.01.01/00/22_008/0004643. The Kapczinski lab was supported by the Strategic Alignment Fund/McMaster University and the St. Joseph's Healthcare Foundation, Hamilton, Canada, and FAPERGS (21/2551-0001990-5), RENASAM (445154/2023-3) and INCT-TM (465458/2014-9), Porto Alegre, Brazil. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Research personnel obtained informed consent from participants following an approved protocol by the local Research Ethics Board (Hamilton Integrated Research Ethics Board (HiREB), Project #13581) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data produced in the present study are available upon reasonable request to the authors.