Mood Monitoring Research Articles

Printed facial skin electrodes as sensors of emotional affect

Electromyography of the zygomaticus major and the corrugator supercilii muscles is a well-established technique to capture positive and negative emotional affect. Despite the great potential, its wide adoption has been so far limited owing to several lingering technical limitations in contemporary electromyography electrodes. In this paper, we report on new printed electrode arrays, specifically designed to capture emotional affect, focusing on their unique and advantageous properties compared with conventional gelled electrodes. Inkjet- or screen-printing, combined with film cutting and lamination techniques, were used to produce customized electrode arrays. Conformity with the skin was guaranteed by printing on very thin and soft films. Unlike conventional gelled-surface electromyography electrodes, the printed electrode arrays are dry, allowing long-term and stable recording. Moreover, the large electrode arrays can be rapidly and conveniently placed on the subject’s face, maintaining excellent electrode–skin compliance. Muscle localization was achieved despite inter-subject variability in facial features and electrode array position, as a result of high spatial resolution and source separation methodology. The presented electrode arrays open new opportunities in brain–machine interfacing, well-being investigations and mood monitoring.

Feasibility and Validity of Smartphone-based Ecological Momentary Assessment for Mood Monitoring in Older Adults

Feasibility and Validity of Smartphone-based Ecological Momentary Assessment for Mood Monitoring in Older Adults

Imagery-Focused Cognitive Therapy (ImCT) for Mood Instability and Anxiety in a Small Sample of Patients with Bipolar Disorder: a Pilot Clinical Audit.

Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT). This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service. Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire. Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus. This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.

Smartphone application for preventing depression: study protocol for a workplace randomised controlled trial

IntroductionDepression is the leading cause of life years lost due to disability. Appropriate prevention has the potential to reduce the incidence of new cases of depression, however, traditional prevention approaches...

A smartphone application for treating depressive symptoms: study protocol for a randomised controlled trial

BackgroundDepression is a commonly occurring disorder linked to diminished role functioning and quality of life. The development of treatments that overcome barriers to accessing treatment remains an important area of clinical research as most people delay or do not receive treatment at an appropriate time. The workplace is an ideal setting to roll-out an intervention, particularly given the substantial psychological benefits associated with remaining in the workforce. Mobile health (mhealth) interventions utilising smartphone applications (apps) offer novel solutions to disseminating evidence based programs, however few apps have undergone rigorous testing. The present study aims to evaluate the effectiveness of a smartphone app designed to treat depressive symptoms in workers.MethodsThe present study is a multicentre randomised controlled trial (RCT), comparing the effectiveness of the intervention to that of an attention control. The primary outcome measured will be reduced depressive symptoms at 3 months. Secondary outcomes such as wellbeing and work performance will also be measured. Employees from a range of industries will be recruited via a mixture of targeted social media advertising and Industry partners. Participants will be included if they present with likely current depression at baseline. Following baseline assessment (administered within the app), participants will be randomised to receive one of two versions of the Headgear application: 1) Intervention (a 30-day mental health intervention focusing on behavioural activation and mindfulness), or 2) attention control app (mood monitoring for 30 days). Participants will be blinded to their allocation. Analyses will be conducted within an intention to treat framework using mixed modelling.DiscussionThe results of this trial will provide valuable information about the effectiveness of mhealth interventions in the treatment of depressive symptoms in a workplace context.Trial registrationThe current trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000547347, Registration date: 19/04/2017).

Tailored Versus Generic Knowledge Brokering to Integrate Mood Management Into Smoking Cessation Interventions in Primary Care Settings: Protocol for a Cluster Randomized Controlled Trial.

BackgroundBoth tobacco smoking and depression are major public health problems associated with high morbidity and mortality. In addition, individuals with depression are almost twice as likely to smoke and less likely to achieve smoking cessation. In the Smoking Treatment for Ontario Patients program, an established smoking cessation program in Ontario, Canada, 38% of smokers in primary care settings have current or past depression with 6-month quit rates that are significantly lower than those without depression (33% versus 40%, P<.001). Integrating self-help mood management (eg, relaxation exercises and mood monitoring) with smoking cessation treatment increases long-term quit rates by 12%-20%. However, integration in real-world settings has not been reported. It is unclear which knowledge translation strategy would be more effective for motivating clinicians to provide resources on mood management to eligible patients.ObjectiveThe objectives of this study are to investigate the following comparisons among depressed smokers enrolled in a smoking cessation program: 1) the effectiveness of generalized, exclusively email-based prompts versus a personalized knowledge broker in implementing mood management interventions; 2) the effectiveness of the two knowledge translation strategies on smoking quit rates; and 3) the incremental costs of the two knowledge translation strategies on the implementation of mood management interventions.MethodsThe study design is a cluster randomized controlled trial of Family Health Teams participating in the Smoking Treatment for Ontario Patients program. Family Health Teams will be randomly allocated 1:1 to receive either generalized messages (related to depression and smoking) exclusively via email (group A) or be assigned a knowledge broker who provides personalized support through phone- and email-based check-ins (group B). The primary outcome, measured at the site level, is the proportion of eligible baseline visits that result in the provision of the mood management intervention to eligible patients.ResultsRecruitment for the primary outcome of this study will be completed in 2018/2019. Results will be reported in 2019/2020.ConclusionsThis study will address the knowledge gap in the implementation strategies (ie, email-based prompts versus a knowledge broker) of mood management interventions for smokers with depression in primary care settings.Trial RegistrationClinicalTrials.gov NCT03130998; https://clinicaltrials.gov/ct2/show/NCT03130998 (Archived on WebCite at www.webcitation.org/6ylyS6RTe)

Erratum: Prospective interepisodal mood monitoring in patients with affective disorders: a feasibility study [Corrigendum

[This corrects the article on p. 517 in vol. 14, PMID: 29491711.].

P.4.003 - Mood instability and reward processing: daily remote monitoring as a modern phenotyping tool for bipolar disorder

Introduction Mood instability is a prominent feature of bipolar disorder (BD) and other affective disorders [1]. Recent research has begun to highlight a strong association between mood instability and cognitive processing, particularly within the decision-making and reward-processing domain, suggesting the ability for mood to bias perception of reward and loss, and to induce risk-taking behaviour [2,3]. However, whilst this has provided an interesting first-line understanding of the phenotypic nature of BD, research to date has failed to explore the complexities of this relationship over a longitudinal basis. Modern technologies, such as remote online platforms, can address this issue by using high frequency and prospective monitoring. This is particularly important given the dynamic nature of mood instability [4] and the expanding need to understand its underlying neural mechanisms in order to develop new and better-suited targets for treatment [1]. Aims Given the emergence of new technologies and the ubiquity of internet access, we aimed to assess whether remote monitoring can capture dynamic mood instability in individuals showing dimensions of BD as measured by the Mood Disorder Questionnaire (MDQ) screening tool, and whether such instability is reflected in risk-taking behaviour in a longitudinal decision-making and reward-processing task. Methods Remote mood and cognitive monitoring over 10 weeks, as part of the Cognition and Mood Evolution across Time (COMET) study. We analysed data from 37 participants scoring >7 on the MDQ (high MDQ group) and 35 matched controls (MDQ Results The high MDQ group showed greater variability in their PANAS positive affect, F (1)=10.56, p F (1)=15.01, p F (1)=14.46, p Whilst the high MDQ participants did not show a significant bias towards riskier decisions in the gambling task in these preliminary analyses, all participants appeared to make less risky choices, F (5.00)=7.42, p F (4.81)=2.50, p Conclusions Longitudinal daily remote mood monitoring captures mood instability in individuals showing dimensions of BD. Concurrent monitoring of cognition, particularly within the reward processing domain, suggests a pattern of dynamic decision-making and warrants further sophisticated analyses to better elucidate the cognitive underpinnings of such mood instability. Nevertheless, findings add to the increasing evidence for mood instability as a marker for BD, and suggest the efficacy of remote monitoring as a modern phenotyping technology in prospectively assessing mood instability and associated cognition. This will aid in the search for biomarkers that can be used in determining the effectiveness of current treatments and in the development of novel therapeutic targets.

S.04.01 - Monitoring the dynamics of real life psychopathology using ambulatory assessment

Real-time mobile smartphone sampling of psychopathological symptoms and behaviour, sometimes also called Ambulatory Assessment [1], has become more and more popular in psychiatric research. This method offers three key advantages: real time assessment, real life assessment and the perspective on within-subject processes/mechanisms. Real time assessment eliminates retrospective biases. Real life assessment enables to investigate symptomatology in the most important context: the everyday life´s of our patients. The within-subject perspective offers the possibility to elucidate psychopathological mechanisms in everyday life. According to current research, the dynamics of affective states and the intentional regulation of emotions are even more important to psychological health and maladjustment, than the affective states itself. However, capturing the ebb and flow in everyday life is not trivial. Recent technical developments resulted in both fancy hardware to collect data in everyday life and powerful data modelling techniques to analyze it. All three advantages come with the promise of increasing validity and reliability and therewith decreasing costs and sample size for future studies. In my talk, I will focus on four examples of Ambulatory Assessment to illustrate opportunities in psychopathology research: a) utilizing high frequency data assessment to model affective dynamics in borderline personality disorder, b) using location-triggered e-diaries to investigate the relation between stress-reactivity and environmental components, which are presumed to be relevant for the development of schizophrenia, c) monitoring physical activity and telecommunication behaviour to predict upcoming episodes in bipolar patients, and d) using Ambulatory Assessment Intervention as a strategy for monitoring and coaching chronobiology and physical activity in ADHD and comorbid conditions. a) Affective instability is hypothesized to be the core pathology in patients with borderline personality disorder (BPD) and the ICD-10 even lists BPD under the category of emotionally unstable personality disorders. Surprisingly, recent work using e-diaries to assess affect over time did not reveal affective instability as a disorder-specific mechanism, as other disorders did impress by similar instability [2]. Accordingly, it has been hypothesized that statically modeling the dynamic interplay between affect and self-esteem is necessary to discriminate between transdiagnostic and disorder-specific mechanisms [3]. Using statistical models which allow decomposing random from true variability, modeling multiple subcomponents of affective processes at the same time, and modeling between-subject and group-specific differences in affective response and regulation processes in 90 patients with BPD and 90 healthy controls, we could reveal specific time based processes of affective instability and self-esteem instability in predicting self-mutilating behavior in patients with BPD. b) Psychiatric research is increasingly interested in the influence of social and environmental contexts on human health. According to recent findings, specific impacts of urban upbringing on neural social stress processing relate to the heightened prevalence of mental disorders, like schizophrenia, in cities [4]. Although this is a major societal problem, it still remains unknown which environmental components (e.g. psychosocial stressors, air pollutants, rare nature experience) are responsible. We use GPS-triggered e-diaries on smartphones to trace participants’ [5], therewith assessing both momentary mental states and exposure to environmental risk and resilience factors. In an ongoing longitudinal study [5], we combine real life psychopathology tracking using ambulatory assessment with functional magnetic resonance imaging and epigenetic approaches to investigate the most relevant environmental factors influencing mental health. c) Smartphone monitoring of mood and behavior-related parameters, like communication, physical activity and sleep, is a promising approach to detect early warning signs in the course of bipolar disorders and to prevent new illness episodes. We monitored communication habits such as length of calls, number of dialed contacts, number and length of messages, furthermore overall activity like smartphone usage, steps and travelled distance, as well as sleep, using end-of-the-day e-diaries, in 30 out-patient participants with bipolar disorder during 356 days, each. Psychopathological interviews for assessing current (hypo-)manic, depressive and euthymic states took place every two weeks. Data analyses revealed substantial associations between psychopathological states and smartphone behaviour. In an ongoing randomized multi-center, observer-blind trial, we test whether smartphone based automated feedback can effectively prolong states of euthymia and prevent hospitalization. d) To illustrate emerging opportunities using Ambulatory Assessment Intervention, I will report an ongoing study where we combine classical Ambulatory Assessment with an intervention component in patients with ADHD. We developed an m-Health system comprising of a smartphone and an activity sensor on the wrist. The smartphone delivers homework reminders, exercise interventions via video clips, and monitors treatment compliance. Feedback on performed treatment parameters is processed in real time, is generated automatically and is sent back to the participant´s smartphone to improve motivation and compliance. I will conclude my talk on specifying disadvantages and pitfalls of Ambulatory Assessment. In conclusion, Ambulatory Assessment does offer a wealth of methodological approaches to enhance the understanding of psychopathological symptoms in the most important context: the daily life´s of our patients.

Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study.

BackgroundFamily and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers’ well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers’ coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person.ObjectiveThis study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype.MethodsThe study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach.ResultsFour behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need.Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program.A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value.ConclusionsThe person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway.

Participants\u2019 perspectives of weekly telephonic mood monitoring in South Africa: a feasibility study

BackgroundMood and anxiety disorders have a high lifetime prevalence, and their chronicity adds to the management burden of already scarce and strained mental health care resources, particularly in developing countries. Non-professional-assisted interventions and technology (such as weekly telephonic mood monitoring) could assist in the early identification of symptoms of relapse and hospitalization prevention. The present study aimed to determine participants’ perspectives and the feasibility of weekly telephonic mood monitoring in order to inform the development of the full study.MethodSemi-structured telephonic interviews (n = 37; 89.2% female; mean age = 33.1 years) were conducted as part of the full-scale feasibility study (N = 61; named the Bipolar Disorder Mood Monitoring (BDMM) Study). The BDMM Study was conducted to determine the viability of weekly telephonic mood monitoring, spanning 26 weeks and starting 1 week post-discharge. Frequency and descriptive statistical analyses (using SPSS version 24) were undertaken, and qualitative data were analyzed using thematic content analysis.ResultsThis article presents the findings from the semi-structured interview section of the BDMM Study. Participants generally expressed positive experiences and perceptions of weekly telephonic mood monitoring, stating that they would advise others to also take part in weekly telephonic mood monitoring. Nonetheless, some participants did make suggestions for improvement of mood monitoring while others expressed negative experiences of weekly telephonic mood monitoring.ConclusionThe results of the semi-structured interviews of the BDMM Study indicated that participants perceived weekly telephonic mood monitoring to be helpful in lightening the burden of mood and anxiety disorders (e.g., having someone to talk to, providing insight into their disorders). Not only did it help them, but they also perceived mood monitoring to be potentially helpful to future participants. However, weekly mood monitoring was also burdensome in itself (including being too time consuming and having to answer questions when feeling down). Importantly, the findings highlighted that participants’ and researchers’ perceptions and experiences may not be congruent (especially in terms of therapeutic misconception). The current findings may inform researchers’ future approach to study design and participant relationships.

Prospective interepisodal mood monitoring in patients with affective disorders: a feasibility study

ObjectivesOur primary objective was to assess the feasibility of interepisodal telephonic mood monitoring in patients with affective disorders in a low-resource setting. Secondary objectives included gathering data on longitudinal mood trajectories and assessing patient acceptance of mood monitoring.MethodsInpatients with a primary mood or anxiety disorder were recruited predischarge. Assessment at intake included demographic information, the Life Events Checklist, and the Childhood Trauma Questionnaire. Participants telephonically completed the Altman Self-Rating Mania Scale (ASRM) and Quick Inventory of Depressive Symptomatology (QIDS), weekly, for 26 weeks. Units of alcohol consumed and life events were recorded. Semi-structured interviews were conducted midway through the mood monitoring protocol.ResultsOf the 61 eligible participants (77% female; mean age =35.3 years), 28 completed 26 weeks of telephonic mood monitoring. Thirty-three participants (54.1%) withdrew prematurely or were lost to follow-up. Males were more likely to terminate study participation prematurely. Despite the significant decline in depression scores over 26 weeks, participants endorsed persistent mild-to-moderate depressive symptoms. Statistically, participants who were married/in a relationship had higher mean depression scores throughout the study compared to participants who were single. Throughout the study, ASRM scores were not indicative of significant mania. Suicidality (as measured by QIDS item 12) was highest at Week 3 and Week 12 postdischarge for those who completed 26 weeks of monitoring.ConclusionDespite the high attrition rate, interepisodal telephonic mood monitoring was deemed to be feasible and it can provide useful information to track progress, encourage medication adherence, and manage early warning signs of relapse. Further research is required to determine the benefit of weekly mood monitoring on mood fluctuations and to examine strategies that enhance retention.

Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm.

BackgroundEffective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice.ObjectiveThe objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician.MethodsWe engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups.ResultsThe app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a “well-being tracker” in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services.ConclusionsThe potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.

Mood regulation, customer participation, and customer value creation in hospitality services

Purpose Customers play a key role in value creation. Not surprisingly, research has investigated customers’ motivations to engage in the creation of value. Thus, this study aims to assess the link between mood-regulatory processes and customer participation in value creation. Design/methodology/approach This study develops a model that relates mood-regulatory processes to customer participation and customer value creation, and tests it with a sample of 419 hotel customers, using partial least squares estimation. Findings It is found that mood clarity relates directly with customer relational value; mood monitoring relates directly with customer participation as well as directly and indirectly with customer economic and relational value; and mood repair relates directly with customer participation and customer economic value, as well as indirectly with customer economic and relational value. Research limitations/implications This is a cross-sectional study limited only to hotels in Iran. This is the first study to evaluate the relationship between mood regulation with customer participation and value creation. Hospitality service organizations interested in promoting customer participation may consider mood as a segmentation criterion. Originality/value Value creation theory was applied to identify the relationship among customer mood regulation, participation, economic value and relational value, as it is first attempted in the hospitality studies.

Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression

Women have a higher prevalence of chronic noncancer pain conditions and report more severe pain, yet, it is not known if the association between long-term opioid analgesic use (OAU) and risk of a new depression episode (NDE) differs according to gender. We analyzed patient data from the Veterans Health Administration (VHA; 2000–2012; n = 70,997) and a large private-sector health care organization (2003–2012; n = 22,981) to determine whether long-term OAU and risk of NDE differed according to gender. Patients were free of depression and OAU for 2 years before baseline. OAU duration was defined as 1 to 30, 31 to 90 and more than 90 days, and NDE was defined according to International Classification of Diseases, Ninth Revision codes. Gender-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs). Propensity scores and subsequent inverse probability of treatment weighting controlled for confounding. In the VHA, more than 90 compared with 1- to 30-day OAU was more strongly associated with NDE among female than male patients (female: HR = 1.79 [95% confidence interval (CI), 1.45–2.22] vs male HR = 1.25 [95% CI, 1.16–1.34], P = .002). In private sector patients, there was no gender difference in the association between more than 90-day OAU and NDE (female HR = 1.97 [95% CI, 1.64–2.37] vs male HR = 1.99 [95% CI, 1.44–2.74]). Risk of NDE after long-term OAU is similar in men and women in private sector patients but may differ for VHA patients. Future prospective studies are needed to identify mechanisms for the association between longer OAU and NDE. PerspectiveExisting research is mixed regarding gender differences in outcomes after long-term prescription opioid use. This study found both genders have increased risk of an NDE after more than 90 days of opioid use. Women and men may benefit from closer monitoring of mood associated with chronic opioid use.

The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials.

The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.

Preliminary Evaluation of a Brief Web and Mobile Phone Intervention for Men With Depression: Men's Positive Coping Strategies and Associated Depression, Resilience, and Work and Social Functioning.

BackgroundPrevious research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men’s mental health needs are required.ObjectiveThis study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed.MethodsA recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes.ResultsA total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures.ConclusionsThis preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time.

Longitudinal mood monitoring in bipolar disorder: Course of illness as revealed through a short messaging service

BackgroundOnline self-monitoring of mood can be used to investigate differences in course patterns across patient groups. This study explored the feasibility of remote symptom capture with True Colours, a self-rated online mood monitoring tool completed on a weekly basis. MethodsParticipants with bipolar disorder (N = 297) completed weekly depression and mania questionnaires over an average of 27.5 months (range 1 –81 months). Subgroups defined by sex, age, and bipolar I vs. II status were compared on time in various mood states, number of episodes, and week-to-week mood variability. ResultsCompliance with weekly questionnaires was generally high (median, 92% of weeks). Mood symptoms occurred for an average of 55.4% of weeks across the follow-up period. Females spent more time with hypomanic/manic and depressive symptoms and had more depressive episodes compared to males. Younger participants were found to experience more hypomanic/manic episodes and showed greater variability in mood symptoms than older participants. No significant differences in mood symptoms or variability were observed between bipolar I and II patients. LimitationsThis was a naturalistic study with a heterogeneous cohort, and did not include a control group. True Colours does not identify mood fluctuations that may occur in the days between weekly assessments. ConclusionsMonitoring moods through an online tool is both feasible and informative regarding course of illness in patients with bipolar disorder. Interventions aiming to reduce mood variability and manic/hypomanic episodes in the early phases of bipolar disorder may enhance the long-term symptomatic course of the illness.

Remote mood monitoring for adults with bipolar disorder: An explorative study of compliance and impact on mental health service use and costs

BackgroundRemote monitoring of mood disorders may be an effective and low resource option for patient follow-up, but relevant evidence remains very limited. This study explores real-life compliance and health services impacts of mood monitoring among patients with bipolar disorder in the UK. MethodsPatients with a diagnosis of bipolar disorder who were registered users of the True Colours monitoring system for at least 12months at study assessment were included in this retrospective cohort study (n=79). Compliance was measured as the proportion of valid depression and mania scale messages received in comparison to their expected numbers over the first 12months of monitoring. Mental health service use data were extracted from case notes, costed using national unit costs, and compared 12months before (pre-TC period) and 12months after (TC period) patients’ engagement with monitoring. Associations with relevant patient factors were investigated in a multiple regression model. ResultsAverage compliance with monitoring was 82%. Significant increases in the annual use and costs of psychiatrist contacts and total mental health services were shown for patients newly referred to the clinic during the pre-TC period but not for long-term patients of the clinic. Psychiatric medication costs increased significantly between the pre-TC and TC periods (£235, P=0.005) unrelated to patients’ referral status. ConclusionsRemote mood monitoring has good compliance among consenting patients with bipolar disorder. We found no associations between observed changes in mental health service costs and the introduction of monitoring except for the increase in psychiatric medication costs.

Parental monitoring protects against the effects of parent and adolescent depressed mood on adolescent drinking

ObjectiveParental monitoring is a well-established protective factor for adolescent drinking. This study examined whether parental monitoring protected against three common risk factors for alcohol use in a sample of high-risk adolescents: parental depressed mood, adolescent depressed mood, and parental alcohol use. MethodsParticipants included 117 adolescents (mean age=15.5; 52% female) who presented to the hospital emergency department due to an alcohol-related event and their primary parent/guardian. Adolescents completed self-report measures of alcohol use frequency, depressed mood, and parental monitoring, while parents completed self-report measures of problematic alcohol use and depressed mood. ResultsHierarchical regression confirmed that parental monitoring was associated with lower frequency of adolescent alcohol use, even after controlling for the three risk factors. Significant interactions were found between parental monitoring and both adolescent and parental depressed mood. Parental monitoring had significant protective effects against drinking frequency among adolescents with higher levels of depressed mood, but not among adolescents with lower levels of depressed mood. By contrast, parental monitoring only had protective effects among those parents with lower levels of depressed mood. Parental problematic alcohol use did not affect the relationship between parental monitoring and adolescent alcohol use. ConclusionsOur results suggest that adolescents with high levels of depressed mood may be more likely to benefit from parental monitoring, whereas parents with high levels of depressed mood may be less likely to monitor effectively. Interventions targeting parental monitoring in high-risk adolescents should take into account the influence of both adolescent and parental depressed mood.