Does the use of an automated tool for self-reporting mood by patients with bipolar disorder bias the collected data?
Automating data collection from patients can improve data quality, enhance compliance, and decrease costs in longitudinal studies. About half of all households in industrialized countries now have a home computer.
While we previously validated the ChronoRecord software for self-reporting mood on a home computer with patients who have bipolar disorder, this study further investigates whether this technology created a bias in the collected data.
During the validation study, 80 of 96 (83%) patients returned 8662 days of data (mean, 114.7 +/- 32.3 SD days). The patients' demographics were compared with those of similar longitudinal studies in which patients used paper-based data collection tools. In addition, because demographic characteristics may influence attitudes toward technology, observer-rated scores on the Hamilton Depression Rating Scale and Young Mania Rating Scale were used to group patients by severity of illness, and the self-reported mood ratings were analyzed for evidence of bias from the patients' gender, ethnicity, diagnosis, age, disability status, or years of education. Analysis was performed using the 2-way analysis of variance and general linear model.
The patients' demographic characteristics were very similar to those of patients with bipolar disorder who participated in comparable longitudinal studies using paper-based tools. After grouping the patients by severity of illness, none of the demographic variables had a significant effect on the patients' self-reported mood using the automated tool.
The use of a computer does not seem to bias sample data. As with studies using paper-based self-reporting, results from studies of patients using ChronoRecord software on a home computer to report mood can be generalized.
Available from: Gilles Bertschy
- "Two studies have demonstrated concurrent validity of self-reporting with the ChronoRecord software and clinician ratings using the Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS) [83, 84]. Furthermore, although a potentially serious bias could be related to the ability of people to use a computer, another study showed that age, years of education, gender, diagnosis, and disability status did not seem to bias patients' use of the ChronoRecord software . A similar study that compared a paper version of the LCM and an online version also demonstrated that patients filled in the electronic chart more often and more carefully than the paper chart . "
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ABSTRACT: This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.
Available from: Martin Alda
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ABSTRACT: Bipolar disorder remains a serious public health problem with a significant personal and economic burden. In line with the widespread recognition of the value of active patient involvement in their care, daily mood charting may increase the patient's understanding of their condition and improve adherence with complex medication regimes. Knowledge about the course and pattern of an individual's disorder may also allow earlier recognition of new episodes and help determine the optimal treatment strategy. Mood charting is also an essential tool for longitudinal studies of patient outcomes. Traditionally, patients have used paper-based tools for this daily self-assessment, but these forms are associated with problems of data quality, poor compliance, high costs for data entry, and only provide limited feedback for the patient and physician. As computer technology has gained acceptance by the public worldwide, new options are available to automate monitoring of patients with mood disorders. This article will review mood charting and describe our experience with the development, validation and use of ChronoRecord, an automated instrument for mood charting.
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ABSTRACT: Patients with bipolar disorder often report depressive symptoms that do not meet the DSM-IV criteria for an episode. Using daily self-reported mood ratings, we studied how changing the length requirement to that typical of recurrent brief depression (2-4 days) would impact the number of depressed episodes.
203 patients (135 bipolar I and 68 bipolar II by DSM-IV criteria) recorded mood daily using ChronoRecord software on a home computer (30,348 total days; mean 150 days). Episodes of depression and days of depression outside of episodes were determined. Symptom intensity (mild versus moderate or severe) was investigated within and outside of depressive episodes.
Decreasing the minimum duration criterion for an episode of depression to 2 days increased the number of patients with a depressed episode two and a half times (52 to 131), and quadrupled both the number of depressed episodes per patient (0.62 to 2.88) and the number of depressed episodes for all patients (125 to 584). With a 2-day episode length, 34% of days of depression remained outside an episode. The ratio of days with severe symptoms within episodes remained consistent (about 25%) in spite of decreasing the episode length to 2 days. Considering only days with severe symptoms, about 25% remained outside of episodes even with a 2-day length. None of the results distinguished bipolar I from bipolar II disorder.
Self-reported data, computer access required, relatively short study length, no control group.
Brief depressive episodes and single days of depression outside of episodes occur frequently in both bipolar I and bipolar II disorder. Moderate or severe symptoms occur during brief episodes at a ratio similar to that for episodes that meet the DSM-IV criteria.
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