Smartphone monitoring of social stimulation in bipolar disorder: an observational prospective pilot study

Background: Social stimulation is the internalised response to social interactions. Irregularity in social stimulation is associated with relapse in Bipolar Disorder (BD) and may represent early-warning signs. Smartphones have the capacity to objectively monitor social stimulation by automatically sensing relevant data, such as telecommunications. This study explores the tolerability of long-term, objective monitoring of social stimulation in BD, using Android smartphones, and participants’ mood over time. Methods: We recruited a small sample (n=12) of individuals with BD for prospective observation of social stimulation and mood. The Berk Depression Rating Scale, Young Mania Rating Scale and Duke Social Support Inventory were administered at baseline, 1-week, 3-, 6-, 9- and 12-months. Phone call and SMS logs, collected via Unforgettable Me and If This Then That applications for up to 12-months, were summarised by day. Results: Individual cumulative sum charts facilitated identification of change in telecommunication patterns and exploration of correspondence between these change points, mood and social stimulation measures. Technological difficulties impacted the tolerability of long-term monitoring. Limitations: The small, mainly female sample, restricted smartphone operating system and inability to capture social-media messaging were the main limitations of this study. Conclusions: This research highlights the opportunities and challenges of automated monitoring of social stimulation in BD, adding to the evidence that subject-specific behaviour patterns offer important insight into mood state in BD. Ongoing efforts to establish reliable data collection, along with more sophisticated change point detection methods, is needed to enhance monitoring of early-warning signs to prevent relapse in individual’s with BD.