A comparative study of engagement in mobile and wearable health monitoring for bipolar disorder

Bipolar Disord. 2020 Mar;22(2):182-190. doi: 10.1111/bdi.12849. Epub 2019 Oct 25.


Objectives: Self-monitoring is recommended for individuals with bipolar disorder, with numerous technological solutions available. This study aimed to identify basic components of these solutions that increase engagement with self-monitoring.

Methods: Participants with bipolar disorder (n = 47) monitored their symptoms with a Fitbit and a smartphone app and were randomly assigned to either review or not review recorded symptoms weekly. We tested whether individuals would better adhere to and prefer monitoring with passive monitoring with an activity tracker compared to active monitoring with a smartphone app and whether individuals would better adhere to self-monitoring if their recorded symptoms were reviewed with an interviewer.

Results: Monitoring with a smartphone app achieved similar adherence and preference to Fitbit (P > .85). Linear mixed effects modeling found adherence decreased significantly more over the study for the Fitbit (12% more, P < .001) even though more participants reported they would use the Fitbit over a year compared to the app (72.3% vs 46.8%). Reviewing symptoms weekly did not improve adherence, but most participants reported they would prefer to review symptoms with a clinician (74.5%) and on monthly basis (57.5%) compared to alternatives. Participants endorsed sleep as the most important symptom to monitor, forgetfulness as the largest barrier to self-monitoring, and raising self-awareness as the best reason for self-monitoring.

Conclusions: We recommend a combined strategy of wearable and mobile monitoring that includes reminders, targets raising self-awareness, and tracks sleep. A clinician may want to review symptoms on a monthly basis.

Trial registration: ClinicalTrials.gov NCT03358238.

Keywords: Bipolar disorder; Fitness Trackers; Monitoring; Physiologic; Smartphone.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bipolar Disorder*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / statistics & numerical data*
  • Wearable Electronic Devices*

Associated data

  • ClinicalTrials.gov/NCT03358238