Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder

Thomas D Bjella; Margrethe Collier Høegh; Stine Holmstul Olsen; Sofie R Aminoff; Elizabeth Barrett; Torill Ueland; Romain Icick; Ole A Andreassen; Mari Nerhus; Henrik Myhre Ihler; Marthe Hagen; Cecilie Busch-Christensen; Ingrid Melle; Trine Vik Lagerberg

doi:10.3389/fmedt.2022.910533

Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder

Front Med Technol. 2022 Jul 22:4:910533. doi: 10.3389/fmedt.2022.910533. eCollection 2022.

Authors

Thomas D Bjella¹, Margrethe Collier Høegh¹, Stine Holmstul Olsen¹, Sofie R Aminoff^{1

2}, Elizabeth Barrett², Torill Ueland^{1

3}, Romain Icick^{4

5}, Ole A Andreassen¹, Mari Nerhus^{1

6}, Henrik Myhre Ihler¹, Marthe Hagen¹, Cecilie Busch-Christensen¹, Ingrid Melle¹, Trine Vik Lagerberg¹

Affiliations

¹ NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
² Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
³ Department of Psychology, University of Oslo, Oslo, Norway.
⁴ INSERM, UMR_S1144, Paris University, Paris, France.
⁵ FondaMental Foundation, Créteil, France.
⁶ Department of Special Psychiatry, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.

Abstract

Introduction: The illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors.

Methods: An app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities (social, occupational, physical exercise, leisure), substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability.

Results: The final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly (Substance Use, Emotional Reactivity, and Psychotic Experiences modules). In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway.

Discussion: We believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health.

Keywords: bipolar disorder; digital characterization; eHealth; illness course; mood; psychotic symptoms; sleep; substance use (drugs, alcohol, smoking).