Digital mental health interventions for chronic serious mental illness: Findings from a qualitative study on usability and scale-up of the Life Goals app for bipolar disorder.

The Life Goals (LG) application is an evidence-based self-management tool intended to help individuals with bipolar disorder (BD) by aligning symptom coping strategies with personal goals. The program has traditionally been offered in-person or via the web, but has recently been translated into an individualized, customizable mobile intervention to improve access to care and reduce provider burden. The LG app previously showed acceptability with ease of use and satisfaction with user interface, but less success in encouraging self-management. To better understand patient needs, our team conducted semi-structured interviews with 18 individuals with BD who used the LG app for 6 months. These interviews also investigated participant interest in sharing LG app data with their provider through an online dashboard. Using affinity mapping, a collaborative, qualitative data analysis technique, our team identified emerging common themes in the interviews. Through this process, team members identified 494 pieces of salient information from interviews that were mapped and translated into three main findings: (1) many participants found Mood Monitoring and LG modules helpful/interesting and stated the app overall had positive impacts on their mental health, (2) some components of the app were too rudimentary or impersonal to be beneficial, and (3) feedback was mixed regarding future implementation of an LG provider dashboard, with some participants seeing potential positive impacts and others hesitating due to perceived efficacy and privacy concerns. These findings can help researchers improve app-based interventions for individuals with BD by increasing app usage and improving care overall.

The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study.

BACKGROUND: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. OBJECTIVE: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. METHODS: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. RESULTS: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. CONCLUSIONS: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments.

Sleep quality and neuropsychological functioning in bipolar I disorder.

BACKGROUND: Individuals with bipolar I disorder (BD-I) experience both poor sleep and neuropsychological dysfunction relative to non-psychiatric populations, which limits functional recovery. Poor sleep adversely affects learning, memory, and executive functioning in healthy individuals; however, little is known about the role of poor sleep in neuropsychological functioning in BD-I. We tested whether sleep disturbance was greater in BD-I than healthy control participants (HC), and compared the effect of sleep quality on learning, memory, and executive functioning between BD-I and HC. METHODS: Participants with BD-I (N=250) and HC (N=206) completed the Pittsburgh Sleep Quality Index, neuropsychological testing, and clinician-administered mood measures as part of a naturalistic study of bipolar disorder. We examined effects of both diagnosis and sleep quality on neuropsychological functioning. RESULTS: Relative to HC, BD-I showed poorer sleep quality and neuropsychological functioning in verbal learning, verbal and visual memory, processing speed, psychomotor speed, inhibitory control, and selective attention (7/9 domains). Poor sleep quality was associated with poorer verbal learning, verbal fluency, processing speed, and interference control (4/9). Effects of poor sleep on neuropsychological functioning did not differ between BD-I and HC. LIMITATIONS: The assessment of sleep quality using a self-report measure and the effects of medications/sleeping aids (given the naturalistic study design) should be considered when interpreting results. CONCLUSIONS: Those with BD-I experiencing poor sleep may also be more vulnerable to verbal learning and executive functioning impairments. The findings of poor sleep in relation to poorer neuropsychological functioning have implications for assessment and treatment of sleep disturbance in BD-I.