The MONARCA system allows patients with bipolar disorder to track and view their moods and psychological indicators with a mobile application (app) and website.
The MONARCA system is an app and website that were iteratively designed with input from patients with bipolar disorder and clinicians. Patients use MONARCA to complete self-assessments of their mood, sleep, activity, and medication adherence, view an overview of their past and present responses to self-assessments, enter triggers and early warning signs, and share their data with clinicians. Patients can also complete self-assessments of universal warning signs, tailored warning signs, alcohol consumption, stress, and add notes about that day. MONARCA sends patients daily reminders to complete self-assessments, tracks passive data from users’ phones, and sends users suggestions based on their responses and triggers. Patients can view responses to self-assessments and change triggers and early warning signs on the website.
Cognitive Behavioral Therapy (CBT)
Young Adults (18-30)
Designing mobile health technology for bipolar disorder: A field trial of the MONARCA system.
Bardram JE, Frost M, Szántó K, Faurholt-Jepsen M, Vinberg M, Kessing LV. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; 2013; Paris, France. 2627-2636. doi: 10.1145/2470654.2481364
Summary: Researchers recruited 12 patients referred by clinicians with stable bipolar disorder to examine the patients’ acceptability of the MONARCA system and adherence to the system compared to paper assessments. Researchers calculated adherence to paper assessments over 62 days prior to the MONARCA trial and compared that to how many assessments patients completed using the MONARCA app over the course of the 69-day study. Participants completed online assessments of usability and intention to use MONARCA in the future. Interviews of participants were also conducted at the end of the study. Participants were provided with smartphones to use during the study. Raw adherence rates were higher for participants using the MONARCA system, but when excluding participants who completed no paper assessments and days where the system malfunctioned and the app was unable to collect data, rates of adherence were equivalent. Interviews with participants indicated that paper assessments were often completed retrospectively and that the app assessments were more accurate. Participants reported that the MONARCA system was useful and overall easy to use. Being able to view past assessment data was considered the most useful feature and managing medication was viewed as the least useful feature. Use of the website component was infrequent. Patients also wanted to be able to personalize what symptoms were tracked in the assessments.
Take Away: Bipolar patients found that the MONARCA system was generally usable and useful and appreciated the ability to track and visualize their symptoms over time.
Daily electronic self-monitoring in bipolar disorder using smartphones – the MONARCA I trial: A randomized, placebo-controlled, single blind, parallel group trial.
Faurholt-Jepsen M, Frost M, Ritz C, et al. Psychological Medicine. 2015. 45: 2691-2704. doi: 10.1017/S0033291715000410
Summary: Researchers recruited 78 participants from a clinic specializing in bipolar disorder to participate in a randomized controlled trial of the MONARCA system. Participants were randomized into a group that received a phone to use the MONARCA system or into a group that received a “placebo” phone without the MONARCA system. Over six months, participants completed monthly assessments of depressive and manic symptoms, perceived stress, psychosocial functioning, quality of life, coping strategies, severity of depressive and manic symptoms, and cognitive and physical functioning. Researchers also assessed participants’ adherence to medication at baseline and 3- and 6-months after baseline. There were no significant differences in primary outcomes (i.e. depressive and manic symptoms) between conditions for the sample as a whole, but there were noted differences for particular subgroups. Among participants with high depression at baseline, those that received MONARCA reported more depressive symptoms than the control group at six-months follow-up. Among participants who reported manic symptoms at any point during the study, those that received MONARCA reported fewer manic symptoms than the control group at six-months follow-up. Participants in the intervention group also reported more distraction-oriented coping than the control group.
Take away: MONARCA may have some preliminary efficacy for improving manic symptoms in the short term. Study results also indicate potential adverse impacts for those with higher depression symptomology. Results indicate the important need for more research to examine the effects of the MONARCA system.