Program Reviews

MONARCA

Program Overview

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.

Last Updated: 06/13/2024

Delivery:
Web-based
Mobile application

Theoretical Approach:
Cognitive Behavioral Therapy (CBT)

Target Condition:
Bipolar Disorder

Target Outcome(s):
Medication adherence
Symptom management

Ages:
Young Adults (18-30)
Adults (30+)

Genders:
Male
Female

Races/Ethnicities:
Unspecified

Setting:
Remote Access

Geographic Location(s):
Unspecified

Country:
Denmark

Language:
Danish

Evaluations

  • 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.

  • 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.

  • The MONARCA self-assessment system: Persuasive personal monitoring for bipolar patients. Frost M, Marcu G, Hansen R, Szaántó K, Bardram JE. 5th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth) and Workshops; 2011; Dublin, Ireland. doi: 10.4108/icst.pervasivehealth.2011.246050

    The MONARCA self-assessment system – A persuasive personal monitoring system for bipolar patients. Bardram JE, Frost M, Szántó K, Marcu G. Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium; 2012; Miami, Florida, USA. 21-30. doi: 10.1145/2110363.2110370

    Daily electronic self-monitoring of subjective and objective symptoms in bipolar disorder – the MONARCA trial protocol (MONitoring, treAtment and pRediCtion of bipolAr disorder episodes): A randomised controlled single-blind trial. Faurholt-Jepsen M, Vinberg M, Christensen EM, Frost M, Bardram J, Kessing LV. BMJ Open. 2013. 3: e003353. doi: 10.1136/bmjopen-2013-003353

    Personal health systems for bipolar disorder: Anecdotes, challenges and lessons learnt from MONARCA project. Mayora O, Arnrich B, Bardram J, et al. 7th International Conference on Human Computing for Healthcare (PervasiveHealth) and Workshops; 2013; Venice, Italy. 424-429. doi: 10.4108/icst.pervasivehealth.2013.252123

    Daily electronic monitoring of subjective and objective measures of illness activity in bipolar disorder using smartphones – the MONARCA II trial protocol: A randomized controlled single-blind parallel-group trial. Faurholt-Jepsen M, Vinberg M, Frost M, Christensen EM, Bardram J, Kessing LV. BMC Psychiatry. 2014. 14(309). doi: 10.1186/s12888-014-0309-5

    Mood instability in bipolar type I vs type II-continuous daily electronic self-monitoring of illness activity using smartphones. Faurholt-Jepsen M, Ritz C, Frost M, et al. Journal of Affective Disorders. 2015. 186: 342-349. doi: 10.1016/j.jad.2015.06.026

    Smartphone data as an electronic biomarker of illness activity in bipolar disorder. Faurholt-Jepsen M, Vinberg M, Frost M, et al. Bipolar Disorders. 2015. 17: 715-728. doi: 10.1111/bdi.12332

    The effect of smartphone-based monitoring on illness activity in bipolar disorder: the MONARCA II randomized controlled single-blinded trial. Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. Psychol Med. 2020. 50(5):838-848. doi:10.1017/S0033291719000710