Does the Use of an Automated Tool for Self-Reporting Mood by Patients With Bipolar Disorder Bias the Collected Data?

Michael Bauer, MD, PhD; Natalie Rasgon, MD, PhD; Paul Grof, MD, PhD; Laszlo Gyulai, MD; Tasha Glenn; Peter C. Whybrow, MD

Disclosures

Results

The demographic characteristics of the patients competing the ChronoRecord validation study were compared with those from published longitudinal studies of patients with bipolar disorder; these patients recorded data using paper-based, daily self-ratings on the NIMH LifeChart^[7,27,28]; paper-based monthly retrospective self-ratings using a 7-point scale of symptom severity^[29]; paper-based clinician ratings every 6 months for 5 years followed by yearly clinician ratings^[5]; or a paper-based, 1-time survey^[30] ( Table 1 ).

When the patients in the ChronoRecord validation study were grouped by severity of illness based on observer ratings, none of the demographic variables had a significant effect on the computerized self-ratings of mood by 2-way ANOVA testing ( Table 2 ). The model was significant in every case (P < .001), and as expected, the HAMD and the YMRS effects were also significant in every case. These findings were confirmed by the linear mixed-model estimates that included the individual-patient factor. In every case, the estimated intercept and coefficients for the values of both the HAMD and YMRS groups were significantly different from zero, whereas none of the coefficients for the demographic variable values were significantly different from zero by t-test. The coefficients for the HAMD group and the YMRS group are shown in Table 3 .

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Cite this: Does the Use of an Automated Tool for Self-Reporting Mood by Patients With Bipolar Disorder Bias the Collected Data? - Medscape - Aug 24, 2005.

Table 1. Comparison of Demographic Characteristics Among Patients With Bipolar Disorder in Longitudinal Studies
Variable	ChronoRecord Study(n=80)	Stanley Foundation Bipolar Network(n=261)^a	Judd Long-Term Study(n=206)^c	Stanley Center Bipolar Disorder Registry(n=2839)^d	2000 NDMDA Survey(n=600)^e
Mean age at start of study	38.67 ± 10.86 SD	83% aged 30-64 years^a	39.2 ± 13.6SD bipolar I^c37.4 ± 13.2 SD bipolar II^c	Median 40.1 ^d	Most between 31 and 60^e
Age group, n (%)
18-29	19 (24%)	32 (12%)	N/A	N/A	N/A
30-44	40 (50%)	40 (50%)
45-64	40 (50%)	40 (50%)
65+	1 (1%)	14 (5%)^b
n (%) male: n (%) female	35 (44%):45 (56%)	116 (44%):145 (56%)^a	87 (42%):119 (58%)^c	35.5%:64.5% ^d	34%:66%^e
Bipolar I (%):bipolar II (%)	58 (73%):22 (28%)	81%:16%^a	175 (66%):71 (34%)^c	N/A	N/A
Onset (years)	23.0 ± 9.8 SD	20^a	23.1 ± 9.8 SD bipolar I^c 20.8 ± 10.0 SD bipolar II^c	19.9 ^d	33% under age 15, 27% between 15-19, 39% > 20^e
Single:married:divorced/other (%)	40%:39%:21.%	31%:43%:26%^b	30%:45%:25%^c	33%:33%:33% ^d	25%:38%:37%^e
5 or more hospitalizations for bipolar disorder (%)	29%	19%^a	N/A	N/A	44%^e
Education (%)
High school or less	4 (5%)	15 (7%)	College or more 60.0% of bipolar I and 54.9% of bipolar II^c
Some college	21 (26%)	77 (38%)		>30%^d
At least college graduate	55 (69%)	111 (55%)^b		33%^d	55%^e
Ethnicity (%)
Caucasian (including Hispanic)	71 (89%)	71 (89%)	100%^c	90%^d	N/A
African American	2 (3%)	2 (3%)
Other	6 (8%)	14 (5%)^b
Employment
Full-time	21 (26%)	65 (25)%	N/A	38.8% of men and 34.3% or women employed^d;33.7% of men and 30.4% of women on disability, welfare or retired^d	25%
Part-time	10 (13%)	35 (9%)			16%
Unemployed	8 (10%)	17 (6%)			58% unemployed or retired^e
Retired	4 (5%)	13 (5%)			58% unemployed or retired^e
Disabled/unable to work^f	23 (29%)	55 (21%)^b
Other	14 (18%)
In US: other country (%)	69%:31% in Canada	78%:22% in Netderlands ^b	100% in US^c	100% in US^d	100% in US^e
Mean number of daily medications	3.8	4.1^g	N/A	1/3 taking at least 3 types of psychotropic medications;2/3 at least 2^d	80% take multiple medications^e
Taking medications (%)
Any mood stabilizers	92.4%	97%	N/A	N/A	70%
Any antidepressant	58.8%	53%			53%
Any neuroleptic	38.8%	33%			42%
Any benzodiazepine	42.5%	49%			N/A
Thyroid hormones	21.1%	26%^g			9%^e

Table 2. 2-Way ANOVA* Analysis of ChronoRecord Mood by Demographics and Grouped HAMD and YMRS, Demonstrating no Significant Demographic Variables
Demographic Characteristics	HAMD (n=281)			YMRS (n=283)
Demographic Characteristics	Primary P	HAMD P	2-way P	Primary P	YMRS P	2-way P
Gender	.161	< .001	.232	.602	< .001	.493
Site	.328	< .001	.257	.515	< .001	.373
Ethnicity	.565	< .001	*	.823	< .001	*
Diagnosis	.608	< .001	.434	.910	< .001	.305
Age	.110	< .001	.898	.278	< .001	.845
Disabled	.659	< .001	.339	.987	< .001	.186
Education	.199	< .001	.480	.132	< .001	.840

*Due to empty cells, 2-way interaction was suppressed.

Table 3. Demographic Characteristics and Coefficients for the HAMD and YMRS Groups
Characteristic	Coefficient for HAMD Group	Coefficient for YMRS Group
Gender = female	t = -.418, P = .676	t = 1.310, P = .192
Site = US	t = .095, P = .924	t = .089, P = .929
Ethnicity = white	t = -.582, P = .562	t = .835, P = .406
Ethnicity = black	t = -.792, P = .430	t = .468, P = .641
Education = high school	t = -.877, P = .382	t = -.818, P = .414
Education = some college	t = .319, P = .750	t = .298, P = .766
Diagnosis = bipolar I	t = -.447, P = .656	t = 1.313, P = .191
Disabled= yes	t = .319, P = .750	t = .298, P = .766
Age group < 30	t = -1.578, P = .116	t = -.859, P = .391
Age group 30-44	t = -1.223, P = .223	t = -.529, P = .598
Age group 45-64	t = .129, P = .897	t = -1.905, P = .085

^a(27)
^b(53)
^c(5)
^d(29)
^e (30)
^fReceives a government disability in ChronoRecord study, unable to work in Stanley study (53).
^g(28)

Table 1. Comparison of Demographic Characteristics Among Patients With Bipolar Disorder in Longitudinal Studies
Variable	ChronoRecord Study(n=80)	Stanley Foundation Bipolar Network(n=261)^a	Judd Long-Term Study(n=206)^c	Stanley Center Bipolar Disorder Registry(n=2839)^d	2000 NDMDA Survey(n=600)^e
Mean age at start of study	38.67 ± 10.86 SD	83% aged 30-64 years^a	39.2 ± 13.6SD bipolar I^c37.4 ± 13.2 SD bipolar II^c	Median 40.1 ^d	Most between 31 and 60^e
Age group, n (%)
18-29	19 (24%)	32 (12%)	N/A	N/A	N/A
30-44	40 (50%)	40 (50%)
45-64	40 (50%)	40 (50%)
65+	1 (1%)	14 (5%)^b
n (%) male: n (%) female	35 (44%):45 (56%)	116 (44%):145 (56%)^a	87 (42%):119 (58%)^c	35.5%:64.5% ^d	34%:66%^e
Bipolar I (%):bipolar II (%)	58 (73%):22 (28%)	81%:16%^a	175 (66%):71 (34%)^c	N/A	N/A
Onset (years)	23.0 ± 9.8 SD	20^a	23.1 ± 9.8 SD bipolar I^c 20.8 ± 10.0 SD bipolar II^c	19.9 ^d	33% under age 15, 27% between 15-19, 39% > 20^e
Single:married:divorced/other (%)	40%:39%:21.%	31%:43%:26%^b	30%:45%:25%^c	33%:33%:33% ^d	25%:38%:37%^e
5 or more hospitalizations for bipolar disorder (%)	29%	19%^a	N/A	N/A	44%^e
Education (%)
High school or less	4 (5%)	15 (7%)	College or more 60.0% of bipolar I and 54.9% of bipolar II^c
Some college	21 (26%)	77 (38%)		>30%^d
At least college graduate	55 (69%)	111 (55%)^b		33%^d	55%^e
Ethnicity (%)
Caucasian (including Hispanic)	71 (89%)	71 (89%)	100%^c	90%^d	N/A
African American	2 (3%)	2 (3%)
Other	6 (8%)	14 (5%)^b
Employment
Full-time	21 (26%)	65 (25)%	N/A	38.8% of men and 34.3% or women employed^d;33.7% of men and 30.4% of women on disability, welfare or retired^d	25%
Part-time	10 (13%)	35 (9%)			16%
Unemployed	8 (10%)	17 (6%)			58% unemployed or retired^e
Retired	4 (5%)	13 (5%)			58% unemployed or retired^e
Disabled/unable to work^f	23 (29%)	55 (21%)^b
Other	14 (18%)
In US: other country (%)	69%:31% in Canada	78%:22% in Netderlands ^b	100% in US^c	100% in US^d	100% in US^e
Mean number of daily medications	3.8	4.1^g	N/A	1/3 taking at least 3 types of psychotropic medications;2/3 at least 2^d	80% take multiple medications^e
Taking medications (%)
Any mood stabilizers	92.4%	97%	N/A	N/A	70%
Any antidepressant	58.8%	53%			53%
Any neuroleptic	38.8%	33%			42%
Any benzodiazepine	42.5%	49%			N/A
Thyroid hormones	21.1%	26%^g			9%^e

^a(27)
^b(53)
^c(5)
^d(29)
^e (30)
^fReceives a government disability in ChronoRecord study, unable to work in Stanley study (53).
^g(28)

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