Self-monitoring and Psychoeducation in Bipolar Patients With a Smart-phone Application (SIMPLe) Project: Design, Development and Studies Protocols

Diego Hidalgo-Mazzei; Ainoa Mateu; María Reinares; Juan Undurraga; Caterina del Mar Bonnín; José Sánchez-Moreno; Eduard Vieta; Francesc Colom


BMC Psychiatry. 2015;15(52) 

In This Article


Even when the current pharmacological and psychological treatments available for bipolar disorder can certainly improve the outcome and quality of life of bipolar patients, the access to such specialized treatments are concentrated in few reference centers around the globe, which can hardly cover the needs of a disease with a prevalence of almost 2% of the world population.[53]

On the other side, during recent years new technologies have facilitated our life in many ways (e.g. internet shopping, traveling and communication), although its implementation in mental healthcare has been slow and underdeveloped when compared to other areas (i.e. commercial). Hence, using this technology in mental healthcare could improve the lives of thousands of people suffering from mental disorders at a very low cost and in a convenient, comfortable and secure way for patients.

Among other treatments, our research group has been promoting and providing high-quality evidence-based psychoeducational programs for more than 15 years.[54,55] However, our current face-to-face approach to psychoeducation excludes many patients who could benefit from it, such as those living in remote locations, those with incompatible schedules, patients who don't want to attend a group therapy, etc. One of the advantages of new technologies, and specifically smartphones, is that it is possible to overcome these difficulties in a cost-efficient way through them. The tested application will represent a user-friendly, low cost and a potentially efficacious way to provide self-monitoring and personalized training to bipolar patients as an add-on to usual pharmacological and psychological care. Another benefit of this device is to include measures to facilitate safety procedures if any risk (i.e. suicidal thoughts) is detected. Furthermore, it can have a positive impact on associated healthcare costs.

There are some potential risks and limitations of this project: The fact that the patient will interact with a device instead of a therapist could decrease the level of compromise with the program. Furthermore, despite the fact that most people can have access to smartphones there is still a requirement of a minimum range of skills to use this kind of devices and operating systems. In this regard, many patients with bipolar disorder have some degree of cognitive or functional impairment,[56] which could limit their capacity to use the device. In fact, a recent study has proven that patients with bipolar disorder show a poorer knowledge of computer use devices, internet and social media when compared with matched healthy controls.[57]

Regarding the limitations of the study itself, the intervention is compared to treatment as usual and patients are not blinded to the intervention that they are receiving. It is almost impossible to create a "placebo smartphone application". Another fact is that all participants will be recruited from a specialized mental healthcare center in bipolar disorder, which could limit the generalizability of the results to primary care contexts due to the clinical characteristics of the sample and the intensive healthcare character of the program.

If the first steps of the project show encouraging results, many of the mentioned limitations could be circumvented in the future including active comparators such as conventional psychoeducational programs and involving non-specialized settings in future efficiency studies.