Identifying mood instability and circadian rest-activity patterns using digital remote monitoring and actigraphy in participants at risk for bipolar disorder

Mood instability and circadian rhythm disruptions are both of increasing interest with regard to a number of psychiatric disorders, notably bipolar disorder (BD), but understanding of their nature and their interrelationship are incomplete. By definition, both have an integral temporal component and, as such, measuring them longitudinally and remotely is desirable. We conducted the Cognition and Mood Evolution across Time (COMET) study to assess the feasibility and value of digital devices to capture mood, its instability, and daily rest-activity patterns, over a 10-week period, in two groups of participants. The first group (n=37) were selected as scoring >7 on the Mood Disorder Questionnaire (MDQ) ( high MDQ), thereby having a history of mood elevation and being at risk for BD. They were compared with a group (n=37) scoring <5 on the MDQ ( low MDQ). Over a 10-week period, using a tablet, mood was rated daily, clinical ratings of depression, mania, and anxiety were captured weekly via the True Colours app, and a GENEactiv actigraph was worn to capture rest-activity pattern data. The main findings are that (1) MDQ score predicts mood instability; (2) high MDQ score is associated with more negative affect and mood symptoms than people with low MDQ, and with a different circadian activity profile; and (3) mood instability and circadian indices appear uncorrelated. The implications are that (1) remote monitoring of these domains is feasible and valuable; (2) selection of participants based on MDQ score is useful for studying mood (in)stability; and (3) the approach has potential for studies of clinical populations and for experimental medicine studies assessing interventions to reduce mood instability.