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Original Investigation
December 12, 2018

Real-time Mobile Monitoring of the Dynamic Associations Among Motor Activity, Energy, Mood, and Sleep in Adults With Bipolar Disorder

Author Affiliations
  • 1Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
  • 2University of Bordeaux, National Center for Scientific Research, Bordeaux, France
  • 3EPHE PSL Research University, Paris, France
  • 4Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
  • 5Department of Biostatistics, University of Pennsylvania, Philadelphia
  • 6Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 7Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
  • 8Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
  • 9Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 10National Institute of Drug Abuse, Bethesda, Maryland
  • 11Laboratory of Neuroimaging, National Institute of Alcohol Abuse and Alcoholism, Bethesda, Maryland
JAMA Psychiatry. 2019;76(2):190-198. doi:10.1001/jamapsychiatry.2018.3546
Key Points

Question  What are the dynamic associations among motor activity, energy, mood, and sleep, as tracked in real time with mobile monitoring technology, in individuals with a history of bipolar disorder or major depression?

Findings  In this case-control study of 242 adults, bidirectional associations were found between motor activity with subjectively rated energy level and sleep duration as well as unidirectional associations between motor activity and mood level. Greater cross-domain reactivity was observed for these associations in people with bipolar I disorder.

Meaning  Interventions that target motor activity and energy may alleviate depressed mood more effectively than could current approaches; simultaneous investigations of multiple regulatory systems in bipolar disorder are important in designing therapeutic targets.


Importance  Biologic systems involved in the regulation of motor activity are intricately linked with other homeostatic systems such as sleep, feeding behavior, energy, and mood. Mobile monitoring technology (eg, actigraphy and ecological momentary assessment devices) allows the assessment of these multiple systems in real time. However, most clinical studies of mental disorders that use mobile devices have not focused on the dynamic associations between these systems.

Objectives  To examine the directional associations among motor activity, energy, mood, and sleep using mobile monitoring in a community-identified sample, and to evaluate whether these within-day associations differ between people with a history of bipolar or other mood disorders and controls without mood disorders.

Design, Setting, and Participants  This study used a nested case-control design of 242 adults, a subsample of a community-based sample of adults. Probands were recruited by mail from the greater Washington, DC, metropolitan area from January 2005 to June 2013. Enrichment of the sample for mood disorders was provided by volunteers or referrals from the National Institutes of Health Clinical Center or by participants in the National Institute of Mental Health Mood and Anxiety Disorders Program. The inclusion criteria were the ability to speak English, availability to participate, and consent to contact at least 2 living first-degree relatives. Data analysis was performed from June 2013 through July 2018.

Main Outcomes and Measures  Motor activity and sleep duration data were obtained from minute-to-minute activity counts from an actigraphy device worn on the nondominant wrist for 2 weeks. Mood and energy levels were assessed by subjective analogue ratings on the ecological momentary assessment (using a personal digital assistant) by participants 4 times per day for 2 weeks.

Results  Of the total 242 participants, 92 (38.1%) were men and 150 (61.9%) were women, with a mean (SD) age of 48 (16.9) years. Among the participants, 54 (22.3%) had bipolar disorder (25 with bipolar I; 29 with bipolar II), 91 (37.6%) had major depressive disorder, and 97 (40.1%) were controls with no history of mood disorders. A unidirectional association was found between motor activity and subjective mood level (β = –0.018, P = .04). Bidirectional associations were observed between motor activity (β = 0.176; P = .03) and subjective energy level (β = 0.027; P = .03) as well as between motor activity (β = –0.027; P = .04) and sleep duration (β = –0.154; P = .04). Greater cross-domain reactivity was observed in bipolar disorder across all outcomes, including motor activity, sleep, mood, and energy.

Conclusions and Relevance  These findings suggest that interventions focused on motor activity and energy may have greater efficacy than current approaches that target depressed mood; both active and passive tracking of multiple regulatory systems are important in designing therapeutic targets.