Passive Mobile Self-Tracking of Mental Health by Veterans with Serious Mental Illness: Study Protocol (Preprint)

BACKGROUND Serious mental illnesses (SMI) are common, disabling, and challenging to treat, requiring years of monitoring and treatment adjustments. Stress or reduced medication adherence can lead to rapid worsening of symptoms and behaviors. Illness exacerbations and relapses generally occur with little or no clinician awareness in real time, leaving limited opportunity to modify treatments. Previous research suggests that passive mobile sensing may be beneficial for individuals with SMI by helping them monitor mental health status, behaviors, and quickly detect worsening mental health for prompt assessment and intervention. However, there is too little research on its feasibility and acceptability in patients with SMI, and the extent to which passive data can predict changes in behaviors and symptoms. OBJECTIVE To study the feasibility, acceptability and safety of passive mobile sensing for tracking behaviors and symptoms of patients in treatment for SMI, as well as developing analytics that utilize passive data to predict changes in behaviors and symptoms. METHODS A mobile application (app) monitors and transmits passive mobile sensor and phone utilization data to track activity, sociability and sleep in patients with SMI. The study consists of a user-centered design phase and a mobile sensing phase. In the design phase, focus groups, interviews and in-lab usability testing inform further app development. In the mobile sensing phase, passive mobile sensing occurs with participants engaging in weekly assessments for up to nine months. Three and nine month interviews study the perceptions of passive mobile sensing and ease of app use. Clinician interviews before and after the mobile sensing phase study the usefulness and feasibility of app utilization in clinical care. Predictive analytic models are built, trained and selected, and make use of machine learning methods. Models use sensor and phone utilization data to predict behavioral changes and symptoms. RESULTS The study was funded in October 2020 and has received IRB approval. The user-centered design phase, consisting of focus groups, usability testing, and pre-intervention clinician interviews has been completed. Recruitment and enrollment for the mobile sensing phase are ongoing. CONCLUSIONS Findings may inform the development of passive sensing apps and self-tracking in patients with SMI, and integration into care to improve assessment, treatment, and patient outcomes. CLINICALTRIAL ClinicalTrials.gov NCT05023252; https://clinicaltrials.gov/ct2/show/NCT0502325