mHEALTH MOOD MONITORING FOR PEOPLE WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RETROSPECTIVE COHORT ANALYSIS

Problem

Co-morbid health anxiety and depression can add to the complexity of managing treatment for patients living with chronic obstructive pulmonary disease (COPD). While digital health technologies for COPD patients support monitoring of vital signs (including oxygen saturation), self-monitoring of mood (as for example with bipolar patients) to support self-management is not currently implemented. Monitoring mood regularly can identify deviations from usual patterns and encourage patients to be more mindful of their mood. The aim of this study was to describe adherence to mood monitoring over 12 months and to identify patterns of depressive and anxious symptoms.

Approach

The sElf-management anD support programme (EDGE) for COPD was a 12-month, primary care based randomised controlled trial involving patients aged ≥40 years with a diagnosis of COPD. Patients were identified following an exacerbation from primary care or hospital records. Participants in the intervention arm of EDGE received a tablet computer with the EDGE mHealth application installed and a Bluetooth-linked pulse oximeter. Participants were asked to complete the General Anxiety Disorder questionnaire (GAD) and the Patient Health Questionnaire (PHQ) every four weeks. Generic health status (EuroQol 5-Dimension Questionnaire), St George’s Respiratory Questionnaire-COPD and smoking status were recorded at baseline. The primary outcome for this analysis was the extent to which participants completed the mood questionnaires as requested; participants answering ≥10 of 12 months termed highly adherent. A threshold of ≥5 was used to define elevated scores for the PHQ and GAD which identifies an increased risk of clinically important anxiety or depression.

Findings

Of study participants, 106 (99.1%) recorded mood data; logging a total of 1,268 responses. Eighty-one participants (76.4%) were highly adherent. Up to 24 participants (22.6%; minimum 8 participants) entered ≥2 responses to the mood questionnaires each month. Adherent participants (n=81) differed significantly by smoking status when compared to participants least adherent (n=25) (chi2=14.973, p=0.001). Fifty-six participants (52.8%) responded with at least mild symptoms of both anxiety and depression whilst 22 participants (20.8%) did not record any elevated scores. Participants with elevated risk of anxiety and depression differed significantly by generic health status and SGRQ-C score when compared with participants without elevated scores (0.6(0.4-0.7) versus 0.7(0.6-0.8), z=2.332, p=0.0197 and 62.2±19.5 versus 50.3±16.3, t=-2.5358, p=0.0133, respectively).

Consequences

Findings suggest that regular mood monitoring in people with COPD is feasible with most patients answering the mood questions over 12 months and, some participants answering more often than requested. This suggests that COPD patients are willing to self-monitor mood over several months. With more than half of participants suggesting an elevated risk of both anxiety and depression (associated with a lower health status and higher respiratory impairment), the opportunity to regularly monitor mood in this patient population could offer helpful information in supporting co-morbidity management within primary care.