Group-based Psychoeducation for Relatives of Patients With Bipolar Disorder, a Randomized Controlled Trial

Mood instability is calculated from daily self-reported mood registration in the app Monsenso. Participating relatives score their daily mood on a 9-point scale from 0-8 where 8 is 'in a brilliant mood' and 0 is 'really sad'

The participant rate daily in the Monsenso app during the time the participate in the study (4-8 months depending on which group they are randomly allocated to).

For each participant, a mood instability measure will be estimated for each day and aggregated by applying the root mean square successive difference (rMSSD) method.

Mood instability is calculated from daily self-reported mood registration via the app Monsenso. The patients score their daily mood on a scale from -3 to +3, where -3 is the worst and +3 is the best mood. Patients' data from the Monsenso app is collected from a parallel RCT, in the time frame in which the relatives are in the study.

Each topic is covered by a single, simple question in the Monsenso app:

• Daily activity level: 'how active have you been?' (7-point scale from very little to very much)
• Sleep: How many hours did you sleep (scale from 0 to 12+hours)
• mixed moods: have you experienced mixed good and bad mood? (yes/no)
• Anxiety: Have you felt anxiety? (5-point scale from 'not at all' to 'to a high degree')
• Irritability:Have you felt irritable? (5-point scale, same as above)
• Cognition: Have you experienced cognitive difficulties? (5-point scale, same as above)
• Stress: Have you been stressed? (5-point scale, same as above)
• Alcohol: how many drinks have you had? (scale from 0 til 10+ drinks)
• Patient support: Have you helped or supported the patient? (5-point scale, same as above)
• Caregiver burden: To which degree have you experienced the patient's mental health problems as a burden to you? (5-point scale, same as above)

Burden Assessment Scale

19 questions covering subjects as economic and practical burden, stigma, worries, conflicts etc, participants answer on a scale from [1: not at all] to [4: to a high degree] or [not relevant]

Reinhard SC, Gubman GD, Horwitz AV, Minsky S. Burden assessment scale for families of the seriously mentally ill. Eval Program Plann. 1. juli 1994;17(3):261-9.

Perceived Criticism Measure

The questionnaire consists of four questions covering criticism in a relationship, answered on a scale from 0 to 10, where 10 is the highest and most negative.

Hooley JM, Parker HA. Measuring expressed emotion: An evaluation of the shortcuts. J Fam Psychol. september 2006;20(3):386-96.

Carer Quality of Life

7 multiple-answer questions and one Visual Analog Scale to evaluate quality of life in the light of being an informal caregiver.

Brouwer WBF, van Exel NJA, van Gorp B, Redekop WK. The CarerQol instrument: A new instrument to measure care-related quality of life of informal caregivers for use in economic evaluations. Qual Life Res. 1. august 2006;15(6):1005-21.

Hoefman RJ, van Exel NJA, Looren de Jong S, Redekop WK, Brouwer WBF. A new test of the construct validity of the CarerQol instrument: measuring the impact of informal care giving. Qual Life Res. 2011;20(6):875-87.

Carer-Self-Efficacy

12 questions about self-efficacy as a caregiver for a person with Bipolar disorder. The questionnaire was originally developed for persons with bipolar disorder (Smith) and later Hubbard et al made a version for caregivers.

Smith LM, Erceg-Hurn DM, McEvoy PM, Lim L. Self-efficacy in bipolar disorder: Development and validation of a self-report scale. J Affect Disord. 1. februar 2020;262:108-17.

Hubbard AA, McEvoy PM, Smith L, Kane RT. Brief group psychoeducation for caregivers of individuals with bipolar disorder: A randomized controlled trial. J Affect Disord. august 2016;200:31-6.

25 questions testing the factual knowledge about bipolar disorder.

"The Bipolar disorders knowledge scale", Trevor A. Stump and Marty L. Eng. Journal of Affective disorders, 2018-10-01, Volume 238, Pages 645-650.

Short Form-12 (54,55) 12 questions on health-related quality of life.

Christensen LN, Ehlers L, Larsen FB, Jensen MB. Validation of the 12 Item Short form Health Survey in a Sample from Region Central Jutland. Soc Indic Res. 1. november 2013;114(2):513-21.

Amir M, Lewin-Epstein N, Becker G, Buskila D. Psychometric properties of the SF-12 (Hebrew version) in a primary care population in Israel. Med Care. oktober 2002;40(10):918-28.

The Brief Symptom Inventory (BSI: Derogatis, 1992), a 53-item self-report inventory of psychopathology and psychological distress, the BSI psychometric profile produces the same nine primary symptom dimensions produced by the SCL-90-R.

Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. august 1983;13(3):595-605.

Perceived Stress Scale

10 questions covering stress symptoms in the last month.

Cohen S. Perceived stress in a probability sample of the United States. I: The social psychology of health. Thousand Oaks, CA, US: Sage Publications, Inc; 1988. s. 31-67. (The Claremont Symposium on Applied Social Psychology).

Mood Disorder Questionnaire

Hirschfeld RMA, Williams JBW, Spitzer RL, Calabrese JR, Flynn L, Keck PE, m.fl. Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire. Am J Psychiatry. november 2000;157(11):1873-5.

Major Depression Inventory

Bech P, Timmerby N, Martiny K, Lunde M, Soendergaard S. Psychometric evaluation of the Major Depression Inventory (MDI) as depression severity scale using the LEAD (Longitudinal Expert Assessment of All Data) as index of validity. BMC Psychiatry. 5. august 2015;15:190.

Bech P, Wermuth L. Applicability and validity of the Major Depression Inventory in patients with Parkinson's disease. Nord J Psychiatry. (52):305-10.

Childhood Trauma Questionnaire (CTQ)

Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, m.fl. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. august 1994;151(8):1132-6.

Depressive symptoms assessed by the Hamilton Depression Rating Scale-6 items (min. value = 0; max. value = 22, with higher values reflecting more depressive symptoms)

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. februar 1960;23(1):56-62.

Manic symptoms assessed by the Young Mania Rating Scale (min. value = 0; max. value = 60, with higher values reflecting more manic symptoms)

Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry J Ment Sci. november 1978;133:429-35.

General functioning assessed by the Functional Assessment Short Test, a 24-item interviewer-administered interview concerning autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time (min. value = 0; max. value = 72, with higher values reflecting poorer function)

Rosa AR, Sánchez-Moreno J, Martínez-Aran A, Salamero M, Torrent C, Reinares M, m.fl. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health CP EMH. 7. juni 2007;3:5.

Automatically smartphone-generated data on physical - and social activity is generated in the Monsenso app using the phone's sensor-data.

physical activity: location and physical activity (step count and movement) social activity: battery level, light level and screen mode.

These automatically generated data has been shown to be informative in prior study:

Faurholt-Jepsen M, Frost M, Vinberg M, Christensen EM, Bardram JE, Kessing LV. Smartphone data as objective measures of bipolar disorder symptoms. Psychiatry Res. 30. juni 2014;217(1-2):124-7.