A randomized comparison of online and paper mood charts for people with bipolar disorder

Document Type

Journal Article

Publication Date



Journal of Affective Disorders








Adherence; Internet; NIMH Life Chart Methodology


Background: Longitudinal mood instability is the essential feature of bipolar disorder, however most rating scales are cross sectional in nature, and focus on acute symptoms. By contrast, the NIMH Life Chart Methodology (LCM) characterizes in detail the severity, duration, and frequency of mood episodes. Adherence to daily rating, however, tends to be low. In this study an online version of the LCM, designed to enhance adherence, was compared to the standard paper version. Methods: Patients from a mood disorders specialty clinic were randomized to the standard LCM or an online, open-source adaptation. The online version used hypertext links embedded in a daily email as the primary rating interface. Participants rated for 90 days. The total number of days rated and the number of days with complete data were compared for the two groups. Results: Forty-eight patients participated in the study. The online group rated approximately twice as many days compared to the standard group (44.3 versus 20.4, p = .029). The online group also entered complete data for a larger portion of days (55.2% versus 27.7%, p = .039). Limitations: This was a small, short-term study. The implications for longer-term rating are unclear. Conclusions: Despite the advantages of documenting mood fluctuation on a daily basis, the LCM is not commonly used, in part because ensuring adequate adherence can be resource intensive. An easily accessible online adaptation that utilizes email checking behavior can make this tool available to a wider range of patients. © 2009 Elsevier B.V. All rights reserved.

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