{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:26:44Z","timestamp":1776792404412,"version":"3.51.2"},"reference-count":52,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Evid Based Mental Health"],"accepted":{"date-parts":[[2019,9,6]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To (1) validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with BD (n=117) evaluated adherence to medication daily for 6\u20139\u2009months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers\u2019 Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>During the study 90.50% of the days were evaluated as \u2018medication taken\u2019, 6.91% as \u2018medication taken with changes\u2019 and 2.59% as \u2018medication not taken\u2019. Adherence to medication measured via smartphones was valid compared with the MARS (B: \u22120.049, 95%\u2009CI \u22120.095 to \u22120.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95%\u2009CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical implications<\/jats:title>\n                  <jats:p>Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01446406\">NCT01446406<\/jats:ext-link> and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02221336\">NCT02221336<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/ebmental-2019-300106","type":"journal-article","created":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T11:35:20Z","timestamp":1581420920000},"page":"2-7","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Validity and characteristics of patient-evaluated adherence to medication via smartphones in patients with bipolar disorder: exploratory reanalyses on pooled data from the MONARCA I and II trials"],"prefix":"10.1136","volume":"23","clinical-trial-number":[{"clinical-trial-number":"nct01446406","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02221336","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0462-6444","authenticated-orcid":false,"given":"Maria","family":"Faurholt-Jepsen","sequence":"first","affiliation":[{"name":"Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mads","family":"Frost","sequence":"additional","affiliation":[{"name":"Monsenso Aps, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen Margrethe","family":"Christensen","sequence":"additional","affiliation":[{"name":"Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob Eyvind","family":"Bardram","sequence":"additional","affiliation":[{"name":"Department of Health Technology, Technical University of Denmark, Lyngby, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maj","family":"Vinberg","sequence":"additional","affiliation":[{"name":"Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars Vedel","family":"Kessing","sequence":"additional","affiliation":[{"name":"Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,11]]},"reference":[{"key":"2025082700042383000_23.1.2.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2005.04.011"},{"key":"2025082700042383000_23.1.2.2","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/S0140-6736(12)61729-2","article-title":"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990\u20132010: a systematic analysis for the global burden of disease study 2010","volume":"380","author":"Vos","year":"2012","journal-title":"The Lancet"},{"key":"2025082700042383000_23.1.2.3","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.185.5.372"},{"key":"2025082700042383000_23.1.2.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2010.00812.x"},{"key":"2025082700042383000_23.1.2.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2007.00405.x"},{"key":"2025082700042383000_23.1.2.6","doi-asserted-by":"crossref","unstructured":"Morriss R , Faizal MA , Jones AP , et al . Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev 2007;64.doi:10.1002\/14651858.CD004854.pub2","DOI":"10.1002\/14651858.CD004854.pub2"},{"key":"2025082700042383000_23.1.2.7","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1176\/appi.ajp.159.11.1927","article-title":"Self-Reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization","volume":"159","author":"Scott","year":"2002","journal-title":"AJP"},{"key":"2025082700042383000_23.1.2.8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1176\/ajp.155.1.30","article-title":"Long-Term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic","volume":"155","author":"Maj","year":"1998","journal-title":"AJP"},{"key":"2025082700042383000_23.1.2.9","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1023\/B:ACLI.0000008175.32403.8e","article-title":"Mood stabilizers and treatment adherence in bipolar disorder: addressing adverse events","volume":"15","author":"Berk","year":"2003","journal-title":"Ann Clin Psychiatry"},{"key":"2025082700042383000_23.1.2.10","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1176\/appi.ps.52.6.805","article-title":"Using drug claims data to assess the relationship of medication adherence with hospitalization and costs","volume":"52","author":"Svarstad","year":"2001","journal-title":"PS"},{"key":"2025082700042383000_23.1.2.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2010.05.021"},{"key":"2025082700042383000_23.1.2.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2011.04.016"},{"key":"2025082700042383000_23.1.2.13","doi-asserted-by":"crossref","unstructured":"Goodwin FK , Jamison KR . Manic-Depressive illness. New Oxford University Press, 1996.","DOI":"10.1007\/978-1-4899-0170-5_6"},{"key":"2025082700042383000_23.1.2.14","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.2002.1r084.x"},{"key":"2025082700042383000_23.1.2.15","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/2045125318804364","article-title":"Medication nonadherence in bipolar disorder: a narrative review","volume":"8","author":"Jawad","year":"2018","journal-title":"Ther Adv Psychopharmacol"},{"key":"2025082700042383000_23.1.2.16","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000000523"},{"key":"2025082700042383000_23.1.2.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra050100"},{"key":"2025082700042383000_23.1.2.18","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12194"},{"key":"2025082700042383000_23.1.2.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.05.041"},{"key":"2025082700042383000_23.1.2.20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1399-5618.2005.00248.x","article-title":"Identifying and improving non-adherence in bipolar disorders","volume":"7 Suppl 5","author":"Colom","year":"2005","journal-title":"Bipolar Disord"},{"key":"2025082700042383000_23.1.2.21","first-page":"47","article-title":"The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness","volume":"70","author":"Velligan","year":"2009","journal-title":"J Clin Psychiatry"},{"key":"2025082700042383000_23.1.2.22","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1176\/appi.ps.201800286","article-title":"Improving medication adherence with telemedicine for adults with severe mental illness","volume":"70","author":"Schulze","year":"2019","journal-title":"PS"},{"key":"2025082700042383000_23.1.2.23","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20060"},{"key":"2025082700042383000_23.1.2.24","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1002\/j.2051-5545.2012.tb00131.x","article-title":"Mobile technologies in psychiatry: providing new perspectives from biology to culture","volume":"11","author":"Swendsen","year":"2012","journal-title":"World Psychiatry"},{"key":"2025082700042383000_23.1.2.25","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000748"},{"key":"2025082700042383000_23.1.2.26","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jpsychires.2018.07.013","article-title":"Therapeutic effects of mobile-based text message reminders for medication adherence in bipolar I disorder: are they maintained after intervention cessation?","volume":"104","author":"Menon","year":"2018","journal-title":"J Psychiatr Res"},{"key":"2025082700042383000_23.1.2.27","unstructured":"Taylor K , Silver L . Smartphone ownership is growing rapidly around the world, but not always equally | Pew research center, 2019. Available: http:\/\/www.pewglobal.org\/2019\/02\/05\/smartphone-ownership-is-growing-rapidly-around-the-world-but-not-always-equally\/ [Accessed 19 Feb 2019]."},{"key":"2025082700042383000_23.1.2.28","unstructured":"Ericsson mobility report November 2018;32."},{"key":"2025082700042383000_23.1.2.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2013.01.036"},{"key":"2025082700042383000_23.1.2.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-014-0309-5","article-title":"Daily electronic monitoring of subjective and objective measures of illness activity in bipolar disorder using smartphones\u2013 the MONARCA II trial protocol: a randomized controlled single-blind parallel-group trial","volume":"14","author":"Faurholt-Jepsen","year":"2014","journal-title":"BMC Psychiatry"},{"key":"2025082700042383000_23.1.2.31","doi-asserted-by":"crossref","unstructured":"Faurholt-Jepsen M , Vinberg M , Christensen EM , et al . Daily electronic self-monitoring of subjective and objective symptoms in bipolAr disorder-the MONARCA trial protocol (monitoring, treAtment and prediction of bipolAr disorder episodes): a randomised controlled single-blind trial, 2013. Available: http:\/\/bmjopen.bmj.com\/content\/3\/7\/e003353.full.pdf+html","DOI":"10.1136\/bmjopen-2013-003353"},{"key":"2025082700042383000_23.1.2.32","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.1017\/S0033291715000410","article-title":"Daily electronic self-monitoring in bipolar disorder using smartphones \u2013 the MONARCA I trial: a randomized, placebo-controlled, single-blind, parallel group trial","volume":"45","author":"Faurholt-Jepsen","year":"2015","journal-title":"Psychol Med"},{"key":"2025082700042383000_23.1.2.33","first-page":"1","article-title":"The effect of smartphone-based monitoring on illness activity in bipolar disorder: the MONARCA II randomized controlled single-blinded trial","volume":"4","author":"Faurholt-Jepsen","year":"2019","journal-title":"Psychol Med"},{"key":"2025082700042383000_23.1.2.34","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1990.01810180089012"},{"key":"2025082700042383000_23.1.2.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8260.1967.tb00530.x"},{"key":"2025082700042383000_23.1.2.36","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.133.5.429"},{"key":"2025082700042383000_23.1.2.37","doi-asserted-by":"crossref","unstructured":"Rosa AR , S\u00e1nchez-Moreno J , Mart\u00ednez-Aran A , et al . Validity and reliability of the functioning assessment short test (fast) in bipolar disorder. Clin Pract Epidemiol Ment Health 2007;3.doi:10.1186\/1745-0179-3-5","DOI":"10.1186\/1745-0179-3-5"},{"key":"2025082700042383000_23.1.2.38","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.schres.2016.10.023","article-title":"Validation study of the medication adherence rating scale. results from the FACE-SZ national dataset","volume":"182","author":"Fond","year":"2017","journal-title":"Schizophr Res"},{"key":"2025082700042383000_23.1.2.39","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-9964(99)00130-9"},{"key":"2025082700042383000_23.1.2.40","doi-asserted-by":"publisher","DOI":"10.1176\/ps.48.8.1042"},{"key":"2025082700042383000_23.1.2.41","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198601000-00007"},{"key":"2025082700042383000_23.1.2.42","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700050182"},{"key":"2025082700042383000_23.1.2.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2007.10.029"},{"key":"2025082700042383000_23.1.2.44","doi-asserted-by":"publisher","DOI":"10.1002\/hup.908"},{"key":"2025082700042383000_23.1.2.45","doi-asserted-by":"crossref","first-page":"399","DOI":"10.5498\/wjp.v6.i4.399","article-title":"Treatment-adherence in bipolar disorder: a patient-centred approach","volume":"6","author":"Chakrabarti","year":"2016","journal-title":"World J Psychiatry"},{"key":"2025082700042383000_23.1.2.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2010.04.039"},{"key":"2025082700042383000_23.1.2.47","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.2147\/NDT.S166730","article-title":"Systematic literature review on patterns of pharmacological treatment and adherence among patients with bipolar disorder type I in the USA","volume":"14","author":"Greene","year":"2018","journal-title":"Neuropsychiatr Dis Treat"},{"key":"2025082700042383000_23.1.2.48","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1007\/s40263-016-0368-x","article-title":"Medication adherence in patients with bipolar disorder: a comprehensive review","volume":"30","author":"Levin","year":"2016","journal-title":"CNS Drugs"},{"key":"2025082700042383000_23.1.2.49","doi-asserted-by":"crossref","unstructured":"Kessing L , Hansen H , Bech P . Attitudes and beliefs among patients treated with mood stabilizers. Clin Pract Epidemiol Ment Health 2006;2.doi:10.1186\/1745-0179-2-8","DOI":"10.1186\/1745-0179-2-8"},{"key":"2025082700042383000_23.1.2.50","doi-asserted-by":"crossref","unstructured":"Bardram JE , Frost M , Sz\u00e1nto K , et al . Designing mobile health technology for bipolar disorder: a field trial of the monarca system. In: In proceedings of the SIGCHI conference on human factors in computing systems. New York, NY, USA, 2013: 2627\u201336.","DOI":"10.1145\/2470654.2481364"},{"key":"2025082700042383000_23.1.2.51","doi-asserted-by":"crossref","unstructured":"Faurholt-Jepsen M , Torri E , Cobo J , et al . Smartphone-Based self-monitoring in bipolar disorder: evaluation of usability and feasibility of two systems. Int J Bipolar Disord 2019;7.doi:10.1186\/s40345-018-0134-8","DOI":"10.1186\/s40345-018-0134-8"},{"key":"2025082700042383000_23.1.2.52","doi-asserted-by":"publisher","DOI":"10.1037\/a0017075"}],"container-title":["Evidence Based Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ebmental-2019-300106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:04:42Z","timestamp":1756278282000},"score":1,"resource":{"primary":{"URL":"https:\/\/mentalhealth.bmj.com\/lookup\/doi\/10.1136\/ebmental-2019-300106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,2,11]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/ebmental-2019-300106"],"URL":"https:\/\/doi.org\/10.1136\/ebmental-2019-300106","relation":{},"ISSN":["1362-0347","1468-960X"],"issn-type":[{"value":"1362-0347","type":"print"},{"value":"1468-960X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}