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Digital Communication Biomarkers of Mood and Diagnosis in Borderline Personality Disorder, Bipolar Disorder, and Healthy Control Populations

  • Gillett, George1, 2
  • McGowan, Niall M.2, 3
  • Palmius, Niclas4
  • Bilderbeck, Amy C.2, 5
  • Goodwin, Guy M.2
  • Saunders, Kate E. A.2, 3
  • 1 Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, The Cairns Library IT Corridor Level 3, Oxford , (United Kingdom)
  • 2 Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford , (United Kingdom)
  • 3 Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford , (United Kingdom)
  • 4 Institute of Biomedical Engineering, University of Oxford, Oxford , (United Kingdom)
  • 5 P1vital Products, Manor House, Howbery Business Park, Wallingford , (United Kingdom)
Published Article
Frontiers in Psychiatry
Frontiers Media SA
Publication Date
Apr 08, 2021
DOI: 10.3389/fpsyt.2021.610457
  • Psychiatry
  • Original Research


Background: Remote monitoring and digital phenotyping harbor potential to aid clinical diagnosis, predict episode course and recognize early signs of mental health crises. Digital communication metrics, such as phone call and short message service (SMS) use may represent novel biomarkers of mood and diagnosis in Bipolar Disorder (BD) and Borderline Personality Disorder (BPD). Materials and Methods: BD (n = 17), BPD (n = 17) and Healthy Control (HC, n = 21) participants used a smartphone application which monitored phone calls and SMS messaging, alongside self-reported mood. Linear mixed-effects regression models were used to assess the association between digital communications and mood symptoms, mood state, trait-impulsivity, diagnosis and the interaction effect between mood and diagnosis. Results: Transdiagnostically, self-rated manic symptoms and manic state were positively associated with total and outgoing call frequency and cumulative total, incoming and outgoing call duration. Manic symptoms were also associated with total and outgoing SMS frequency. Transdiagnostic depressive symptoms were associated with increased mean incoming call duration. For the different diagnostic groups, BD was associated with increased total call frequency and BPD with increased total and outgoing SMS frequency and length compared to HC. Depression in BD, but not BPD, was associated with decreased total and outgoing call frequency, mean total and outgoing call duration and total and outgoing SMS frequency. Finally, trait-impulsivity was positively associated with total call frequency, total and outgoing SMS frequency and cumulative total and outgoing SMS length. Conclusion: These results identify a general increase in phone call and SMS communications associated with self-reported manic symptoms and a diagnosis-moderated decrease in communications associated with depression in BD, but not BPD, participants. These findings may inform the development of clinical tools to aid diagnosis and remote symptom monitoring, as well as informing understanding of differential psychopathologies in BD and BPD.

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