The user experience of ambulatory assessment and mood monitoring in bipolar disorder : systematic review and meta-synthesis of qualitative studies

Abstract

Background: Mood monitoring and ambulatory assessment hold promise for supporting self-management and data collection in bipolar disorder (BD), but the effectiveness of these depends crucially on the preferences and perspectives of those who use them. To date, these user experiences have not been systematically synthesized. Objective: This study aimed to explore and synthesize qualitative evidence on the user experience of mood monitoring and ambulatory assessment in BD, with a focus on identifying barriers and facilitators for both individuals with BD and clinicians, as well as the intended purposes of these tools. Methods: We conducted a systematic review and meta-synthesis of qualitative and mixed-methods studies reporting on ambulatory assessment and mood monitoring in BD (PROSPERO CRD42023396473). A total of 8 electronic databases were searched. Studies were appraised using established criteria for qualitative research. First- and second-order constructs were extracted, and a third-order synthesis was developed using the Noblit and Hare meta-ethnographic approach. Results: A total of 20 studies comprising 2365 participants met inclusion criteria. We identified 9 overarching themes: adverse effects, barriers to use, facilitators to use, perceived purpose, sharing with others (positive and negative), clinician concerns, clinician suggestions, and desired features. Users reported both benefits and harms. Some experienced increased insight, behavioral change, and relapse prevention skills, while others reported emotional burden, repetitive content, and worsened mood or anxiety. Preferences varied widely, but a strong, consistent emphasis was placed on personalization, including the ability to control what is tracked, when and how it is shared, and the level of engagement with health care providers. Passive data collection was often seen as less intrusive and more sustainable. Sharing data was sometimes seen as empowering, especially when it enabled communication with trusted individuals or clinicians, but also raised concerns around autonomy, misinterpretation, and privacy. Clinicians echoed many user views but raised additional concerns about liability and interpretability of data. Participants also highlighted the need for onboarding or support to aid comprehension and effective use. Conclusions: This review highlights the complexity and diversity of user experiences with ambulatory assessment and mood monitoring in BD. While many found these tools valuable for fostering insight, self-management, and relapse prevention, others found them burdensome or confronting. User engagement appears closely tied to perceived control, relevance, and personal fit. These findings underscore the need for flexible, user-centered design in future interventions. Customizability should be prioritized—including what is monitored, how feedback is delivered, and whether data is shared externally. Incorporating onboarding and adaptive feedback could help users better understand and apply their data to better self-manage. By aligning interventions more closely with user preferences and lived experience, ambulatory assessment and mood monitoring protocols may achieve greater uptake, engagement, and ultimately, a more effective intervention. Trial Registration: PROSPERO CRD42023396473; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023396473