Monitoring and evaluation of digital mental health assessments in adults with mild to moderate intellectual disability and concurrent mental illness: a pilot study

Background
People with intellectual disability (PWID) experience a high incidence of mental illness, and yet there are limited resources available to effectively support their mental health needs. This pilot study aimed to evaluate the use of digital tools to support the assessment and monitoring of mental health–related parameters in adults with mild to moderate intellectual disability and concurrent mental illness. The current clinical practice of mental health assessment partially relies on paper-based recording of symptoms, placing a significant burden on the staff, carers and patients. In this study, we compared existing paper-based recording methods with digital methods for recording mood, anxiety, and sleep and assessed physical activity levels among participants.

Methods
In this observational pilot study, we collected data from 10 participants over a period of seven days. We compared mood and anxiety scores collected via a bespoke smartphone application developed for this study with existing paper-based recordings. The sleep data were collected using a wrist-based wearable Axivity AX3 accelerometer (AX3) and compared with paper-based recordings. Lastly, data on moderate-to-vigorous physical activity (MPVA) was obtained from AX3 and compared against the World Health Organisation (WHO) 2020 recommendations of a total of 150 min of MPVA per week. We applied Wilcoxon signed-rank tests, Spearman correlations, and Bland–Altman plots to assess method differences for exploratory and descriptive purposes.

Results
In this pilot study, no large discrepancies were observed between mobile app and paper-based mood and anxiety ratings, with exploratory analyses indicating similar score distributions across methods. Comparisons between AX3-derived and paper-based sleep measures showed broadly similar estimates, although discrepancies were noted for longer sleep durations. Physical activity data indicated that most participants did not meet the WHO guideline of 150 min of MVPA per week, suggesting low physical activity levels in PWID.

Conclusion
This pilot study assessed some aspects of the feasibility and acceptability of methods and procedures to be used in future larger studies. We provide preliminary evidence that digital tools can be used to collect mood, anxiety, sleep, and physical activity data in a small, highly selected group of adults with mild to moderate intellectual disability and concurrent mental illness. Findings should be interpreted cautiously, given recruitment limitations and the exploratory nature of the analyses. Larger studies with clearly prospectively defined and broader aspects of feasibility, acceptability, usability, and validation of outcomes are required before wider implementation can be considered.