Trajectories of hallucinations, mood, and sleep during a mobile health intervention for schizophrenia

Objectives Mobile health (mHealth) interventions are increasingly used to support illness self-management for individuals with schizophrenia spectrum disorders (SSD). Yet limited research explores how symptom patterns that vary throughout an intervention period can be used to identify individuals who may benefit from tailored support. Leveraging daily self-ratings from FOCUS, an mHealth intervention for SSD, we identified and characterized distinct self-reported symptom patterns. Methods We conducted a prospective cohort study as a secondary analysis using data from a hybrid type 3 effectiveness–implementation trial of FOCUS across 23 community mental health programs. Participants used FOCUS for up to 90 days and provided daily self-ratings on mood, sleep, and/or auditory hallucinations. Group-Based Trajectory Modeling (GBTM) was used to identify longitudinal trajectories for each domain. We examined demographic, psychiatric, and functioning correlates of trajectory group membership. Results Overall, 190 participants provided daily self-ratings for mood, sleep, or hallucinations. Participants provided a median of 33 ratings (IQR: 10, 84) across a median 82 days (IQR: 50, 88). For each domain, five distinct trajectory groups emerged. Mood ratings were largely stable over time, with one improving group. Sleep domain showed a unique worsening trajectory. Multiple groups improved in hallucinations self-ratings. Higher early self-rating response rates were associated with improving mood trajectories. Conclusions Individuals with SSD exhibited distinct symptom expression trajectories over the course of treatment with an mHealth intervention. Trajectory-based approaches may inform adaptive mHealth designs and more targeted allocation of mHealth and clinical support resources.