Researching the Effectiveness of a Alivis, a Digital Health Application for Borderline Personality Disorder

The PHQ-9 is the 9-item depression module from the full PHQ with comparable sensitivity and specificity, and includes the 9 criteria upon which the diagnosis of DSM-IV depressive disorders is based. Rating is done on a 4-point Likert scale ranging 0 = "not at all" to 3 = "nearly every day". As a severity measure, scores range from 0 to 27 and represent: mild (0-4), moderate (5-9), moderately severe (10-14), and severe depression (≥15). According to several studies, the German version can be considered reliable regarding psychometric standards. Higher total scores indicate greater depressive symptom severity and thus a worse outcome, whereas lower scores indicate fewer depressive symptoms and a better outcome.

This self-administered patient questionnaire is used as a screening tool and severity measure for generalized anxiety disorder (GAD). Studies report good reliability, as well as criterion, construct, factorial, and procedural validity. The GAD-7 is scored on a Likert scale ranging from 0 = "not at all" via 1 = "several days" and 2 = "more than half the days" to 3 = "nearly every day", yielding a sum score ranging from 0-21. Scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate and severe anxiety, respectively. Higher total scores indicate greater anxiety symptom severity and thus a worse outcome, whereas lower scores indicate fewer anxiety symptoms and a better outcome.

Costs caused due to BPD will be assessed with a self-compiled instrument assessing inpatient and outpatient treatment, support from friends, family and professional services, contacts with members of the judicial authorities and public security, medication, sick leave, and physician/therapist visits during work time. Higher values indicate greater resource utilization and higher costs and thus a worse economic outcome, whereas lower values indicate lower resource use and a better economic outcome.

The WSAS is a 5-item self-report scale to measure social functioning in regard to physical, mental and social health as well as age group referenced competence for performance. The PROM has good psychometric properties with good criterion validity, good sensitivity and strong internal consistency (α = 0.89). Individual items address work, home management, social leisure, private leisure and relationships. Each item is rated on a 9-point Likert scale from 0 = "not at all impaired" to 8 = "very severely impaired". The total score ranges from 0 to 40. Higher total scores indicate greater functional impairment and thus a worse outcome, whereas lower scores indicate less disability and a better outcome.

The PAM-13 assesses patients' active participation in their medical care using 13 items. Items are answered on a Likert scale ranging from 1 = "strongly disagree" to 4 = "strongly agree," yielding a raw total score between 13 and 52. The German version of the PAM-13 (PAM-13-G) is validated and demonstrates good psychometric properties, including good internal consistency (Cronbach's α = 0.84). In this study, raw scores were converted into the standardized 0-100 patient activation score using a min-max transformation, with higher scores indicating greater patient activation and thus a better outcome.

The AQoL-8D is a health-related quality-of-life questionnaire consisting of 35 items forming eight health dimensions: independent living, happiness, mental health, coping, relationships, self worth, pain, senses. Validation of the AQoL-8D assessing health-related quality of life showed good psychometric properties in a German patient sample, including excellent reliability (Cronbach's α = 0.96) and construct validity (strong correlation with the SF-36, r = .81). The AQoL-8D score ranges from 0-100; higher scores indicating higher quality of life.