Accessibility and availability of smartphone apps for schizophrenia

Abstract

App-based interventions have the potential to enhance access to and quality of care for patients with schizophrenia. However, less is known about the current state of schizophrenia apps in research and how those translate to publicly available apps. This study, therefore, aimed to review schizophrenia apps offered on marketplaces and research literature with a focus on accessibility and availability. A search of recent reviews, gray literature, PubMed, and Google Scholar was conducted in August 2022. A search of the U.S. Apple App Store and Google Play App Store was conducted in July 2022. All eligible studies and apps were systematically screened/reviewed. The academic research search produced 264 results; 60 eligible studies were identified. 51.7% of research apps were built on psychosis-specific platforms and 48.3% of research apps were built on non-specific platforms. 83.3% of research apps offered monitoring functionalities. Only nine apps, two designed on psychosis-specific platforms and seven on non-specific platforms were easily accessible. The search of app marketplaces uncovered 537 apps; only six eligible marketplace apps were identified. 83.3% of marketplace apps only offered psychoeducation. All marketplace apps lacked frequent updates with the average time since last update 1121 days. There are few clinically relevant apps accessible to patients on the commercial marketplaces. While research efforts are expanding, many research apps are unavailable today. Better translation of apps from research to the marketplace and a focus on sustainable interventions are important targets for the field.

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

“…However, there is also a lack of consensus or standards for assessing and monitoring engagement with and attrition from digital tools, limiting progress in the field [ 39 ]. In addition, most of the research on and development of digital tools focuses on conditions outside SMI [ 11 ]. Digital technologies, particularly smartphone apps, have the potential to be novel tools for managing SMIs, especially in LMICs [ 40 ].…”

“…This will involve a comprehensive analysis of implementation costs, integration into the existing IT infrastructures of the institution, and regulatory and privacy compliance, but this may not have been adequately assessed at the beginning of the process. A result is that many digital health technologies are not iterated and sustained, with a 2022 review finding that nearly half of apps created for schizophrenia research in the last decade are no longer accessible or supported [ 11 ]. These challenges in funding impede replication and impair the research-to-clinical translation of digital mental health tools (see further discussion in theme 4).…”

“…In general, many digital health studies fail to reach the market or translate into real-world clinical care, and even when they do, rates of adoption can be low [ 119 ]. For example, in a study of smartphone apps for schizophrenia, <10 of those identified from a search of interventions from the research literature were easily accessible to the population, and the picture was similar in a parallel search of marketplace apps [ 11 ]. These were also few in number and lacked frequent updates (average time since last update 1121 days).…”

“…Increasing access to care for people with severe mental illnesses (SMIs) such as psychosis and bipolar disorder is a priority worldwide for mental health, particularly in low- and middle-income countries (LMICs) [ 8 ]. Although people with SMI experience major health inequalities and have a life expectancy 10 to 25 years shorter than that of the general population [ 9 , 10 ], less research on digital interventions has been conducted in this patient group compared with other conditions [ 11 ]. Assumptions that people with SMI will not be able or willing to engage in technology-augmented assessment and treatment have combined with the known element of digital exclusion due to the intersection of SMI and socioeconomic inequities, resulting in a shortfall of development in this area [ 12 , 13 ].…”

A systematic review of digital interventions for smoking cessation in patients with serious mental illness

“…It is also important to note that although this review identified a total of nine digital smoking cessations trialed in SMI, only two of these ( QuitGuide and quitStart ) are readily available online, which showed poorer results in terms of effectiveness and have not been assessed as thoroughly as mSMART MIND and iCOMMIT for acceptability and safety. The general inaccessibility of evidence-based digital interventions for SMI is a problem which extends far beyond smoking cessation, with a recent review finding that only ~15% of apps trialing in schizophrenia are currently available online (Kwon, Firth, Joshi, & Torous, 2022 ). Clearly, further work is needed to improve the dissemination of effective digital approaches into the public sphere more generally.…”