Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis

Abstract

BACKGROUND Recently, there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD). However, their efficacy for BD remains unclear. AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD. METHODS A systematic literature search was performed on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials (RCTs) or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included. Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD. The primary outcome measures were set for mania and depression symptoms. Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms. RESULTS We identified ten articles, including seven RCTs (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic [g = -0.19, 95% confidence interval (CI): -0.33 to -0.04, P = 0.01] and depressive (g = -0.28, 95%CI: -0.55 to -0.01, P < 0.05) symptoms. In within-group analysis, smartphone-based interventions significantly reduced manic (g = 0.17, 95%CI: 0.04 to 0.30, P < 0.01) and depressive (g = 0.48, 95%CI: 0.18 to 0.78) symptoms compared to the baseline. Nevertheless, smartphone-based monitoring systems significantly reduced manic (g = 0.27, 95%CI: 0.02 to 0.51, P < 0.05) but not depressive symptoms. Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive (g = -0.62, 95%CI: -0.81 to -0.43, P < 0.01) and manic (g = -0.24, 95%CI: -0.43 to -0.06, P = 0.01) symptoms compared to the controlled conditions, while the interventions without psychoeducation did not ( P > 0.05). The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms (g = -0.47, 95%CI: -0.75 to -0.18, P = 0.01). CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.

Smartphone‐based interventions in bipolar disorder: Systematic review and meta‐analyses of efficacy. A position paper from the International Society for Bipolar Disorders (ISBD) Big Data Task Force

“…A recent meta‐analysis compared the effect of smartphone‐based interventions and monitoring with control methods in BD 60 . This study concluded that smartphone‐based interventions in BD are effective in reducing manic and depressive symptom severity.…”

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

“…A recent systematic review and meta‐analysis concerning the efficacy of digital interventions in bipolar disorder found positive effects on both depressive and manic symptoms 118 , but only four of the ten included studies were randomized controlled trials 45,119‐121 . As to unipolar depressive disorder, while an increasing number of randomized controlled trials of apps with psychotherapy‐related content have been published 26 , several of them have shown no evidence that delivering psychological interventions via smartphone confers a significant advantage beyond control conditions 122‐124 .…”

Notwendigkeit für Symptom-Monitoring und Frühwarnzeichenerkennung bipolarer Episoden durch eine App? – Ansichten von PatientInnen und Angehörigen zu e-health Bedarf

“…Eine technologische Analyse könnte für die zwischenmenschliche Beziehung von Vorteil sein. Es könnte sein, dass m-health Produkte als Zusatz- oder Einzeltherapie einen Vorteil gegenüber der derzeitigen Therapie bringen können 37 , auch wenn derzeit aufgrund der Heterogenität der Produkte und fehlenden Goldstandards keine generellen Empfehlungen für das Monitoring bipolarer PatientInnen ausgesprochen werden kann 38 . In der Vergangenheit waren ÄrztInnen und TherapeutInnen auf subjektive, retrospektive Informationen angewiesen.…”