Currently submitted to: Journal of Medical Internet Research
Date Submitted: May 26, 2026
Open Peer Review Period: May 28, 2026 - Jul 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Health Technologies for Psychotic Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
ABSTRACT
Background:
Digital health technologies (DHTs) for psychosis may help address the substantial gap in access to psychological services, yet prior syntheses are limited by heterogeneous designs and populations. T
Objective:
This systematic review and meta-analysis aimed to synthesize evidence from randomized controlled trials (RCTs) to estimate the relative effectiveness of DHTs in individuals with confirmed psychotic disorders.
Methods:
Web of Science, PubMed, Embase, Scopus, PsycINFO, and CENTRAL were searched from inception to January 2026. Eligible studies were RCTs enrolling adults with psychotic disorders that evaluated DHT-delivered psychological interventions targeting psychotic symptoms. Comparators included passive and active controls. Primary outcomes were positive, negative, and overall symptoms. Secondary outcomes included depression, anxiety, functioning, quality of life, dropout, and adverse events.
Results:
Forty-one RCTs (N = 4139) were included. Compared with passive controls, DHTs showed small to moderate significant reductions in positive (g = -0.18, 95% CI: -0.33 to -0.03; I2= 60%), negative (g = -0.32, 95% CI: -0.56 to -0.07; I2= 63%), and overall symptoms (g = -0.41, 95% CI: -0.71 to -0.10; I2= 78%) at posttreatment, with effects for positive symptoms also at follow-up. No significant effects were observed when compared with active controls. Subgroup analyses indicated significant effects for delusions but not auditory hallucinations, and stronger effects for therapist-supported versus interventions delivered fully automated. Secondary outcomes showed small improvements both posttreatment and follow-up in depression, anxiety, and general functioning, but not for quality of life. Heterogeneity was moderate to high in some of the analyses. Dropout rates were comparable across groups, with no consistent pattern of serious adverse events identified, although safety reporting was inconsistent.
Conclusions:
DHTs represent a promising approach, with outcomes that appear broadly comparable to face-to-face interventions, while offering potential advantages in accessibility, scalability, and flexibility. Further high-quality RCTs with active comparators and standardized safety monitoring are needed. Clinical Trial: CRD42021251108
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