JMIR Publications

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.

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, and CENTRAL were searched from inception to August 2026. Eligible studies were RCTs enrolling adults with psychotic disorders that evaluated DHT-delivered psychological interventions targeting psychotic symptoms. Comparators included inactive and active controls. Primary outcomes were positive, negative, and overall symptoms. Secondary outcomes included depression, anxiety, functioning, quality of life, dropout, and adverse events. Risk of bias was assessed using Cochrane RoB 2 and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Random-effects meta-analyses using restricted maximum likelihood with Hartung-Knapp adjustments estimated Hedges'g separately for inactive and active comparators.

Results:

A total of 47 RCTs were included in the systematic review and 42 in the meta-analyses. Compared with inactive controls, DHTs reduced positive (g= -0.33, 95% CI -0.60 to -0.05), negative (g= -0.30, 95% CI -0.59 to -0.01), and overall symptoms (g=-0.48, 95% CI -0.94 to -0.003) at posttreatment, but effects were not sustained at follow-up. No significant effects were found for delusions or auditory hallucinations, or for primary outcomes versus active controls. For secondary outcomes, DHTs were associated with small improvements at 3-to 6-month follow-up in depression and anxiety, but not in social functioning or quality of life. No prespecified intervention characteristics moderated effects. Evidence certainty was very low to moderate for key outcomes, with substantial heterogeneity. Dropout was reported descriptively, while harms remained insufficiently characterized due to inconsistent adverse-event monitoring and reporting.

Conclusions:

By integrating efficacy, longer-term outcomes, moderators, attrition, and safety, this review discusses both the potential and current limitations of DHTs for psychosis. DHTs may yield short-term small improvements in clinical outcomes, but further research is needed to determine how to achieve sustained, safe, and clinically meaningful benefits. Clinical Trial: Prospero - CRD42021251108