JMIR Publications

ABSTRACT

Background:

Smartphone apps are an increasingly popular means for providing psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyse and summarize the state of the art, both from a psychological and technical perspective.

Objective:

This systematic review focuses on the use of smartphones for psychological interventions. We aim to: (i) analyze the evolution of research over time as well as the covered mental disorders; (ii) study the characteristics of assessments that were performed; (iii) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media; and (iv) provide an overview of developed smartphone apps per mental disorder.

Methods:

The PRISMA guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, APA PsycNET and MEDLINE, covering a period of over five years (2013+). We included papers that describe the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and ICT, to select and classify articles based on psychological and technical features.

Results:

111 articles met the inclusion criteria. We observed an increasing interest in this field. More and more studies are focusing on clinical effects in addition to (only) usability/UX, but Randomly Controlled Trials (RCT) are still a small minority (16,2%). Around 70% of the papers focus on 6 mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum and other psychotic disorders, or a combination of disorders. More than half of known mental disorders are not or very scarcely (<3%) represented. Whereas interventions are leveraging the improved modalities (screen, sound) and interactivity of smartphones, their truly novel capabilities, such as sensors, alternative delivery paradigms and analytical methods, are only sparingly exploited.

Conclusions:

We found an overall increase in smartphone-based interventions over time. Most research targets disorders with high prevalence, i.e., depressive (19,8%) and anxiety disorders (12,6%). Hence, there is a need for designing interventions that focus on disorders with high severity as well, such as personality disorders, which are currently only scarcely found. The majority of assessments evaluated usability/UX, and we found only a limited number of RCT. We contend that, to improve the robustness and trustworthiness of assessments, an increasingly systematic focus is needed as to effect on clinical symptomatology. Regarding technical aspects, most studies rather conservatively transfer traditional ICT interventions to smartphones. We argue that more innovative use of their novel capabilities is needed to fully realize promising treatments, such as Ecological Momentary Interventions, as they require context-awareness, though the use of sensors and analytics, to determine the need for interventions at times that patients need them most.